Breaking Gridlock: The Determinants of Health Policy Change in Congress

Abstract

Prior to the 2010 health care reforms, scholars often commented that health policy making in Congress was mired in political gridlock, that reforms were far more likely to fail than to succeed, and that the path forward was unclear. In light of recent events, new narratives are being advanced. In formulating these assessments, scholars of health politics tend to analyze individual major reform proposals to determine why they succeeded or failed and what lessons could be drawn for the future. Taking a different approach, we examine all health policies proposed in the U.S. House of Representatives between 1973 and 2002. We analyze these bills' fates and the effectiveness of their sponsors in guiding these proposals through Congress. Setting these proposed policies against a baseline of policy advancements in other areas, we demonstrate that health policy making has indeed been far more gridlocked than policy making in most other areas. We then isolate some of the causes of this gridlock, as well as some of the conditions that have helped to bring about health policy change.

Effectiveness of Connected Legislators

“…Volden et al [2013] have used it to explore the legislative effectiveness of women for the 93th -110th Congresses. A similar index, Health ILESs, was proposed by Volden and Wiseman [2011] to examine which House members has been most successful to advance health care bills for the 93th to 110th Congresses.…”

Beyond Path Dependence: Explaining Healthcare Reform and Its Consequences

“…Models of Congressional gridlock provide further insights into the enactment of health reform. Craig Volden and Alan Wiseman (2011) evaluate whether gridlock over health policy issues in Congress is particularly ingrained. Moving away from narratives that have been the mainstay of our understanding of major health reform efforts, Volden and Wiseman turn their attention to a quantitative analysis of all health policy bills introduced in Congress from 1973 through 2002.…”

Executive Opportunism, Presidential Signing Statements, and the Separation of Powers

“…Based on our positive analysis, we argue that the use of such statements by courts in interpreting statutes results in an inversion of the constitutionally prescribed lawmaking process, and further discourages cooperation between the president and Congress, a functional consideration of great importance under the prevailing conditions of inter-branch polarization (e.g., McCarty, Pool & Rosenthal 2006;Volden & Wiseman 2011). For many of the same reasons, and contrary to a common view, we also conclude that signing statements should not necessarily receive the traditional deference that courts give to agencies' post-enactment interpretation of statutes.…”