Weekly Checkup

Why the Process of Policymaking Matters

This week is my last at the American Action Forum (AAF), and thus, this is my last Weekly Checkup—though certainly not the last Weekly Checkup. After nearly a decade at AAF, a full 16 years working in and around health policy in D.C., and over four years writing the Weekly Checkup, this week’s column is an opportunity for me to reflect on the trajectory of health policy, and policymaking more broadly. In short, I see a concerning trend toward seeking policy wins at all costs.

Policymaking is inextricably linked to politics, and there is no denying that both can look more like blood sport than governing at times. Even in war, there are rules and retroactive accountability in the form of tribunals, but as in real war, the more we think about our politics as combat, the less the rules seem to matter in the heat of battle. When every disagreement is cast as a matter of life and death, when every policy debate is framed as an existential crisis, quibbling over process seems pedantic. Who cares how we achieve a policy objective? It’s the policy itself that matters most! 

The argument that policy outcomes matter more than the process used to achieve them might sound sensible, but another way to express that sentiment is to say that the ends always justify the means. The problems with legislating and governing using an “ends justify the means” approach are myriad, but here are two. 

First, when individual policy objectives trump process, trust is eroded. Trust in the process of lawmaking is crucial in a society as diverse and fragmented as ours. America’s diversity has historically been held up as one of our strengths, but diversity also brings conflict, and conflict requires resolution. President James Buchanan is said to have referred to the Senate as the world’s greatest deliberative body. No one would seriously make that assertion today, but that is in fact the role we need Congress to play if all Americans are to feel invested in our society and confident in our institutions. The absence of trust in the processes by which we govern ourselves—be they legislative, regulatory, judicial, or electoral—will unavoidably lead to fragmentation, anger, and eventually violence. We’ve already seen this. 

Second, if specific policy outcomes are the most important thing, and the process for achieving them is secondary, we will—and already do—see increasing reliance on short cuts. Take, for example, the budget reconciliation process, which was originally developed to insulate difficult spending-reform decisions from political pressures. Today, Congress has increasingly turned the budget-control tool into a brute-force policymaking weapon used to jam partisan legislation through the Senate. Similarly, we see an increasing reliance on executive action to make policy—with Congress’ active consent—because this way is quicker and easier. This “pen and phone” policymaking, as former President Obama christened it, through regulatory and enforcement powers has its own problems. In addition to leaving opponents out of the process, policy made through executive fiat is intrinsically fragile. Anything one administration can do through executive action can be reversed by the next. As the political whims of the executive branch swing wildly from election to election (Bush, Clinton, Bush, Obama, Trump, Biden), an unstable regulatory environment emerges in which people and businesses don’t know quite what to expect from one year to the next, making long-term planning impossible and impeding economic growth.  

In health care policy discussions now, there is increasing chatter about what will happen when the American Recovery Plan Act’s enhanced premium tax credits expire. A short-term policy and political win, accomplished through budget reconciliation, the credits are set to terminate after two years with Americans getting the bad news right before an election. The result will likely produce bad political outcomes for the very politicians who pushed the credits through in the first place. 

This is admittedly a simplistic summation of nuanced issues, but the argument is simple: process matters. A healthy, consistent, trustworthy policymaking process matters more in the long run than any single policy. Good process, more often than not, will lead to better, more considered policy outcomes. Trust in institutions is eroding, and there are short-term political and even policy wins to be had furthering that erosion. The long-term result, however, won’t leave any winners

Chart Review: Average Subsidized Premiums, 2022-2032

Jackson Hammond, Health Care Policy Analyst

Last week, the American Action Forum’s  Center for Health and Economy  (H&E) published its  annual baseline estimates, which include 10-year projections of health insurance coverage, federal budgetary impacts, plan choice, and premiums for Americans under the age of 65, based on current law. As health care costs continue to grow, H&E estimates that individual market premiums in Platinum and Gold plans will grow, while Silver plans will stay relatively stable and Bronze plans will decrease, as the chart below demonstrates. It should be noted that in 2022, there is no income cap on Affordable Care Act subsidy eligibility, leading to artificially low premiums this year that are expected to increase across all categories except for Bronze plans.

Average Subsized Premiums, Individual Market


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