Policy Feedback Effects Research Articles

The Affordable Care Act and the Diffusion of Policy Feedback: The Case of Medicaid Work Requirements

Over the last five years, many states have sought to limit access to Medicaid by adopting restrictive policies. How can we reconcile this development with studies that imply that Medicaid should be insulated from policy backlash? The answer lies in understanding the policy feedback effects that accompanied Medicaid expansion and how these effects created electoral pressure that led to policy modification. We situate our expectations within a policy diffusion framework that accounts for variation in both the content and timing of policy adoptions across states. We develop and test several hypotheses using survey data and an original dataset on gubernatorial support for Medicaid work requirements. Our hypotheses are generally supported and provide a more nuanced understanding of the policy feedback effects following Medicaid expansion.

Boomtown or Bust? Policy Feedback Effects of Divisive Facilities on Social Capital in Japan

Boomtown or Bust? Policy Feedback Effects of Divisive Facilities on Social Capital in Japan

Policy Feedback and the Racialization of Affirmative Action, 1961-1980

ABSTRACT Since the 1960s, U.S. lawmakers have used affirmative action policies to promote equal opportunity. Although these policies have played an important role in redressing historical discrimination by helping women, racial and ethnic minorities, citizens with disabilities, and veterans to make progress in employment and education, their effects for racial equity in higher educational access have come to dominate popular perceptions of affirmative action and drive the often contentious political discourse surrounding it. How did popular understandings of affirmative action policy become so racialized, and what are the implications of this racialization for its capacity to redress past wrongs? This paper examines the early political development of affirmative action policy in the U.S. from its emergence in 1961 through 1980. Historical analysis suggests that the contentious race-centered politics of affirmative action that emerged after the landmark Regents v. Bakke case is a matter of policy feedback effects.

Conflicting Messages: Multiple Policy Experiences and Political Participation

Most Americans benefit from several policies, yet studies connecting policy receipt to political participation generally treat these interactions as isolated from each other. This article grounds itself in this reality by examining how multiple policy experiences interact to alter political participation. Focusing on policies that send conflicting messages to beneficiaries, I provide a political learning framework and set of quantitative findings that nuance conventional understandings of the relationship between the American welfare state and turnout behavior. The results demonstrate that politically mobilizing universal policies and demobilizing means‐tested policies can cancel each other out, such that individuals benefitting from both exhibit no change in their participatory behavior. Thus, the political impact of policies within each tier are shown to be contingent on one's involvement in the other tier. In a counterintuitive finding, this analysis further shows that multiple policy experiences within the means‐tested tier can combine to increase turnout rates due to the political lessons imparted by Head Start's uniquely democratic design. In advancing our understanding of the role public policies play in shaping American democracy, these findings demonstrate the importance of considering how policy feedback effects impact each other.

The political economy of health financing reform in Malaysia.

There is growing evidence that political economy factors are central to whether or not proposed health financing reforms are adopted, but there is little consensus about which political and institutional factors determine the fate of reform proposals. One set of scholars see the relative strength of interest groups in favour of and opposed to reform as the determining factor. An alternative literature identifies aspects of a country’s political institutions–specifically the number and strength of formal ‘veto gates’ in the political decision-making process—as a key predictor of reform’s prospects. A third group of scholars highlight path dependence and ‘policy feedback’ effects, stressing that the sequence in which health policies are implemented determines the set of feasible reform paths, since successive policy regimes bring into existence patterns of public opinion and interest group mobilization which can lock in the status quo. We examine these theories in the context of Malaysia, a successful health system which has experienced several instances of proposed, but ultimately blocked, health financing reforms. We argue that policy feedback effects on public opinion were the most important factor inhibiting changes to Malaysia’s health financing system. Interest group opposition was a closely related factor; this opposition was particularly powerful because political leaders perceived that it had strong public support. Institutional veto gates, by contrast, played a minimal role in preventing health financing reform in Malaysia. Malaysia’s dramatic early success at achieving near-universal access to public sector healthcare at low cost created public opinion resistant to any change which could threaten the status quo. We conclude by analysing the implications of these dynamics for future attempts at health financing reform in Malaysia.

