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Media Representations of State-Level Health Care Reforms in the United States (2002-2011): Policy Narratives, Media Frames, and Legislative Outcomes in the Massachusetts and Utah Cases Open Access


Other title
Health care reform in American states
policy narratives
United States health care reform
media representations
media narratives
media framing
Type of item
Degree grantor
University of Alberta
Author or creator
Epperson, Brent L
Supervisor and department
Brodie, Janine (Political Science, University of Alberta)
Examining committee member and department
Church, John (Political Science, University of Alberta )
Epp, Roger (Political Science, University of Alberta)
Garber, Judy (Political Science, University of Alberta)
Haussman, Melissa (Political Science, Carleton University)
Department of Political Science

Date accepted
Graduation date
2017-11:Fall 2017
Doctor of Philosophy
Degree level
This doctoral dissertation examines the relationship between newspaper media representations, health care reform efforts, and legislative outcomes in the United States. Offering valuable insights into media representations for researchers, decision-makers and activists, this research focuses on the editorials, opinion columns, and news stories from daily newspapers of the political right, left, and centre that helped structure public support for, and opposition to, two American state-level health care reforms: the Massachusetts Health Reform Law (Romneycare) (2002-2006) and the Utah Health System Reform (UHSR) (2004-2011). Insights gathered through this research may serve to inform future media communication strategies in health care and other policy reform campaigns. More than a decade after the failure of the Clinton administration’s Health Security Act (HSA), between 2002 and 2012, a number of state-level health reform efforts paralleled the federal Affordable Care Act (Obamacare) debates. Collectively, these reforms revealed greater political openness to health care policy change. My dissertation examines newspaper media coverage of the Massachusetts and Utah health reform efforts at three critical junctures: the preceding state election campaigns, the legislative debates surrounding the reforms, and the period following legislative passage. This study critically examines the movement of neoliberal language framing metaphors and narratives of health care within the state-based and national newspapers, as well as challenging narratives of the political left and the political right that offered alternatives to the meso-narrative of neoliberalism. This study reveals coalescence of health care reform narratives between national and local print media, between Democratic-leaning and Republican-leaning newspapers, and between the Massachusetts and Utah health reforms. This dissertation concludes by demonstrating that, although the Democratic-leaning national and state-level newspapers were somewhat more favourable to health care reform than Republican-leaning newspapers, both Republican-leaning and Democratic-leaning newspapers were largely favourable to reform in their coverage. Newspapers emphasized rising costs and inadequate access to health insurance as the central challenges of the health care system that served as the impetus for change. Interpreting the health care narratives of these two state reforms is particularly important in light of the ongoing federal reform efforts. The debates between libertarian, conservative, and moderate factions within and beyond the Republican Party in the efforts to “repeal and replace” Obamacare have been largely recycled from the Utah Health System Reform debates and the fringes of Republican resistance to Romneycare in Massachusetts.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
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