Interest Groups and Institutional Change: Health Policy and the House Reforms of the 104th Congress

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This dissertation examines the effects of institutional change in Congress on interest group activity. The research looks specifically at groups with a stake in health insurance policy during the 1990s. Interviews were conducted with lobbyists for 34 organizations. Respondents were asked about their work on three issues: the Clinton administration efforts to reform health care, the Health Insurance Portability and Accountability Act of 1996, and the debate over a Patients Bill of Rights in the latter part of that decade. Analysis of campaign finance contributions from 1990-1998 supplements the interview data. A comparison of group activity across these issues illuminates group behavior in light of the reforms introduced to the House of Representatives by the new Republican majority in the 104th Congress. The main argument presented in the dissertation is that groups in the health community responded to these reforms by changing the ways they lobbied Congress and otherwise sought to influence legislation. Organizations were not, however, uniformly affected by the changes; a number of intervening variables mitigated their effects. These variables include group partisanship, group resources, and the nature of each issue. The analysis suggests the changes in House institutions mattered to the interest group community for two reasons. First, these changes were driven by partisan concerns. Second, the reforms had important consequences for the long-term relationships that interest groups develop with members of Congress. These results highlight the importance of group access to key members of Congress. The need for access drives the pragmatic behavior of interest groups, allowing them to adjust to the changing political and institutional environments in which they work. Groups will place more or less emphasis on certain strategies in order to increase their access. If institutional changes affect the capacity of certain interest groups to generate or maintain this access, or if they affect the nature of existing relationships, they can have important consequences for how interest groups pursue their policy goals.
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The Dirksen Congressional Center, The American Association of University Women
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interest groups; congressional institutions; lobbying
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Government Document
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dissertation or thesis
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