Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Environmental and Public Affairs

First Committee Member

Jason L. Wasden

Second Committee Member

Christopher Stream

Third Committee Member

Jasmine Waddell

Fourth Committee Member

Jessica Word

Fifth Committee Member

Marcia Ditmyer

Number of Pages



"CHOICES" Florida's version of ObamaCare was a unique case voted in by the public in Alachua County Florida. A mixed methods research design was utilized and provided context in which policy entrepreneurs operated, as well as an explanatory model of internal determinants. Social, economic and political factors were examined to determine the predictor variable in the adoption of the "CHOICES" health services program. The results revealed that voters 51 years of age and older had a greater probability of voting for the Alachua Referendum. "CHOICES" legality has not been under contention but its effectiveness has. This study found that "CHOICES" has been effective at providing comprehensive primary preventative care in a disjointed incremental system of healthcare by purposefully collaborating with all stakeholders involved. A model for purposeful collaboration is presented and is titled the policy adoption wheel of collaboration.


Health care reform; Health insurance; Primary health care--Government policy


Community Health and Preventive Medicine | Health Services Administration | Public Administration | Public Policy