Making What Government Does Apparent to Citizens: Policy Feedback Effects, Their Limitations, and How They Might Be Facilitated

Public policies sometimes generate “policy feedback effects,” reshaping public opinion and political participation among beneficiaries or the public generally, often with the effects of generating supportive constituencies that help to sustain the program. Yet such effects do not always occur; in fact, despite that Americans use more social policies than ever, antipathy to government runs high—evidence of a seeming “government-citizen disconnect.” Policy design and delivery matters for policy feedback, as policies that make government’s role more visible may make more of an impression on beneficiaries; yet political polarization and distrust in government can interfere with such effects. In addition, those who are most aware of the government’s role in social provision often participate least in politics, and vice versa. This article considers strategies that public officials and other civic and political leaders can use to facilitate policy feedback effects.

Policy Feedback in an Age of Polarization

A large body of research has explored how policies, once enacted, reshape public opinion, governing institutions, and political organizations—a process known as “policy feedback.” Yet this productive research agenda has yet to be translated into practical recommendations of the sort regularly provided by other social science research. This volume of The ANNALS presents the findings of a major collective effort to do just this. The Policy Feedback Project (PFP) is an effort to develop research-backed arguments about how policy feedback might be harnessed to address collective problems in today’s age of partisan polarization and economic inequality. This article orients readers to our collective approach and summarizes some of the contributing authors’ findings. In particular, we show how the feedback effects of policies could be used to (1) tackle long-standing public problems that have resisted effective responses, (2) increase the long-term durability of policy initiatives designed to address these problems, and (3) build political momentum and power to facilitate the adaptation and expansion of these initiatives over time.

Antitrust Enforcement as Federal Policy to Reduce Regional Economic Disparities

Regions of the United States have seen their incomes diverge dramatically over the last four decades. This article makes the empirical and political case for treating regional economic disparities as a national phenomenon best resolved through federal policy, rather than exclusively as a matter of local responsibility. It then considers reinvigorated antitrust enforcement as an example of a federal policy that would strengthen local economies while benefiting from policy feedback effects.

Asymmetric Partisan Polarization, Labor Policy, and Cross-State Political Power-Building

As the Republican Party has moved to the Right, conservative politicians have become more comfortable viewing policy as a means of demobilizing their political adversaries. In this article, I show how conservative activists within the Republican Party have leveraged cutbacks to union rights to weaken their political opponents. This case study thus reveals the role of policy feedback strategies in asymmetric partisan polarization. It also illustrates lessons about the conditions under which policy feedback can durably shift the distribution of power in America’s fragmented polity. These insights underscore how the success of policy feedback effects depends not just on the initial passage of policies in one city or state, but on the ability of political actors to organize in multiple venues simultaneously. In particular, they highlight the importance of organizing at the cross-state level given the substantial political authority of states.

Offsetting Policy Feedback Effects: Evidence from the Affordable Care Act

The U.S. welfare state provides key benefits indirectly. The Affordable Care Act (ACA), for example, uses a package including exchanges, subsidies, and penalties to increase health insurance enrollment. Prior research indicates that indirect policies do not produce feedback effects on public opinion, but the ACA was unusually salient and complex. Can such indirect policies produce feedback effects, and are any such effects heterogeneous? Here, we use several data sets and inferential strategies to show that groups especially affected by the exchanges and the associated insurance mandate did shift their ACA attitudes, albeit in opposing directions and with more limited effects than descriptive analyses suggest. Among our findings, those who experienced rising local prices became more opposed to the ACA while those who stood to benefit from some changes to the individual markets became more favorable. Overall, positive changes in attitudes were offset by demographically concentrated, negative shifts among the uninsured.

Can Health Insurance Regulations Generate Citizen Constituencies?

