Healthcare policy: Cost versus solutions

Healthcare is a dynamic policy issue, encompassing a number of multifaceted problem areas such as insurance, cost-efficiency, equity, and recourse allocation. As a result, legislation often addresses the broader problem piecemeal, on a one-issue-at-a-time basis. This project aims to examine this piecemeal process, with regard to the proportion of legislation devoted to amending prior bills and the proportion of legislation advancing novel solutions to pressing healthcare problems. Further, because legislation has often historically targeted specific populations, I examine which populations are most often targeted in reform efforts, and how targeted efforts play a role in legislative success. I analyzed major health care legislation through data gathered from the Policy Agendas Project as well as other policy databases, with a focus on three essential reform efforts including the successful New Deal implementation of Medicare and Medicaid, the failed Clinton effort, and the controversial Patient Protection and Affordable Care Act. Using an original coding system to categorize the provisions bills and enable a clear breakdown of their content, I look at the proportions of each bill that are amendments to prior legislation and the proportions that are targeted to special populations. By accumulating enough data, I develop an average threshold of these proportions by comparing legislation that pass and that failed. My analysis reinforces the idea that policy makers often function as pluralists, and special populations will amass the most awareness, impeding more universal reform.