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Designing policy resilience: lessons from the Affordable Care Act

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Abstract

Public policies are the products of political conflict, constituted by mixes of diverse tools and instruments intended to achieve multiple goals that may change over time and not always be internally consistent or coherent. Recent studies dealing with policy robustness and resilience have theorized about the temporal development of mixes of policy instruments and the need to ensure consistency and coherence over time, yet they have generally failed to develop these insights into lessons for policymakers and practitioners. Drawing on evidence from the implementation of the Patient Protection and Affordable Care Act (ACA) in the USA, this paper examines the relationship between policy mixes and policy resilience or the ability of a policy to withstand challenges to its elements and to remain effective over time, even when deliberate efforts are made to alter, adapt, or repeal all or part of its original content or intention. Although the ACA is at an early stage in its history, it provides many lessons about how, and how not, to design complex policy mixes that can survive determined political opposition.

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Notes

  1. The term “policy mix” is commonly used to describe both mixes of instruments in a single policy area as well as multi-sectoral or multi-issue policies composed of more than a single program or policy. Here it is used in the former sense (Rogge and Reichardt 2016; Howlett and del Rio 2015).

  2. For a discussion of these three issues see (Cox et al. 2016).

  3. In 2018, over half the states relied wholly on the federal government’s alternative arrangements, even though the federal government allowed states to develop hybrid state-federal models that reduced the administrative burden on states when establishing these new bodies (KFF 2018b; Jones et al. 2014a).

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Acknowledgements

The authors thank the anonymous reviewers, guest co-editors Ben Cashore and Sebsatian Sewerin, discussant Rob Ackrill, and the other participants to the International Public Policy Association workshop “Policy Feedback and Policy Dynamics: Methodological and Theoretical Challenges” (Pittsburgh, June 2018).

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  1. Department of Political Science, McGill University, Montreal, Canada

    Daniel Béland

  2. Department of Political Science, Simon Fraser University, Burnaby, BC, Canada

    Michael Howlett

  3. Department of Political Science, Marquette University, Milwaukee, WI, USA

    Philip Rocco

  4. Department of Politics and International Relations, University of Leicester, Leicester, UK

    Alex Waddan

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Béland, D., Howlett, M., Rocco, P. et al. Designing policy resilience: lessons from the Affordable Care Act. Policy Sci 53, 269–289 (2020). https://doi.org/10.1007/s11077-019-09368-w

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