Forty Years of 'Testing, Testing': The Past and Future Role of Policy Experimentation in Healthcare Reform

Abstract

When Congress undertook reform of the United States healthcare system in 2009, it faced a daunting task that had eluded policymakers for decades: how to come up with a politically feasible way to rein in healthcare costs while improving quality. Healthcare reform is not challenging due to lack of ideas, but because so far, no one has been able to identify and implement politically viable ideas that actually work. To solve this problem, Congress turned to an old tool: the pilot project. The federal government has used policy experimentation, in the form of pilot and demonstration projects, to test innovative health policies for more than forty years. This is the first article in the legal literature to analyze the use of systematic policy experimentation by the federal government to reform the healthcare system. Are pilot projects a useful policymaking tool in the context of healthcare reform? Although healthcare pilot projects are not the panacea suggested by some of their strongest proponents, they may play an important role in the health policymaking process by generating valuable information for future reforms and creating a pathway toward widespread implementation for less controversial policy innovations.