Congress, Policy Sustainability, and the Affordable Care Act: Democratic Policy Makers Overlooked Implementation, Post-Enactment Politics, and Policy Feedback Effects

Abstract

When crafting and passing health care reform, did policy makers appreciate and attempt to address potential implementation and sustainability challenges, or were they largely oblivious to the reality that adoption of the Affordable Care Act (ACA) would not automatically settle its future? Utilizing in-depth, in-person interviews with the key congressional actors who were most directly involved in the ACA’s genesis and approval, I examine this heretofore unexplored matter. I find that the legislative players failed to recognize the significance of the ACA’s post-enactment period, and that pre-enactment choices might shape the law’s trajectory. After discussing various aspects of policy makers’ shortsightedness, I raise five possible explanations for what may appear to be my intuitively illogical findings.