The Patient Protection and Affordable Care Act: The Victory of 'Unorthodox Lawmaking'

Abstract

The 2010 Health care reform was a major legislative achievement of the 111th Congress. This Law structurally reform the American health care system by encouraging universal health care coverage through regulated competition among private insurance companies. When looking at process for reform, what strikes an observer of US Health care policy in the first place is the fact that the Democratic majority was able to enact something in a political field characterized by strong resistance to change.This paper builds on this observation. Arguments developed concentrate on the legislative process of the reform and support the idea that the 2010 health care reform may be partly explained by considering an evolution of American legislative institutions, mostly in a sense of a more centralized legislative process.Based on approximately 100 semi-directed interviews, I argue that the democratic majority, building on lessons from both Clinton's health care reform attempt and from Republicans' strategies of using strong congressional leadership to pass social reforms, was able to overcome institutional constraints that have long prevented comprehensive change. A more centralized legislative process, which has been described as unorthodox lawmaking (Sinclair, 2007), enabled the Democratic leadership to overcome multiple institutional and political veto players.