The Policy Process: Part II
March 18, 2013
Any significant policy amendment or introduction of new legislation in the United States is always fraught with the perils of partisan politics. Health care policy is a particularly divisive issue, one which seems to summon a lot of passion on both sides. President Barack Obamaâ€™s Patient Protection and Affordable Care Act (PPACA), which, combined with the Health Care and Education Reconciliation act (HCERA), formed the Health Care Reform Act of 2010, is a perfect example of how difficult it is in America to push through health care legislation. Together, Obamaâ€™s reforms were directed at solving many ...view middle of the document...
After a new policy is implemented, advocates, opponents, or â€œinterested partiesâ€ begin to consider the consequences of the decision and its implementation. At this point, the final stage of the policymaking process has begun. Either through formal means such as data analysis or through informal means such as citizen reaction, evaluating a policy reveals its success, failure, or the need for modification. If a problem is observed in a particular policy, the â€œstagesâ€ begin again. (IP-19)
On the surface, as Theodoulou and Kofinis (2004) explain, the evaluation stage seems straightforward: it simply seeks to identify whether or not public policy has, or has not, achieved its objective(s). However, the process is just as divisive and acrimonious as any other phase of policymaking. As Theodoulou and Kofinis (2004) contend, the evaluation process is not free from the intervention of â€œpolitical interest groupsâ€ and â€œpolicy actorsâ€ (Political Science 490).
The PPACA, while extremely relevant to American politics, is perhaps a poor choice for analyzing the evaluative process of health care policy, because of its timeline: introduced in March of 2010, its implementation ends in 2018, with the establishment of a high-cost plan excise tax (â€œAffordable Care Act Implementation Timelineâ€). However, it may be possible to focus on one aspect of the PPACA, and discuss its possible trajectory through the evaluation, analysis, and revision stages.
Essentially, the process moves through stages, as outlined by Birkland (2011): issue emergence, agenda setting, alternative selection, enactment, implementation and evaluation. The main point, however, of Birklandâ€™s scheme is that the process is a feedback loop: the policy is evaluated, and the â€œresults of evaluation provide feedback to the process, where it begins anewâ€ (with issue emergence) (p. 26). Therefore, the process is blurred. As Birkland (2011) emphasizes, â€œone cannot separate the implementation of a policy from its evaluation, because evaluation happens continuously as a policy is implementedâ€ (p. 26). This is very apparent with the PPACA, which, as mentioned, is politically divisive; therefore, as the policy is implemented, it is expected that legal assaults may be launched as to its constitutionality â€“ and against other aspects of its provisions.
One main issue with the PPACA that imperils its proper implementation is its constitutionality â€“ in particular, its provision for mandatory insurance coverage has been claimed as unconstitutional, violating the Commerce Clause. The provision that is under fire is minimum coverage, sometimes known as â€œindividual mandate.â€ Basically this provision simply acts upon Obamaâ€™s goal of universal health care. Individuals must be covered either individually or through their employer, or pay a fine. Remaining uninsured is not a crime; the fine merely deters healthy people...