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

• Published in: Journal of health politics, policy and law policy and law, 2012-10, Vol.37 (5), p.741-778
• Main Author: Beaussier, Anne-Laure
• Format: Article
• Language: English
• Subjects: Central Government; Clinton, William Jefferson (Bill); Competition; Heads of state; Health care; Health care policy; Health Care Reform - legislation & jurisprudence; Health Care Services; Health Care Services Policy; Health insurance; Health policy; Humans; Law; Leadership; Legislation; Legislative Bodies; Legislative Process; Majorities; Medical service; Medicine and Health; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act - legislation & jurisprudence; Patient safety; Patients; Policy making; Political behavior; Political leadership; Political Science; Politics; Presidents; Protection; Public Health and Health Policy; Public Policy; Reform; Reforms; Social reform; Socialized Medicine; Strikes; U.S.A; United States; United States of America; Veto
• ISSN: 0361-6878; 1527-1927
• DOI: 10.1215/03616878-1672709

The 2010 Patient Protection and Affordable Care Act was a major legislative achievement of the 111th Congress. This law structurally reforms the US health care system by encouraging universal health care coverage through regulated competition among private insurance companies. When looking at the process for reform, what strikes an observer of US health care policy in the first place is that the Democratic majority was able to enact something in a political field characterized by strong resistance to change. This article builds on that observation. Arguments concentrate on the legislative process of the reform and support the idea that it may be partly explained by considering an evolution of US legislative institutions, mostly in the sense of a more centralized legislative process. Based on approximately one hundred semidirected interviews, I argue that the Democratic majority, building on lessons from both President Bill Clinton's health care reform attempt and the Republicans' strategy 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,” enabled the Democratic leadership to overcome multiple institutional and political veto players.