Finding Success

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This week's readings take on the weighty issue of policy outcomes and success. McConnell (2010)'s piece presents a framework for evaluating policy outcomes, which is organized around process, program, and political domains and contains a "spectrum of success" consisting of resilient success, conflicted success, precarious success, and failure (p.345). Through this framework McConnell attempts to systematically address the complicated objective and subjective criteria that impact evaluations of policy outcomes, taking into account not only goal achievement, but also levels of opposition and support.

Hacker (2010)'s analysis and summary of his involvement with the 2009-2010 movement for health care reform in the United States provides a useful case example for further examining elements and frameworks of policy outcomes and success. Through his account of the political features involved in the passage of the Affordable Care Act, Hacker highlights some of the key political actors and forces involved in present-day reform efforts. Among these elements include the impacts of political polarization, the agenda setting function of interest groups, and clout of party elites, which harken back to the earlier readings of McCarty (2007), Cigler and Loomis (1991), and Domhoff (1998).

The chapters featured from Patashnik (2008)'s book Reforms At Risk serve as a useful end cap for this week's readings in that they explore the interests, actors, and mechanisms that undermine the sustainability policy reform efforts. The case study of 1986's Tax Reform Act serves to illustrate these elements that can scale back the reforms of earlier policymakers and render a piece of legislation essentially ineffective.

Given what we have read this week about the evaluation of policy outcomes and the political and structural threats that may undermine the sustainability of hard-won reform efforts, what chances do you think the Affordable Care Act has to endure as a lasting piece of policy reform? What political actors or forces do you think might contribute to its long-term success or eventual demise?

3 Comments

One of ACA’s most important steps to control costs is the inclusion of a plan to create an Independent Payment Advisory Board (IPAB) and this seems like a challenge ACA will face. It is doubtful that politicians will give the IPAB enough power to control costs like many of its proponents intended.Politicians in both parties are calling for repealing or weakening the IPAB. This is because, to be successful, the board must make tough choices to limit the most costly and least effective kinds of care. Also, public opinion matters in this case since it is a general interest reform and I do believe that few Americans would tolerate having their health care rationed by IPAB.

While I think there are certainly some things that the ACA has in its favor such as withstanding legal battles over its constitutionality and generally positive feedback from interest groups, the challenges it is also facing make its future precarious. On a political culture end, the ACA has not necessarily realigned partisan structures, something Pataschnik said was crucial for long-lasting reform. Additionally, both Democrats and Republicans are displeased with the law, with the former seeing it as coming up short on comprehensive health care reform and the latter viewing it as a step too far in government control and oversight. Without a partisan realignment, especially in a polarized system, I envision the ACA will struggle to maintain some of its most broad reforms as government will likely change partisan control and thus usher in the opportunity for the reform to fail through the passage of counter legislation.

I agree with both of your assessments regarding some of the future challenges the Affordable Care Act may face in ensuring its long-term sustainability. An additional political element that I find worrisome is the power of future congressional leaders who oppose the expansion of Medicare coverage through the Act to undo such reforms through the budget reconciliation process, as was mentioned in the Brookings video for this week.

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