Political Parties and Policy Reform: Expansion of Healthcare in Latin America
Under review at Cambridge University Press
Reforms of their underfunded and highly inegalitarian healthcare systems rose high on the agenda of most Latin American countries by the beginning of the 21st century. Most countries did introduce reforms. Yet not all reforms were created equal. This book innovates upon previous scholarship by showing that the political process behind the formation of these reforms severely affected their success. When political parties were highly committed to the reform, these were better planned and more sustainable. This book shows that the programmatic commitment of political parties is a crucial explanatory factor in the quality of legislation. Reforms can follow a path in which parties shape specifications regarding implementation and funding or one in which disengaged parties let technocrats without partisan ties dominate the policymaking process. Both paths can lead to an increase in formal coverage and even a rise in funding for the healthcare sector. However, the key difference between the two paths is the feasibility of granting effective access to healthcare and the sustainability of the necessary funding to deliver these benefits.
This study provides an in-depth analysis of the healthcare reform processes in Chile, Mexico, and Peru that began in the 2000s, analyzing the entire policymaking process, from agenda-setting and debate to implementation in the short and long run. It draws on twelve months of extensive field research, during which I conducted over 150 in-depth interviews with political elites, technocrats, and leaders of interest groups. This book emphasizes the relevance of meticulous analysis that disentangles the mechanisms through which political parties affect policy.
The reform approved in Peru in 2009 during a right-wing government deviates from similar attempts to expand access to healthcare. Left-wing parties in Peru were extremely weak during the policymaking process and the political parties were non-programmatic. Based on original field research, this paper demonstrates how parties that lacked core values uniting their leaders and had no commitment to the reform did not care for the definition of specifications regarding funding and implementation. Instead, technocrats dominated the process of policy formation, which accompanied by the lack of commitment from key political actors, led to poorly specified policy and deficient implementation.
Selected by the Harvard Kennedy School’s Women and Public Policy Program for its Gender Action Portal
Are elected officials more responsive to men than women inquiring about access to government services? Women face discrimination in many realms of politics, but evidence is limited on whether such discrimination extends to interactions between women and elected officials. In recent years, several field experiments have examined public officials’ responsiveness. The majority focused on racial bias in the United States, while the few experiments outside the US were usually single-country studies. We explore gender bias with the first large-scale audit experiment in 5 countries in Europe (France, Germany, Ireland, Italy, Netherlands) and 6 in Latin America (Argentina, Brazil, Chile, Colombia, Mexico, Uruguay). A citizen alias whose gender is randomized contacts members of parliament about unemployment benefits or healthcare services. The results are surprising. Legislators respond significantly more to women (+3% points), especially in Europe (+4.3% points). In Europe, female legislators in particular reply substantially more to women (+8.4% points).
This article presents an analysis of the main political events of 2018. After the resignation of Pedro Pablo Kuczynski (PPK), the first year of Martín Vizcarra’s government began. His government faced numerous scandals triggered by the Lava Jato case, resulting in the detention of key politicians (including former presidents PPK and Ollanta Humala) and the transformation of the three branches of government. Moreover, a series of audio recordings uncovered a network of illegal under-the-table practices within the Judiciary, which included the protection of politicians and the negotiation of positions and reduction of penalties. In response, Vizcarra’s government promoted a group of institutional reforms via referendum, which are set in a context of institutional precariousness.
Latin American welfare states have undergone major changes over the past half century. As of 1980, there were only a handful of countries (Argentina, Brazil, Chile, Costa Rica, and Uruguay) with social policy regimes that covered more than half of their population with some kind of safety net to insure adequate care during their old age and that provided adequate healthcare services. With the turn of the century, the economic and political situation changed significantly. The commodity boom eased fiscal pressures and made resources available for an increase in public social expenditure. Democracy was more consolidated in the region and civil society had recovered from repression. Left-wing parties began to win elections and take advantage of the fiscal room which allowed for the building of redistributive social programs. The most significant innovation has been expansion of coverage to people in the informal sector and to people with insufficient histories of contributions to social insurance schemes. The overwhelming majority of Latin Americans now have the right to some kind of cash assistance at some point in their lives and to healthcare provided by their governments. In many cases, there have also been real improvements in the generosity of cash assistance, particularly in the case of non-contributory pensions, and in the quality of healthcare services. However, the least progress has been made toward equity. With very few exceptions, severe inequalities continue to exist in the quality of services provided through the new and the traditional programs.
