298 PART FouR • PolicymAking
Patient Protection and
Affordable Care Act
A law passed in 2010
that seeks, among
other things, to provide
health-care insurance
to all American citizens.
The act, nicknamed
“Obamacare” by
opponents and journalists,
is supplemented by the
Health Care and Education
Reconciliation Act.
Gross Domestic
Product (GDP)
The dollar value of all
final goods and services
produced in a one-year
period.policy transfers income from certain individuals or groups to others, often based on the
belief that these transfers enhance fairness. Social Security is an example. Promotional
policy seeks to foster or discourage various economic or social activities, typically through
subsidies and tax breaks. A tax credit for buying a fuel-efficient car would qualify as pro-
motional. Typically, whenever a policy decision is made, some groups will be better off and
some groups will be hurt. All policymaking generally involves such a dilemma.
In this chapter, we look at domestic policy issues involving health care, immigration,
and energy and the environment. We also examine national economic policies undertaken
by the federal government—for example, the issue of the federal budget deficit. As we
analyze the first of these issues, health care, we take a look at how public policy is made.ThE PolicymAking PRocEss:
hEAlTh cARE As An ExAmPlE
How does any issue get resolved? First, of course, the issue must be identified as a prob-
lem. Often, policymakers have only to open their local newspapers or letters from their
constituents to discover that a problem is brewing. On rare occasions, a crisis—such as
that brought about by the terrorist attacks of September 11, 2001—creates the need to
formulate policy. Like most Americans, however, policymakers receive much of their infor-
mation from the national media. Finally, various lobbying groups provide information to
members of Congress.
No matter how simple or how complex the problem, those who make policy follow a
number of steps. We can divide the process of policymaking into five steps: (1) agenda build-
ing, (2) policy formulation, (3) policy adoption, (4) policy implementation, and (5) policy
evaluation.
The health-care legislation passed in 2010 can be used to illustrate this process.
In March 2010, President Barack Obama signed into law the Patient Protection and
affordable care act, a massive overhaul of the nation’s health-care funding system.
A few days later, Obama signed the Health Care and Education Reconciliation Act, a
series of adjustments to the main legislative package. These two measures constituted
the most important legislative package in the United States between the 2008 and 2010
elections.health care: Agenda Building
First of all, an issue must get on the agenda. In other words, Congress must become aware
that a problem requires congressional action. Agenda building may occur as the result of a
crisis, a technological change, or a mass media campaign, as well as through the efforts of
strong political personalities and effective lobbying groups. To understand how health care
came to be an important issue, and how health-care reform became part of the national
agenda, we need to examine the background of the issue.health care’s Role in the American Economy. Spending for health care is now esti-
mated to account for 17.6 percent of the total U.S. economy. In 1965, about 6 percent of
our national income was spent on health care, but that percentage has been increasing
ever since. Per capita spending on health care is greater in the United States than almost
anywhere else in the world. Measured by the percentage of the gross domestic product
(gDP) devoted to health care, America spends almost twice as much as Britain or Japan.
(The GDP is the dollar value of all final goods and services produced in a one-year period.)LO1: Describe the five steps of
the policymaking process, using
the health-care reform legislation
as an example.
Copyright 2014 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.