Policy Design and Democratic Accountability

Andrea Louise Campbell

Journal of Health Politics, Policy and Law2026https://doi.org/10.1215/03616878-12461739article
ABDC A
Weight
0.50

Abstract

The One Big Beautiful Bill Act of 2025 extends the 2017 federal tax cuts, with most benefits going to the top of the income spectrum while cutting social programs for lower- and middle-income households including Medicaid, Medicare, provisions of the Affordable Care Act, and SNAP. An open question is whether Republican candidates will suffer electoral punishment as a result, or whether the cuts are hidden enough for the GOP to escape electoral retribution. The OBBBA uses strategic policy design to cut social policy spending in submerged, invisible ways by taking advantage of delegation to states and to private insurers and by increasing administrative burden rather than making overt eligibility or benefit reductions. An examination of previous social policy retrenchment efforts suggests that the OBBBA has more in common with the 1996 welfare reform, which retrenched through heightened administrative burdens and real declines in funding, than it does with more overt and unsuccessful retrenchment attempts, such as cuts to Social Security in the 1980s and the 2017 ACA repeal and replace effort, whose visibility resulted in policymaker backtracking and electoral retribution. Hidden policy designs can defang opposition, diminishing democratic voice.

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https://doi.org/https://doi.org/10.1215/03616878-12461739

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@article{andrea2026,
  title        = {{Policy Design and Democratic Accountability}},
  author       = {Andrea Louise Campbell},
  journal      = {Journal of Health Politics, Policy and Law},
  year         = {2026},
  doi          = {https://doi.org/https://doi.org/10.1215/03616878-12461739},
}

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Evidence weight

0.50

Balanced mode · F 0.40 / M 0.15 / V 0.05 / R 0.40

F · citation impact0.50 × 0.4 = 0.20
M · momentum0.50 × 0.15 = 0.07
V · venue signal0.50 × 0.05 = 0.03
R · text relevance †0.50 × 0.4 = 0.20

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