Breaking Gridlock

The Determinants of Health Policy Change in Congress

Over the years, scholars have assessed key health policy proposals and their successes or failures in great detail, including the failed Clinton health plan of the early 1990s. But any lessons learned from such individual assessments are bound to be narrowly drawn ones.

The authors of this study took on a broad approach and examined all health policy bills introduced in the House of Representatives between 1973 and 2002. They compared 9,740 health policy bills with 109,300 bills not dealing with health to determine if health policy-making is different and perhaps more susceptible to gridlock.

They tested their hypotheses and found quantitatively that, compared to other proposals, health policy proposals are:

  • Less likely to pass through Congress and become law.
  • Especially subject to policy gridlock from committee structures and bicameralism.
  • More likely to be raised by extremists rather than centrists.
  • More likely to achieve legislative success if there is strong majority party and committee leadership support, substantial involvement from policy entrepreneurs, bipartisan support from moderates, backing by extensive expertise, and arising from state experiences.

They offer that “this work may serve as a lens through which to examine the numerous bills that will undoubtedly follow on the heels of recent reforms.”