In 2002, Thailand achieved universal health coverage (UHC) through three public health insurance programs. This study examines how political economy factors have influenced the development of UHC reform in Thailand by applying a political economy framework. This study concluded that while path dependency plays a significant role in pressurizing resistance to change, the reform team’s ability to generate and effectively use evidence to guide policy decisions helped put reform on such a “good path” that it was able to overcome resistance.