Congress, Policy Sustainability, and the Affordable Care Act: Democratic Policy Makers Overlooked Implementation, Post-Enactment Politics, and Policy Feedback Effects

2018 ◽  
Vol 45 (3) ◽  
pp. 279-314 ◽  
Author(s):  
Eileen Burgin
Keyword(s):  
Affordable Care Act ◽  
Policy Feedback ◽  
Feedback Effects ◽  
Policy Makers ◽  
The Affordable Care Act

Is the Affordable Care Act Cultivating a Cross-Class Constituency? Income, Partisanship, and a Proposal for Tracing the Contingent Nature of Positive Policy Feedback Effects

2018 ◽  
Vol 43 (1) ◽  
pp. 19-67 ◽  
Author(s):  
Jacqueline Chattopadhyay
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Policy Feedback ◽  
Feedback Effects ◽  
Middle Income ◽  
Policy Makers ◽  
Public Managers ◽  
Long Run ◽  
The Affordable Care Act ◽  
Nationally Representative

Abstract Social Security and Medicare enjoy strong political coalitions within the mass public because middle-class Americans believe they derive benefits from these programs and stand alongside lower-income beneficiaries in defending them from erosion. By pooling data from nine nationally representative surveys, this article examines whether the Affordable Care Act (ACA) is cultivating a similar cross-class constituency. The results show that middle-income Americans are less likely than low-income Americans to say the ACA has helped them personally so far. On the other hand, partisanship conditions the relationship between income and beliefs about benefits likely to be derived from the ACA in the long run. In total, the results suggest that cross-class Democratic optimism about long-run benefits may enable the ACA to reap positive beneficiary feedbacks, but a large and bipartisan cross-class constituency appears unlikely. Drawing on these results, this article also makes theoretical contributions to the policy feedback literature by underscoring the need for research on prospections' power in policy feedbacks and proposing a strategy for researchers, policy makers, and public managers to identify where partisanship intervenes in the standard policy feedback logic model, and thereby to better assess how it fragments and conditions positive feedback effects in target populations.

scholarly journals When and How New Policy Creates New Politics: Examining the Feedback Effects of the Affordable Care Act on Public Opinion

2018 ◽  
Vol 16 (2) ◽  
pp. 345-363 ◽  
Author(s):  
Lawrence R. Jacobs ◽  
Suzanne Mettler
Keyword(s):  
Public Opinion ◽  
Political Behavior ◽  
Affordable Care Act ◽  
Policy Design ◽  
Panel Study ◽  
Policy Feedback ◽  
Political Factors ◽  
Feedback Effects ◽  
New Politics ◽  
The Affordable Care Act

Following E. E. Schattschneider’s observation that “a new policy creates a new politics,” scholars of “policy feedback” have theorized that policies influence subsequent political behavior and public opinion. Recent studies observe, however, that policy feedback does not always occur and the form it takes varies considerably. To explain such variation, we call for policy feedback studies to draw more thoroughly on public opinion research. We theorize that: (1) feedback effects are not ubiquitous and may in some instances be offset by political factors, such as partisanship and trust in government; (2) policy design may generate self-interested or sociotropic motivations, and (3) feedback effects result not only from policy benefits but also from burdens. We test these expectations by drawing on a unique panel study of Americans’ responses to the Affordable Care Act. We find competing policy and political pathways, which produce variations in policy feedback.

The Affordable Care Act and Mass Policy Feedbacks

2020 ◽  
Vol 45 (4) ◽  
pp. 567-580
Author(s):  
Andrea Louise Campbell
Keyword(s):  
Real Time ◽  
Affordable Care Act ◽  
Time Frame ◽  
Causal Models ◽  
Policy Feedback ◽  
Feedback Effects ◽  
Policy Effects ◽  
New Information ◽  
The Affordable Care Act ◽  
Empirical Approaches

Abstract The Affordable Care Act (ACA) has allowed researchers to examine mass policy feedback effects—how public policies affect individuals' attitudes and political behaviors—in real time while using causal models. These efforts help address criticisms of the extant feedbacks literature and have revealed new policy feedback effects and new information on the conditions under which policy feedbacks occur. The ACA case also raises empirical and theoretical questions about the types of data needed to assess feedback effects, the magnitude of policy effects required for detection, the time frame in which feedbacks occur, and the suitability of various empirical approaches for assessing policy feedback effects. Thus, the ACA not only adds an important empirical case to the study of policy feedbacks but also helps refine policy feedback theory.

