The Failed ACA Repeal: Five Political Science Questions

As I wrote some months back, this is the best time ever to be a political scientist. The past six months of debate about repealing and replacing the Affordable Care Act is one of the most important public policy debates in recent American history. With the failure of Skinny Repeal, here are five questions about the Affordable Care Act and the politics of replacing it, inspired by five core concepts in political science.

Structure versus Agency. Is the fundamental problem with the ACA repeal the fact that the ACA is complex legislation that affected many parts of the U.S. economy that had become fairly popular in a closely divided Senate (structure), or the failure of the White House and the Congressional GOP leadership to craft effective legislation and persuade the GOP majority to go along with it (agency or leadership)?

Credible Commitments. Four GOP Senators asked for a credible commitment from the House GOP leadership that the so-called Skinny Repeal would not be the final bill upon which the House voted. Speaker Ryan’s inability to provide such a commitment doomed the effort. What would have truly credible commitment by Speaker Ryan have looked like? Was it even possible?

Status Quo Bias. When the status quo is suboptimal, it would seem straightforward that any superior plan would be preferred. The ACA is suboptimal, but the GOP effort to repeal it was shrouded in uncertainty about its replacement. Would a better strategy have been to specify clearly the alternative, even had it been largely unpopular?

Policy feedback. New policies create new politics. The labelling of the ACA as “Obamacare” is a strategy to associate a complex policy regime with a polarizing individual, but the ACA proved substantively valuable even to many of the former President’s staunchest critics. How did this happen? In what ways was this intended policy-feedback-by-design, and in what ways unintended?

Mobilization and resistance. American progressives have been tirelessly working to protect the ACA. Senators Collins, McCain, and Murkowski are hardly progressives. So what effects did progressive mobilization ultimately have? Agenda setting in the media? Coordinating the health care establishment? Others? Nothing at all?

I’d happily read a long essay about any of these questions. Feel free to leave your own political science-inspired questions in the comments.