The Republican Health Care Debacle

How Not to Make Public Policy

The U.S. Capitol building on the day of a House of Representatives vote on the American Health Care Act, March 2017. Jim Bourg / Reuters

In early May, the U.S. House of Representatives passed the American Health Care Act of 2017 (AHCA), which would undo significant parts of the Obama administration’s Affordable Care Act (ACA) and alter crucial aspects of Medicaid as it existed prior to the ACA. The proposed changes in federal policy—rolling back recent changes in insurance market regulations, sharply reducing federal subsidies for health care for lower- and middle-income Americans, and providing a large tax cut for upper-income Americans—would be dramatic. Even more striking is that these changes emerged from a legislative process that blatantly violated the norms of professional policymaking. Indeed, the development and passage of the AHCA is a case study in how not to make public policy.

The traditional process for developing and passing major legislation is straightforward although admittedly cumbersome: members of Congress and their staffs advance ideas for changing public policy; they describe the

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