Implementing the ACA: the Executive, Judicial and Legislative Branches
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The document discusses the separation of powers among the executive, legislative, and judicial branches in the implementation of the Affordable Care Act (ACA). It outlines the roles of various government entities in rulemaking, regulatory processes, and the challenges of legislative reform in relation to the ACA. Additionally, it highlights the influence of interest groups, congressional oversight, and judicial decisions on the policy landscape surrounding the ACA.
Implementing the ACA: the Executive, Judicial and Legislative Branches
- 1. Implementing the ACA: The Executive, Judicial and Legislative Branches Separation of Powers
- 2. Lael Keiser, Associate Professor University of Missouri Justin Dyer, Associate Professor University of Missouri
- 3. Implementation: Continuation of politics • ACA: Difficult to reform legislatively. Federal Executive Branch: - interprets (rulemaking) - applies law (enforcement) State Governments: Medicaid Expansion
- 4. Executive Branch • President (Executive Office of the President) • Political Appointees (Secretary of HHS) • Civil Service
- 5. What is Rulemaking? • Proposal and adoption of regulations by public agencies • Force of law • Quasi legislative
- 6. Creates Public Policy -Federal regulations pre-empt state laws. -Kaiser Family Foundation 2008- 6 regulations could result in $12 billion reduction in federal Medicaid spending.
- 7. Congress Delegated Power in ACA • Mandatory rulemaking provisions (40) 1.Stipulate substance of rules. 2. Whether consultative or rulemaking procedures should be used. 3. Deadlines
- 8. • Discretionary rulemaking provisions 1.Permit but do not require agency to issue rules. 2.Agency Head discretion
- 9. Alternatives to Rulemaking • Interpretative Rules • Policy Statements • ACA also requires HHS to establish programs and procedures but does not specifically mention regulations.
- 10. Where can I find information about rulemaking? • Unified Agenda (published in spring and fall) - regulatory agenda: that describe regulatory actions in development. - regulatory plan: most important significant regulatory action agency reasonably expects to issue in proposed or final form.
- 11. Administrative Procedures Act • Proposed rule published in Federal Register (Part of Unified Agenda) • notice and comment period • Code of Federal Regulations
- 12. What guides rulemaking? • Content - Intent of enabling legislation • Procedures - Administrative Procedures Act - Procedures required by Congress
- 13. Procedural Requirements (determined by Congress) • cost benefit analysis • Negotiated rule-making
- 14. Who pays attention? • Interest groups - business groups and public interest groups • State governments • General Public- depends
- 15. Rulemaking: Separation of Powers in Action President • Political Appointees • Executive Office of the President - Office of Management and Budget
- 16. Congress • Agency Budgets: provisions in agencies’ appropriations bills - prohibitions on the finalization of particular proposed rules - restrictions on certain types of regulatory activity - restrictions on implementation or enforcement
- 17. • Controls authority to write rules • Pass laws to overturn rule • Oversight Hearings: encourage or discourage rules
- 18. • Senate Confirms Political Appointees • Meet with agency officials • Congressional Review Act (1996): - requires submit final rules to Congress and allows for expedited legislative procedures.
- 19. Courts • Any person or group affected by rule can challenge rule in court. • Can overturn rule if - unconstitutional - does not follow congressional intent - appropriate procedure not followed
- 20. Courts • Can Order Agency to Write Rule - example EPA and Green House Gases (MA v. EPA 2007)
- 21. Importance of Interest Groups • Bring cases to courts • Lobby Congress and President • Interact with bureaucracy - informal - notice and comment period
- 22. Responsiveness to Notice and Comment • Susan Web Yackee (2005, 2006) • Do agencies change proposed rule in response to comments? – when comments uniform, 72% chance agency change rule. – when comments not uniform, 37% chance.
- 23. Major Rules in ACA - Established of the Basic Health Program - Disproportionate Share Hospital Payment Reduction. - Requirements for Long-Term Care Facilities - Food Labeling: Nutrition Labeling for Food Sold in Vending Machines - Medicaid, Exchanges, and Children’s Health Insurance Programs.
- 24. Election matters for Future of ACA • Congress (oversight, budgets, confirmations) • President- political appointees to agencies and judicial appointments
- 25. Implications of Court Decisions • Commerce Clause and the ACA’s Insurance Mandate - National Federation of Independent Businesses v. Sebelius (2012) • Preventative Coverage and the Religious Freedom Restoration Act (1993) - Burwell v. Hobby Lobby (2014)