Breaking gridlock: the determinants of health policy change in Congress

A Look Under the Hood: Regulatory Policy Making and the Affordable Care Act

The Affordable Care Act (ACA) was signed into law a decade ago. Partisanship has limited the number of statutory changes, leaving the law mostly unchanged across the past 10 years. However, the ACA delegated vast powers to the executive branch, which opened the door for significant regulatory policy-making activities (also called "rulemaking"). We collected data on all regulatory actions related to the Affordable Care Act that have been taken since its passage to provide the first exploratory analyses of both the public law itself and the ensuing rulemaking activities. We also provide illustrative examples of two controversial issues: short-term limited-duration insurance plans and contraceptive coverage for women. Despite relative statutory stasis, regulatory actions have continued to shape the implementation of the Affordable Care Act. Both the Obama and Trump administrations have taken advantage of a vast delegation of policy-making power. Importantly, regulatory policy making holds the potential to yield significant changes depending on the policy goals of the presidential administration. Scholars, policy makers, and the public are well-advised to pay attention to ACA-related rulemaking activities. Moreover, "quasi-rulemaking" (i.e., the use of agency guidance as a policy tool) remains largely unexplored but could indicate an even greater regulatory enterprise than illustrated here.

Party politics and enactment of "Obamacare": a policy-centered analysis of minority party involvement

The Patient Protection and Affordable Care Act of 2010 (ACA) passed with no Republican votes and was accompanied by intense criticism that the reform was "rammed through" the legislative process by the majority party. By contrast, many Democrats emphasized the extensive yearlong debate over health care reform and argued that the final bill represented a compromise of good ideas from both parties. We undertake a policy-centered analysis to help reconcile these conflicting reports of this legislative episode. Drawing on real-time accounts published in the Capitol Hill newspaper Roll Call, we compare the success of Democratic and Republican Parties' policy proposals in terms of centrality to the policy agenda and inclusion in the enacted legislation. Our findings indicate that Republican-backed proposals were more present on the policy agenda than in the final legislation--although both were dominated by Democratic policy proposals. In this case, the major limit on majority party power seemed to be intraparty conflict, rather than opposition from the minority party.