Designing policy resilience: lessons from the Affordable Care Act

Public policies are the products of political conflict, constituted by mixes of diverse tools and instruments intended to achieve multiple goals that may change over time and not always be internally consistent or coherent. Recent studies dealing with policy robustness and resilience have theorized about the temporal development of mixes of policy instruments and the need to ensure consistency and coherence over time, yet they have generally failed to develop these insights into lessons for policymakers and practitioners. Drawing on evidence from the implementation of the Patient Protection and Affordable Care Act (ACA) in the USA, this paper examines the relationship between policy mixes and policy resilience or the ability of a policy to withstand challenges to its elements and to remain effective over time, even when deliberate efforts are made to alter, adapt, or repeal all or part of its original content or intention. Although the ACA is at an early stage in its history, it provides many lessons about how, and how not, to design complex policy mixes that can survive determined political opposition.