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New Policy Elites and the Affordable Care Act: The Making of Long-Term Insiders

Published online by Cambridge University Press:  10 February 2022

WILLIAM GENIEYS ,
MOHAMMAD-SAÏD DARVICHE  and
BRENT EPPERSON
WILLIAM GENIEYS
Affiliation:
Science Po Paris, France
MOHAMMAD-SAÏD DARVICHE
Affiliation:
University of Montpellier, France
BRENT EPPERSON
Affiliation:
University of Montpellier, France
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Abstract

This paper examines the career trajectories of new health policy elites in the American federal government, identifying areas of expertise, partisan alignments, relationships to interest groups, and institutional constraints. We demonstrate that, in both the American and French cases, policy elites who have risen through prestigious educational institutions and undertaken extensive professionalization in government, have in fact developed comparable characteristics that blend broad knowledge of social, institutional, and partisan issues with technical skills. We argue that, benefiting from extensive experience in the back offices of power, deeply entrenched in the health policy sector, and promoting a programmatic reform agenda that reaffirms the regulatory powers of government, the new American health policy elites worked behind the scenes to draft and implement the final ACA legislation. Their ambitious, far-reaching reform effort succeeded where many advocates of comprehensive reform had failed, anchoring the political and institutional framework of the U.S. health care system.

Keywords

Affordable Care Act (ACA)U.S. health care policypolicy elitesDepartment of Health and Human ServicesClinton PlanHHS Strategic Plan
Type
Article
Information
Journal of Policy History , Volume 34 , Issue 1 , January 2022 , pp. 1 - 24
Copyright
© Cambridge University Press 2022

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References

NOTES

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10. This article is based on empirical data collected in the OPERA (Operationalizing Programmatic Elites Research in America) study, funded by the French Agence nationale de la recherche from 2008 to 2012 (ANR-08-BLAN-0032). The project focused on the transformation of the highest levels of U.S. governing structures, particularly in the health sector from 1988 to 2010. The project enabled the creation of a database of 152 detailed biographies and 191 anonymous and semidirective interviews. A second program, Programmatic Action in Times of Austerity: Elites Competition in the Health Sector Governance in the Health Sector in France, Germany, United Kingdom (England), and the US (ProAcTA) 2008–2018 (ANR-17-FRAL-0008-01/DGF BA 1912/3-1) is in progress. In this context, we carried out more than a dozen additional interviews (June 2018 to February 2019) in Washington DC with some key actors in the Patient Protection and Affordable Care Act reform to test the hypothesis developed in this article.

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35. Oberlander, The Public Life of Medicare.

36. Genieys, Gouverner à l’abri des regards, chaps. 4, 5.

37. Darviche et al., “Des ‘long timers’ au sommet de l’État Américain,” 22–26.

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48. OPERA Interview, Washington DC, April 2, 2010.

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56. OPERA Interview, Washington DC, April 28, 2010, 5.

57. OPERA Interview, Washington DC, May 18, 2010.

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