Senior Honors Projects, 2020-current

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Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Date of Graduation


Document Type


Degree Name

Bachelor of Science (BS)


Department of Political Science


Kathleen M. Ferraiolo

Liliokanaio X. Peaslee

Maria G. DeValpine


Unlike most developed countries, the U.S. does not have a form of universal healthcare, where the government provides insurance for all citizens, despite attempts dating back to 1915. The Patient Protection and Affordable Care Act (ACA), passed in 2010 by President Obama, was a significant expansion of government power in healthcare policy, yet did not guarantee universal insurance. In recent years, universal healthcare proposals have gained traction as the U.S. healthcare system faces issues of low access, high cost, and mediocre quality. In this thesis, I intended to discover the factors that influenced the passage of past U.S. healthcare reforms and potential paths forward.

I applied Kingdon’s multiple streams approach, which addresses the factors in the policymaking process that influences a bill’s passage, to the ACA and the Health Security Act, which was a universal healthcare proposal by President Clinton. The ACA was able to achieve passage because of its incremental approach and Obama’s presidential strategy, which included delegating the creation of the legislation to Congress, negotiating with organized forces, and maximizing his political capital. Kingdon’s multiple streams approach highlights the difficulty Medicare for All advocates will have in gaining passage, especially due to insufficient support among the policy community and political actors. In the short-term, advocates should pursue other policies, such as a public option or Continuous Autoenrollment with Retroactive Enforcement (CARE), that can contain costs and expand coverage.



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