When Bad Policy Makes Good Politics: Running the Numbers on Health Reform
When Bad Policy Makes Good Politics: Running the Numbers on Health Reform
Associate Professor of Political Science
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Abstract
Since the 1960s, America’s policymaking system has lurched from one in which leaders could simply disparage the concept of budget projections to one in which policymakers manipulate cost estimates. After rounds of good government reforms, the very rules and safeguards put in place to thwart economically unsound legislation now cause chaos by incentivizing the development of flawed, even blatantly unworkable, policies. The pathologies of the new system are illustrated by the CLASS Act and its role in aiding passage of President Barack Obama’s landmark health reform law. CLASS was supposed to address America’s serious problem concerning the availability and affordability of long-term care. A dedicated band of interest group advocates working with Senator Edward Kennedy succeeded in having CLASS become law as part of the Affordable Care Act. But when the Obama administration abandoned the program several months later, CLASS was widely derided as an unviable policy crafted by unrealistic idealists. Yet what appeared to be a naïve proposal was actually a carefully framed policy designed to fit the rules of the game, particularly the cost-projection process of the Congressional Budget Office (CBO). Although CLASS was destined to collapse into a “death spiral” requiring massive government bailouts, the CBO estimated the program would save tens of billions of dollars. These official “savings” made CLASS an attractive add-on to the health reform bill and helped facilitate its passage. Understanding why CLASS was designed in an unworkable manner but nevertheless helped ensure passage of health reform provides insight into how the contemporary policymaking process really functions and highlights its shortcomings.
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Front Matter
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1
Introduction
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2
Washington’s Old and New Systems of Policymaking
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3
A Legacy of Failure: Long-Term Care’s Policy History and the Genesis of the CLASS Act
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4
Learning from Failure: Only Bad Policy Stands a Chance
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5
CLASS on Capitol Hill, Part 1: Dodging Committee Jurisdiction and the Number Crunchers
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6
CLASS on Capitol Hill, Part 2: A Bipartisan Backlash and the Missing “Fixes”
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7
Two Can Play at That Game
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8
Conclusion
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End Matter
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