Abstract Context: A political science literature has emerged on the policy feedback effects of alternative health care coverage expansions, focusing on whether programs like Medicare, Medicaid, and the Affordable Care Act can generate robust public constituencies. Yet, scholars have mainly examined direct governmental benefits and rarely studied the feedback effects from the underlying regulatory frameworks that allow health care markets to function, such as regulations that determine eligibility for nongroup and continuation coverage. Methods: Drawing on literature from multiple disciplines, this article analyzes political and policy factors that promote and undermine such regulations' capacity to stimulate positive feedback and the emergence of citizen constituencies. Findings: While some factors may help these regulations to cultivate constituencies, there are barriers to this positive feedback generation. The most notable is the failure of these regulatory policies to confer politically useful resources on citizens unless other, mutually supportive policies are also in place, such as policies to control premiums. Conclusions: Steps in the policy feedback model that are typically left unexplored in the literature deserve greater scrutiny when scholars examine the weak self-reinforcing effects of health insurance regulations. A take-away lesson, relevant to the Affordable Care Act, is that even when policies broaden nongroup coverage and ostensibly assist many people, a robust citizen constituency is unlikely to emerge, leaving key protections of access to health insurance vulnerable to erosion or reversal over time.

A Behavioral Theory of Policy Feedback in Tobacco Control: Evidence From a Difference‐In‐Difference‐In‐Difference Study

Public policy scholars argue that in highly tangible policies, such as tobacco control, the public learns from the direct experience of the beneficial effects of the policy. Empirical evidence supports this argument, suggesting that in the United States the introduction of tobacco control measures makes people more inclined to further regulation. By relying on a set of cases which allows testing the effects of the introduction of tobacco control measures across European countries on a series of relevant variables, this study confirms that the introduction of tobacco control measures makes the public more inclined to further regulation. Yet, when the effects of these policies are disaggregated between smokers and nonsmokers, results show that these positive effects are driven by smokers. This puzzle suggests that different effects than mass attitudinal policy feedback effects, driven by learning from direct experience, might explain the positive reaction to tobacco control. This study puts forward a behavioral theory of policy feedback, which suggests that smokers react positively to the introduction of tobacco control measures because they see these measures as commitment devices, which can help them quit smoking. Evidence for this argument is found by demonstrating that the introduction of tobacco control measures increases smokers’ welfare.

Policy Feedback Effects on Mass Publics: A Quantitative Review

There has been an impressive stride in the research on policy feedback effects on mass publics over recent years. However, we lack systematic evidence on how large such policy feedback effects are in the literature. This article provides a review of 65 published studies and quantifies the findings and key themes in the policy feedback literature. The results show a great degree of heterogeneity in the domains and outcomes being studied and in the effects of policies on the public. In line with the findings from narrative reviews, feedback effects are greater for outcomes related to political participation and engagement. Last, the review sheds light on important theoretical and methodological limitations to be addressed in future research.

Healthcare Reform Repeal Efforts in the United States in 2017: An Inquiry into Public Advocacy Efforts by Key Interest Groups

The Affordable Care Act (ACA) was subjected to repeated repeal and replace efforts in the United States Congress in 2017. Attempts to repeal and replace the law failed, but penalties for not complying with its mandate that individuals purchase health insurance were removed in tax legislation passed late in the year and administrative actions taken by President Trump yielded additional concerns about the stability of the law’s reform approach and the expanded health insurance access that it created. This article explores public advocacy efforts by key interest groups from three major policy sectors—health providers, the insurance industry, and the business community—that had served as an “axis of opposition” to past American healthcare reform efforts. It identifies resource and incentive policy feedback effects that appear likely to influence these groups due to design features of the ACA and assesses whether patterns of advocacy efforts in 2017 are consistent with what might be expected if these design features had their predicted effects. Our assessment reveals patterns of interest group advocacy that are consistent with what might be expected to arise from resource and incentive based policy feedback effects, and interest group political dynamics that differ from what was in place prior to passage of the ACA. It also reveals advocacy patterns that are not well explained by resource and incentive based policy feedback effects, and—in so doing—yields insights that are relevant to the design of policy reforms and future research.

Standing in Line When Queues Are on the Decline: Services Satisfaction Following the Swedish Health Care Waiting Time Guarantee

Understanding mass public support for health systems and welfare polices is required in order to safeguard the legitimacy of democratic governance of the welfare state. If policies to meet dissatisfaction go unnoticed, the whole idea of responsive democracy is in vain. This paper focuses on the 2005 Swedish health care waiting‐time guarantee, which resulted in drastically lower hospital waiting times in Västra Götaland County. Exploring questions of significant theoretical relevance in the literature about policy feedback effects, the paper investigates if the decrease in waiting times affected hospital service satisfaction and if this effect was moderated by policy proximity and visibility. Data from the West Sweden SOM survey are utilized, measuring hospital service satisfaction from 2004 to 2009. To disentangle the role of policy proximity, two indicators are used—user status and subjective health status. Furthermore, policy visibility is measured by an individual’s level of political interest. The results show that the decrease in waiting times resulted in a substantial increase in hospital service satisfaction. However, the increase was not more pronounced among groups with higher proximity and visibility. On the contrary, results indicate that the increase in hospital service satisfaction was stronger among those already in good health.

