The Secretary Shall . . . : Implementing the Affordable Care Act's Private Insurance Expansions

The federal bureaucracy played a critical role in implementing most aspects of the Affordable Care Act's private insurance coverage expansion. Through brief case studies, the authors review three dimensions of this role: the development of the Center for Consumer Information and Insurance Oversight, rulemaking in the formulation of the essential health benefits package, and the implementation of the federal website. They relate these to themes in the public administration literature. Politics—both through state decisions and through continuing congressional action (and inaction)—pervaded the implementation process. The challenges of staffing and situating the new bureaucracy effectively changed vertical boundaries within the Department of Health and Human Services, with long-lasting consequences. Finally, the complex design of the policy itself made passage of the legislation easier but implementation much more difficult. Ultimately, however, implementation was remarkably successful, achieving improvements in coverage consistent with the Congressional Budget Office's projections.

Reviving Legislative Avenues for Gerrymandering Reform with a Flexible, Automated Tool

After seeking a “manageable standard” to apply to claims of partisan gerrymandering for over three decades, the Supreme Court has finally given up the chase, ruling that such claims are nonjusticiable. What is to be done? An extended history of successful congressional action suggests that the legislative pathway is more practical than often believed. Statutory requirements also make it possible to consider a broader suite of districting objectives. This paper presents a flexible new software and a framework for evaluating the practical implications of explicit objectives. I apply this approach to the conditions last required by Congress, generating equipopulous, contiguous, and compact districts. Among these conditions, the formal definition of compactness has proven contentious. Does it matter? I contrast the representation of the political parties and of racial and ethnic minorities under plans optimized according to 18 different definitions of compactness. On these grounds, the definitions are markedly consistent. These methods may be extended to alternative districting objectives and criteria.

Fixing Social Security: Major Reform or Minor Repairs?

Without congressional action, the Social Security reserve fund will be exhausted by 2035. When that occurs, benefit payments must be cut by one-fifth. To avoid that outcome, Congress must agree on a reform plan that boosts revenues, cuts pensions, or does both. The choice of a reform strategy should depend on voters’ support for the goals of the Old-Age, Survivors, and Disability Insurance (OASDI) program and evidence about the program’s effectiveness in achieving those goals. This article explains the aims of the Old-Age and Survivors Insurance (OASI) program, briefly describes how the program attempts to achieve those aims, and considers evidence on whether the goals have been achieved and at what cost. It then considers alternative reforms that address OASI’s main problem, namely, the long-term shortfall in program revenues compared with pension commitments. It concludes by identifying the reforms that seem best suited to achieving OASI’s core aims while conforming to voter preferences.

Part IV Section 4 in Theory, 14 Improving Section 4

This chapter examines some of the suggestions made for improving Section 4. Those suggestions that would require congressional action or, worse yet, a constitutional amendment, are rejected as being too difficult to make happen. More promising are reforms that require only presidential leadership or keen work by the President’s legal staff. Presidents and their teams typically construct elaborate contingency plans for using Section 4. These plans need to be resolute about handling potentially difficult ambiguities. They also need to be publicized so that wider knowledge—among the President, his staff, and the general public—will prevent damaging uncertainty from ever arising in an actual case.