West Virginia University.
J Health Polit Policy Law. 2018 Apr 1;43(2):271-304. doi: 10.1215/03616878-4303498.
The implementation of the Affordable Care Act (ACA) has been a politically volatile process. The ACA's institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, postreform politics depends on more than policy feedback alone; rather, it is shaped by the partisan and interest-group environment. We argue that "intense policy demanders" played an important role in defining the policy alternatives that comprised congressional Republicans' efforts to repeal and replace the ACA. To test this argument, we drew on an original data set of bill introductions in the House of Representatives between 2011 and 2016. Our analysis suggests that business contributions and political ideology affected the likelihood that House Republicans would introduce measures repealing significant portions of the ACA. A secondary analysis shows that intense policy demanders also shaped the vote on House Republicans' initial ACA replacement plan. These findings highlight the role intense policy demanders can play in shaping the postreform political agenda.
平价医疗法案（ACA）的实施在政治上一直是一个不稳定的过程。ACA 的制度设计和延迟反馈效应为其党派对手在联邦和州一级发起挑战创造了机会。然而，正如最近的研究表明的那样，改革后的政治不仅取决于政策反馈；相反，它是由党派和利益集团环境塑造的。我们认为，“强烈的政策需求者”在确定构成国会共和党人废除和取代 ACA 的政策替代方案方面发挥了重要作用。为了验证这一论点，我们利用了众议院在 2011 年至 2016 年期间提出的法案的原始数据集。我们的分析表明，企业捐款和政治意识形态影响了众议院共和党人提出废除 ACA 重要部分的措施的可能性。二次分析表明，强烈的政策需求者也塑造了众议院共和党人最初的 ACA 替代计划的投票。这些发现强调了强烈的政策需求者在塑造改革后政治议程方面可以发挥的作用。
