Victims of Health‐Care Reform: Hirschman's Rhetoric of Reaction in the Shadow of Federalism

Abstract

This paper harnesses the Narrative Policy Framework's articulation of characters as vital components of policy narratives to enhance the analytical traction of Albert O. Hirschman's typology of reactionary and progressive rhetoric. Using content analysis of transcripts containing policy narratives presented in federal legislative, executive, and judicial venues, this paper presents an analysis of the rhetorical use of victims as surrogates for an underlying conflict over fundamental values of liberty and equity in debates surrounding the Affordable Care Act (ACA) in the United States. This research finds that Hirschman's rhetorical typology continues to be useful in analyzing the development of the welfare state, while benefitting from its pairing with the NPF's focus on the characters which occupy policy narratives. Victims are strategically deployed in policy narratives around the ACA. Reactionary rhetoric had a statistically significant association with the value of liberty and portraying state and local governments as victims of federal overreach. Progressive rhetoric had a strong and statistically significant association with the invocation of family as victim whereas those using reactionary rhetoric type more often employed government as victim. These differences in the types of victims can be understood as reflecting a conflict between the values of equity and liberty in federal relations undergirding the U.S. health‐care system, shifting control of state‐level government, and as differences between the political makeup of the Democratic and Republican parties.