Award Date


Degree Type


Degree Name

Doctor of Philosophy in Public Affairs


Public Administration

Advisor 1

Chris Stream, Committee Chair

First Committee Member

Lee Bernick

Second Committee Member

Anna Lukemeyer

Graduate Faculty Representative

David Damore

Number of Pages



Market-based state health expansion programs are alternatives to government programs like Medicaid and SCHIP which also seek to expand access to health insurance for uninsured populations. These programs either utilize the private health insurance market or function according to market principles. The market-based policies at issue in this research are state high-risk health insurance pools, limited benefit plans, group purchasing arrangements, reinsurance programs, and Health Insurance Flexibility and Accountability waivers. This research addresses two separate but related research questions: (1) Do these market-based programs provide general economic and social benefits for the citizens of a state? (2) What role does citizen ideology and partisanship play in the adoption of market-based programs at the state level? This research indicates that the implementation of market-based programs at the state level, as measured by an additive index, do provide some general benefits to the people of a state. Regression analyses with panel-corrected standard errors and a Prais-Winsten transformation indicate that market-based programs help to reduce mortalities per capita and emergency outpatients treated. There is also evidence that these market-based programs are successful in helping to increase the gross state product. Separate analyses focused on the presence and expansiveness of high-risk pools indicate that these programs individually also provide general benefits. Looking at the second research question regarding the influence of ideology and partisanship on the adoption of market-based programs, the results are mixed. The Cox proportional regression analysis found that having a higher percentage of Democrats in the state legislature contributes to the adoption of market-based health insurance expansion programs, while a higher level of citizen liberalism reduces the probability of market-based programs being adopted. This suggests that a more liberal citizen population is more supportive of government-based programs, but Democratic legislators will nevertheless support the adoption of market-based programs as they require the expenditure of limited financial and political capital but still allow the Democrats to claim credit for advancing access to health care. Anecdotal examples of this could be seen in the 2009 debate over the Obama health care plan.


Health care accessibility; Health insurance; Health policy; Market-based health insurance; Policy adoption; Program evaluation; Public policy; State high-risk health insurance pools


Health Policy | Immune System Diseases | Public Administration | Virus Diseases

File Format


Degree Grantor

University of Nevada, Las Vegas




IN COPYRIGHT. For more information about this rights statement, please visit