Analysis of Pivotal Politics in Health Care Reforms

In Pivotal Politics Theory, as proposed by Keith Krehbiel, supermajorities are needed to overcome gridlock, which is the downside of simple majority. A supermajority vote is one that includes more than half the vote and is used in the United States congress quite often. Common supermajorities include the two thirds, three fifths, and three quarters vote. A simple majority vote is one that uses the highest number of votes for a given party or candidate, and can be an easy solution to decision making. However, using simple majority often results in two parties casting a filibuster and can lead to gridlock. So, supermajority can be quite helpful since more than half the total amount of voters must approve the piece of legislation being passed. Supermajorities can be a way to get policy out of the gridlock region between the filibuster and veto vote on Krehbiel’s pivotal politics model, whereas simple majority keeps policy stuck in this region.

Supermajorities have been used throughout history in the United States Congress when passing a bill and are a good way to find a balance in policy making in bipartisan coalitions. Healthcare in the United States has been a long debated topic, and during the Clinton presidency, both simple and supermajority were used in devising health care reforms. Clinton’s health care plan drafted in 1993 was a reform proposed by the administration of Clinton and aided by the chair of the task force, First Lady Hillary Clinton. Clinton’s plan was to provide universal healthcare for all Americans through a health care security card that would allow every citizen access to medical treatment regardless of pre-existing conditions. The bill was proposed to the House of Representatives and won by a simple majority vote which was easily won by the democratic majority in the senate. While using simple majority can be an easy and quick way for policy to be passed, it can be dangerous since only half of the total amount of voters must agree upon the terms. This can be especially dangerous if a proposed bill is widely unaccepted by one party, but can still be easily passed by the other.

However, the bill still had to be passed by the senate with a three-fifths super majority vote in order to become a law. The bill was widely opposed by republicans, libertarians, and the health insurance industry; the bill faced enormous backlash from a barrage of advertisements paid for by the pharmaceutical industry. When the senate made their votes, the bill did not pass meaning the status quo would remain the same. Depending on which side of policy people sit at, supermajority voting can be beneficial, or it can shut down a president’s high ambitions for executing their envisions. While it can keep the parties who tend to have polarities in their opinion from implementing destructive bills, it can also keep them from passing bills that will make any real change to policy. In some cases President’s either fail completely to pass a bill or a smaller, less effective bill is passed in place of what was originally intended.

Before Clinton’s plan was proposed, the status quo for the health care policy used in the example below was the Medicare and Medicaid reform in 1965. Until the Clinton plan, these provisions held the most significant overhaul of coverage in the United States healthcare system. Medicare’s primary purpose is to insure Americans sixty five years of age and older, and those with disabilities. Medicaid provides medical care costs for people with limited income. On the pivotal politics graph below, Clinton’s policy is too far from the median voter to get policy to be passed and the status quo remains.

After the initial bill was proposed, the conservatives filibustered and the bill did not pass. So, Clinton’s administration went back to discuss a new proposal that would win sixty votes in the senate. Senator Jay Rockeller argued for expanded coverage for children and pregnant women, and saw child health care as a way to win bipartisan support for a new bill. First Lady Hillary Clinton and Senators Kennedy and Hatch devised a program in 1997 to encourage states to expand access to affordable health care coverage called the Children's Health Insurance Program, or CHIP. This would give states more flexibility to expand Medicaid for children, establish separate CHIP programs, or both. While this plan was not nearly what Clinton originally wanted, it still included the same principles from his earlier plan, and won the votes needed to pass a supermajority in the senate. Since programs are run by individual states, not every state has to offer all of the benefits, but still allows policy to be moved closer to the preferred position.

In the pivotal politics graph below, the status quo is the original Medicaid/Medicare plan, and the new policy is Clinton’s healthcare reform bill after the revisions to include CHIP. Since this new policy is closer to the median voter than the status quo, policy will be passed and moved to the new position. While this new policy is less representative of what the Clinton administration was originally trying to achieve, it is more bipartisan and appeals to the more moderate voters.

Another, more recent example of Pivotal politics, supermajority, and simple majority being used in the healthcare system was in 2010 when the Affordable Healthcare Act, or ACA, was proposed by the Obama Administration. The ACA maintained much of what was outlined in the Medicare and Medicaid programs, but wanted to expand to cover all adults below the poverty line, and generally make the costs of healthcare lower. As part of the bill, an individual mandate was issued to ensure that adverse selection would not take place. When presented to the House of Representatives, a simple majority of 220 members voted to pass the bill moving it to the senate to be voted upon. Once again the House of Representatives has been used to examine how simple majority voting can be an easy solution to decision making, but does not require enough votes to determine whether or not a piece of legislation is fit to become law.

Once the bill was passed in the House, the Republican minority in the senate were determined to filibuster the bill, and sixty votes would be needed to prevent the bill from dying. The democratic party only had fifty eight votes secured, and started negotiating even before the vote took place. After compromising on abortion rules and removing public option from the bill, the democratic party had the sixty votes needed to pass the ACA. The bill passed through a cloture vote with sixty democratic senators approving, thirty nine repiblican senators disproving, and one not voting.

As shown in the example below for the given policy decision previously described the current policy is marked by the status quo and the new policy would make changes to move policy closer to the left.

The bill was still not implemented however, because in 2010 Senator Scott Brown was elected to replace Kennedy giving the republican party the forty first vote they needed to filibuster. The Obama Administration laid out a proposal to consolidate the bill, and would pass in the house to avoid another vote to take place in the senate. They drafted the Health Care and Educational Reconciliation Act as a reconciliation process to amend the ACA. Reconciliation would make the budget for the original bill subject change, which would in turn result in the bill now being able to be implemented with the force Obama intended. However, this was more appealing to conservative parties and was a way around the filibuster. The bill was revoted upon in the house winning 219 votes for a simple majority rule and was signed into law in 2010.

During the Obama Presidency, decisions regarding healthcare involved the use of both simple and majority voting. Simple majority voting proved to be more effective in getting policy passed, especially in this case when the opposing party disliked the proposed bill so extensively. Without a simple majority vote, the ACA may not have been passed at all, even though some of the provisions had to be modified. Majority rule voting shown in this example shows how when two parties have polar opinions on a given subject, a decision can not be made that will fit either preferences and compromises must be made. Supermajority can be quite helpful, however, to the minority party by ensuring a fair voting system where their preferences can still be upheld and met.

In Pivotal Politics theory, supermajorities are used to keep politics out of gridlock and satisfy and large bipartisan union. Simple majority is obviously easier voting rule to meet, and can be good for making quick and easy decisions. It is more beneficial to the party proposing the bill, because it takes a smaller number of people to agree on the terms. Supermajority, on the other hand, is more likely to be favored by the opposing party because it challenges the proposer of the decision to have a larger number of supporters than in simple majority. Supermajority fosters compromise and negotiation to suit the needs of the opposers in order to win their vote, and can be argued to be a more fair system for decision making. However, simple majority allows more meaningful propositions be passed that could have a greater effect than a more moderate decision. There are both positives and negatives to both voting rules, and it is important that congress uses both as a means of checks and balances on the other.