The Politics of Healthcare Expansion: Policy Reform and Political Parties in Latin America (Under production with 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 demonstrating that the political process behind the formation of these reforms significantly impacted 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 offers an in-depth analysis of the healthcare reform processes in Chile, Mexico, and Peru that commenced in the 2000s, examining the entire policymaking process, from agenda-setting and debate to implementation in both the short and long term. 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 importance of meticulous analysis that disentangles the mechanisms by which political parties influence policy.
REFEREED JOURNAL ARTICLES
Immigration and Deportation Attitudes: Sexuality, Economic Contributions, and Respondents’ Partisanship, with Gabriele Magni. (Accepted at International Migration Review). Immigrant deportations are salient in many countries, but scholarship on deportation attitudes remains limited. Because some immigrants are especially likely to face harm if deported, we examine how immigrants’ identity and economic characteristics shape deportation attitudes. We focus on unauthorized LGBTQ+ immigrants in the United States, examining the interplay between immigrants’ economic contributions and respondents’ partisanship. We rely on an original survey experiment with a sample of U.S. respondents that mirrors Census quotas for key socio-demographic indicators. We present three main findings. First, without any information on economic contributions, similar levels of support emerge for the deportation of gay and straight unauthorized immigrants. Second, immigrants’ economic contributions substantially reduce support for deportation among both groups. Third, this apparent consensus masks important partisan differences. Democrats reward gay unauthorized immigrants significantly more than straight unauthorized immigrants for their economic contributions. The opposite occurs for Republicans: support for deportation is substantially lower for straight unauthorized immigrants who have made economic contributions. More broadly, these findings illustrate how partisan identity structures the application of deservingness heuristics in immigration attitudes, with implications for immigration policy debates around vulnerable immigrant populations.
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 that parties lacking core values that united their leaders and showing no commitment to reform did not prioritize the definition of specifications regarding funding and implementation. Instead, technocrats dominated the policy formation process, which, accompanied by a lack of commitment from key political actors, led to poorly specified policies 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 the responsiveness of public officials. 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 through the first large-scale audit experiment conducted in 11 countries: 5 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 respond 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, the negotiation of positions, and the 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 ensure adequate care during their old age and that provided adequate healthcare services. With the turn of the century, the economic and political landscape underwent significant changes. 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 the expansion of coverage to individuals in the informal sector and those with limited 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, as well as in the quality of healthcare services. However, the least progress has been made toward equity. With very few exceptions, severe inequalities persist in the quality of services provided through both new and traditional programs.
CHAPTERS IN EDITED VOLUMES
"Field Experiments" with Gabriele Magni. 2026. In Political Science Research in Practice, 3rd ed. Akan Malici and Elizabeth Smith, eds. Routledge. Forthcoming.
"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. 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.
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.