The Administrative Presidency, Waivers, and the Affordable Care Act
The Administrative Presidency, Waivers, and the Affordable Care Act
复制标题
DOI：
10.1215/03616878-8255553
复制
发表时间：
2020-08-01
影响因子：
4.2
通讯作者：
Thompson, Frank J.
中科院分区：
文献类型：
--
作者：
Gusmano, Michael K.;Thompson, Frank J.
在美国各机构分享权力的体系中，行政部门相对于国会发挥着越来越重要的政策作用。行政部门行使的巨大行政自由裁量权提升了总统的权力。共和党和民主党总统都使用了大量的行政工具来实现他们的政策目标：高层任命、行政规则制定、行政命令、公告、备忘录、指导文件、指示、亲爱的同事信、签署声明、重组、资金决定等等。奥巴马总统和特朗普总统利用了这些工具中的大部分，以努力塑造平价医疗法案(ACA)在最初十年的实施和结果。本文的重点是奥巴马和特朗普政府利用全面豁免来影响ACA的实施。奥巴马政府使用豁免说服共和党州扩大医疗补助计划的成功与否参差不齐。与奥巴马相比，特朗普政府发现通过豁免来实现其政策目标更加困难，但如果法院支持特朗普政府的工作要求和1332项豁免倡议，这将使总统能够利用豁免来实现更广泛的目标，包括削减计划。
Within the American system of shared power among institutions, the executive branch has played an increasingly prominent policy role relative to Congress. The vast administrative discretion wielded by the executive branch has elevated the power of the president. Republican and Democratic presidents alike have employed an arsenal of administrative tools to pursue their policy goals: high-level appointments, administrative rule making, executive orders, proclamations, memoranda, guidance documents, directives, dear colleague letters, signing statements, reorganizations, funding decisions, and more. Presidents Obama and Trump employed most of these tools in an effort to shape the implementation and outcomes of the Affordable Care Act (ACA) during its first decade. This article focuses on the Obama and Trump administrations' use of comprehensive waivers to shape ACA implementation. The Obama administration had mixed success using waivers to convince Republican states to expand Medicaid. Compared to Obama, theTrump administration has found it harder to accomplish its policy goals through waivers, but if the courts support the Trump administration's work requirement and 1332 waiver initiatives, it would enable the president to use waivers to achieve an ever broader set of goals, including program retrenchment.