Geographic Variation in Medicaid Acceptance Across Michigan Primary Care Practices in the Era of the Affordable Care Act

2017 ◽  
Vol 75 (5) ◽  
pp. 633-650 ◽  
Author(s):  
Renuka Tipirneni ◽  
Karin V. Rhodes ◽  
Rodney A. Hayward ◽  
Richard L. Lichtenstein ◽  
HwaJung Choi ◽  
...  
Keyword(s):  
Primary Care ◽  
Geographic Variation ◽  
Affordable Care Act ◽  
Policy Makers ◽  
Lower Baseline ◽  
Before And After ◽  
Care Practices ◽  
The Affordable Care Act ◽  
Using Data ◽  
Primary Care Practices

Coverage and access have improved under the Affordable Care Act, yet it is unclear whether recent gains have reached those regions within states that were most in need of improved access to care. We examined geographic variation in Medicaid acceptance among Michigan primary care practices before and after Medicaid expansion in the state, using data from a simulated patient study of primary care practices. We used logistic regression analysis with time indicators to assess regional changes in Medicaid acceptance over time. Geographic regions with lower baseline (<50%) Medicaid acceptance had significant increases in Medicaid acceptance at 4 and 8 months post-expansion, while regions with higher baseline (≥50%) Medicaid acceptance did not experience significant changes in Medicaid acceptance. As state Medicaid expansions continue to be implemented across the country, policy makers should consider the local dynamics of incentives for provider participation in Medicaid.

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

2020 ◽  
Vol 45 (5) ◽  
pp. 771-786 ◽  
Author(s):  
Simon F. Haeder ◽  
Susan Webb Yackee
Keyword(s):  
Affordable Care Act ◽  
Policy Making ◽  
Regulatory Policy ◽  
Executive Branch ◽  
Policy Makers ◽  
The Public ◽  
Policy Tool ◽  
Policy Goals ◽  
The Affordable Care Act ◽  
Regulatory Actions

Abstract 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.

Trends in State-Level Opinions toward the Affordable Care Act

2019 ◽  
Vol 44 (5) ◽  
pp. 737-764 ◽  
Author(s):  
Julianna Pacheco ◽  
Elizabeth Maltby
Keyword(s):  
Affordable Care Act ◽  
Presidential Election ◽  
Policy Making ◽  
Small Area ◽  
Public Support ◽  
State Level ◽  
Policy Feedback ◽  
Positive Effects ◽  
Slow Progression ◽  
The Affordable Care Act

Abstract Context: This article argues that the devolution of the Affordable Care Act (ACA) to the states contributed to the slow progression of national public support for health care reform. Methods: Using small-area estimation techniques, the authors measured quarterly state ACA attitudes on five topics from 2009 to the start of the 2016 presidential election. Findings: Public support for the ACA increased after gubernatorial announcement of state-based exchanges. However, the adoption of federal or partnership marketplaces had virtually no effect on public opinion of the ACA and, in some cases, even decreased positive perceptions. Conclusions: The authors' analyses point to the complexities in mass preferences toward the ACA and policy feedback more generally. The slow movement of national ACA support was due partly to state-level variations in policy making. The findings suggest that, as time progresses, attitudes in Republican-leaning states with state-based marketplaces will become more positive toward the ACA, presumably as residents begin to experience the positive effects of the law. More broadly, this work highlights the importance of looking at state-level variations in opinions and policies.

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