Clintoncare and Obamacare: Lessons for Gridlock Theory

Abstract

The passage of the Affordable Care Act (ACA) in 2010 marked a significant achievement for congressional health reform. Despite increased partisanship, decreased productivity, and increased polarization of Congress, major health reform legislation was passed. We compare the ACA’s passage to the failure of Clinton-era health reform, emphasizing gridlock theory, which some scholars interpreted to predict that major health reform would not be possible in 2010. We identify several ways in which the different outcomes for the ACA and the Clinton reform effort can be explained by gridlock theory: pivotal actors, the gridlock window, and the status quo. However, factors not included in gridlock theory, such as the role of parties and institutional change, appear to also have contributed to the success of the ACA relative to the failure of Clinton health reform. Lessons learned from health reform suggest an opportunity to expand gridlock theory to account for these additional factors.