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

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.

Types of labor market policy and the electoral behavior of insecure workers

Recent research finds a significant difference in voting behavior of workers with secure employment and those without. What is less understood are the conditions in which the divergent political choices of these two groups overlap. Focusing on two types of labor market policies—unemployment insurance and active labor market programs, this paper examines how more generous government spending on different types of welfare programs shapes the electoral behavior of individuals with adverse labor market experience. By using multilevel analysis of individual surveys from 18 European countries (1999–2015), I find that unemployed and temporary workers are more likely to vote against traditional left-wing parties and to withdraw from voting at all. The greater spending on unemployment insurance, however, alters the outcome by realigning insecure workers with old left parties such as social democratic and center-left socialist parties. By contrast, expenditure on active labor market programs has a weak conditional impact in general. The important implication of this study is that while government policy does moderate the effect of adverse labor market experience, types of social policy matters in understanding policy feedback effects. I further discuss this point in relation to the different implications of income support and activation programs for risk mitigation.

Liberal Financial Markets in the Interest of Staatskredite – A Process-Tracing Study of the Link between Sovereign Debt Policy and the 1908 Bourse Law Reform in the German Empire

Abstract This study of the reform of the German Bourse Law in 1908 argues that the “self-undermining negative policy feedback effects” of the initial Bourse Law of 1896 on the market for Imperial and state bonds explain why exchange regulation was liberalized although the dominant political forces, the Conservatives and the Clericals, were opposed to bourses and capital markets. Based on an original assessment of primary documents, the study uses the method of explaining-outcome process tracing to show that the initial Bourse Law caused losses to the Imperial government and the large banks; this induced both actors to remove the prohibition of speculation. Because the German Empire can be viewed as a kind of laboratory for (first) treatment effects on financial market regulation of the sovereign debt market, this study contains lessons for understanding the relationship between states and financial markets in general.

Is the Affordable Care Act Cultivating a Cross-Class Constituency? Income, Partisanship, and a Proposal for Tracing the Contingent Nature of Positive Policy Feedback Effects.

Social Security and Medicare enjoy strong political coalitions within the mass public because middle-class Americans believe they derive benefits from these programs and stand alongside lower-income beneficiaries in defending them from erosion. By pooling data from nine nationally representative surveys, this article examines whether the Affordable Care Act (ACA) is cultivating a similar cross-class constituency. The results show that middle-income Americans are less likely than low-income Americans to say the ACA has helped them personally so far. On the other hand, partisanship conditions the relationship between income and beliefs about benefits likely to be derived from the ACA in the long run. In total, the results suggest that cross-class Democratic optimism about long-run benefits may enable the ACA to reap positive beneficiary feedbacks, but a large and bipartisan cross-class constituency appears unlikely. Drawing on these results, this article also makes theoretical contributions to the policy feedback literature by underscoring the need for research on prospections' power in policy feedbacks and proposing a strategy for researchers, policy makers, and public managers to identify where partisanship intervenes in the standard policy feedback logic model, and thereby to better assess how it fragments and conditions positive feedback effects in target populations.

Electoral Competition and Policy Feedback Effects

Some government policies can systematically influence citizens’ acquisition of economic information. Since voters evaluate policy platforms in light of this information, politicians might exploit these policy feedback effects to shape voter’s future policy preferences to their advantage. We illustrate this logic in the context of government subsidies to property ownership. Using an extension of the Romer-Meltzer-Richard model with imperfect information about the economy, we show how subsidies to ownership of real estate—such as mortgage interest deductions or discounted sales of public housing—produce an electorate that is systematically less favorable to redistributive taxation. The resulting political complementarity between home subsidies and fiscal conservatism is consistent with several empirical regularities.