"Global Disputes and National Ineffectiveness: Vaccinating in Times of COVID-19." In Alberto Vergara and Adrian Lerner, eds. Perú Global. Fondo Editorial de la Universidad del Pacífico/Planeta. Forthcoming.
“Here to Stay”: Immigration and Deportation Attitudes, with Gabriele Magni.
APSA 2022 Summer Centennial Center Research Grant
The deportation of undocumented immigrants has been central to the political discourse of many countries. Yet, scholarly work on deportation attitudes is limited. In this article, we ask, what determines deportation attitudes? What conditions successfully contrast support for deportation? We surveyed 2,100 residents in the U.S. and 1,200 residents in Brazil, and embedded two experiments within our original surveys. Despite the differences in immigrant share of the population and baseline support for deportation, we find strikingly consistent results across the two countries. Respondents exposed to a story describing an immigrant’s economic contributions or the risk of violence if deported are substantially less likely to support deportation of undocumented immigrants. We also find that undocumented immigrants from both lower-income and high-income countries face stronger opposition to their deportation when they have made significant economic contributions. In the U.S., this is especially true for immigrants from lower-income countries, who are particularly rewarded for their positive characteristics that challenge long-rooted prejudice.
"Immigration and Welfare Deservingness. Evidence from a Survey Experiment in Brazil," with Sara Niedzwiecki.
In the past decade, international migration to the Global South has grown at a faster rate than in the rest of the world. This has led to an increase in anti-immigrant sentiment, including discussion about immigrants’ “deservingness” of social benefits. Previous literature has shown that all immigrants are seen as less deserving of welfare than nonimmigrants. In this paper, we argue for the need to disaggregate types of policies and immigration status. Through original survey experiments in Brazil in 2022, we find that respondents express less support for immigrants’ access to social assistance compared with public healthcare and that unauthorized immigrants are seen as less deserving than authorized immigrants. We argue that the gap across policies responds to narrowly targeted policies such as social assistance eliciting more welfare chauvinism than universal social policies that are seen as a social right. Individual prejudices, in turn, explain the difference in opinions across immigration status.
Who Gets to Stay? Economic Contributions, Sexuality, and Partisanship in Deportation Attitudes, with Gabriele Magni.
This paper explores a topic that has received limited attention in existing scholarship on immigration attitudes, but that is central to the political discourse of many countries: the deportation of undocumented immigrants. We examine how immigrants’ identity and economic characteristics interact to shape deportation attitudes. In particular, we focus on immigrants’ sexual orientation and economic contributions. We investigate the topic in the United States, a country where immigration is a key political issue that has become increasingly polarizing. The analysis relies on an original survey experiment with a sample of respondents that mirror Census quotas for key socio-demographic indicators. We find that gay immigrants do not face stronger calls for deportation. When no information is provided about their economic contributions, similar levels of support emerge for the deportation of gay and straight undocumented immigrants in the overall sample. Although a consensus emerges with regard to immigrants’ economic contributions, which significantly decrease support for deportation among both Republicans and Democrats, this apparent consensus masks an important distinction once immigrants’ sexuality is taken into account. Republicans and Democrats respond in opposite ways. While Democrats reward gay immigrants significantly more for job creation, the trend is reversed among Republicans, whose support for deportation in the presence of job creation decreases substantially more for straight immigrants. This paper offers one of the first analyses of public support for deportation in the U.S. and contributes to the study of LGBTQ+ politics and immigration attitudes, suggesting possible frames to contrast calls for deportation.
“Party-Voter Policy Congruence: Rethinking its Relationship to Clientelism."
This article examines the level of congruence between representatives and supporters at the party level across seven policy issues: 1) the state’s responsibility in the provision of jobs, 2) pensions, 3) health care services, 4) ensuring the well-being of the people, 5) a state-run economy, 6) the reduction of inequality, and 7) same-sex marriage. I argue that party-voter policy congruence and clientelism can be compatible. I test this argument using elite and mass survey data on 53 political parties in 17 Latin American countries. I show that congruence is higher for parties showing higher levels of clientelism, regarding the public provision of excludable benefits, the state’s responsibility for ensuring the well-being of the people, and in the case of conservative parties, approval of same-sex marriage. Moreover, I find that left-wing parties are more congruent on socioeconomic issues than right-wing parties.