Setting the agenda in health care: Politics and processes in the Michigan Legislatur

This dissertation has two main purposes. First, it synthesizes the main theories in political science that have a bearing on agenda-setting in state legislatures. Although the literature on agenda-setting is limited, several perspectives in the broader literature on public policymaking raise important questions about the formation of legislative priorities. To establish a foundation for exploring legislative agenda-setting and to provide a basis for assessing which theories are most useful in explaining legislative agenda-setting in Michigan, a range of contrasting theoretical approaches is described.;Second, the dissertation explores the politics and processes of legislative agenda-setting in health care in Michigan. Little is known about agenda-setting in state legislatures, especially in the health domain. The main source of information was a series of interviews with over 100 individuals involved in health policymaking within the state. The research focuses on the 84th legislature, 1987-1988.;The study's main findings include the following. First, an analysis of the role that different participants play in agenda-setting showed that contrary to the common notion that the "Governor proposes and the legislature disposes," the Governor, his advisers, and political appointees played a minimal role in setting the legislative agenda in health. Instead, the main agenda-setters in health were legislative committees, especially the chairs of committees, and interest groups. Next, an exploration of agenda-setting in the leading health-related committees showed that deliberations were broadly participatory and generally noncontroversial, and that the agenda was determined largely as bills presented themselves, rather than by an a priori set of priorities. Finally, an analysis of the utility of Cobb and Elder's model in explaining the agenda-status of a sample of health-related issues showed that the model generally failed to predict which issues would (and would not) rise on the agenda. A fundamental conclusion drawn from this research was that there seems to be no single "theory of agenda-setting" that is adequate in explaining the dynamics of setting the agenda in state government. Rather, a number of theories in the literature on public policymaking help to explain different pieces of what was found.