Policy Feedback and the Politics of the Affordable Care Act

Abstract

There is a large body of literature devoted to how “policies create politics” and how feedback effects from existing policy legacies shape potential reforms in a particular area. Although much of this literature focuses on self‐reinforcing feedback effects that increase support for existing policies over time, Kent Weaver and his colleagues have recently drawn our attention to self‐undermining effects that can gradually weaken support for such policies. The following contribution explores both self‐reinforcing and self‐undermining policy feedback in relationship to the Affordable Care Act, the most important health‐care reform enacted in the United States since the mid‐1960s. More specifically, the paper draws on the concept of policy feedback to reflect on the political fate of the ACA since its adoption in 2010. We argue that, due in part to its sheer complexity and fragmentation, the ACA generates both self‐reinforcing and self‐undermining feedback effects that, depending of the aspect of the legislation at hand, can either facilitate or impede conservative retrenchment and restructuring. Simultaneously, through a discussion of partisan effects that shape Republican behavior in Congress, we acknowledge the limits of policy feedback in the explanation of policy stability and change.

Varieties of Policy Feedback Research: Looking Backward, Moving Forward

“…Béland, Rocco, and Waddan () examine two types of policy dynamics in policy feedback processes, self‐reinforcing, which receives the most scholarly attention, and self‐undermining, a more recent concept introduced by Jacobs and Weaver (), in relation to the Affordable Care Act (ACA). Given its complexity, its lengthy implementation timeframe (2010–15), and its diverse policy designs, Béland et al identified how it exhibits both types of effects.…”

“…Turning from empirical tests of feedback effects, the following three articles engage in conceptual and theoretical development of key issues that require much greater attention and incorporation into policy feedback research. Béland, Rocco, and Waddan (2019) examine two types of policy dynamics in policy feedback processes, self-reinforcing, which receives the most scholarly attention, and self-undermining, a more recent concept introduced by Jacobs and Weaver (2015), in relation to the Affordable Care Act (ACA). Given its complexity, its lengthy implementation timeframe , and its diverse policy designs, Béland et al identified how it exhibits both types of effects.…”

Disaggregating the dependent variable in policy feedback research: an analysis of the EU Emissions Trading System

“…However, following an influential intervention by Weaver (2010), there has been a stronger focus on negative feedback and its role in weakening policies. A number of studies have also looked at the interaction between positive and negative feedbacks (e.g., Béland et al 2018;Jacobs and Weaver 2015;Jordan and Matt 2014;Meckling 2019;Oberlander and Weaver 2015;Skogstad 2017).…”

“…Ideally, an expanded focus on both positive and negative feedbacks should lead to a more in-depth discussion of which policy aspects are being strengthened or weakened by policy feedback. But the existing literature has largely chosen to adopt a highly blunt, i.e., aggregated, definition of policy, defined variously as an individual policy instrument (e.g., Jordan and Matt 2014), a policy mix (Skjaerseth 2018), a piece of legislation (Béland et al 2018), or a policy regime (Weaver 2010). However, some scholars have begun to explore how policy feedback can have distinct effects on the constituent elements of an overall policy.…”

Tracking the Coverage of Public Policy in Mass Media

“…Other related research demonstrates implications for citizenship and civic participation (Mettler, 2005). Very recent work identifies self-undermining effects, where policy actually undermines public support over time (Béland, Rocco, & Waddan, 2019). Policy also can influence support for elected officials (Fording, 2018).…”