Simon F. Haeder

West Virginia University
Political Science

Department of Political Science
John D. Rockefeller IV School of Policy & Politics
Morgantown, WV
United States
26506
simon.haeder@mail.wvu.edu |  Visit Personal Website


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Simon F. Haeder is an Assistant Professor in the Department of Political Science in the John D. Rockefeller IV School of Policy & Politics at West Virginia University. His teaching and research interests include the public policymaking process, regulatory politics, lobbying and interest group politics, and healthcare policy. His most recent work has been published in the American Political Science Review, Health Affairs, the Journal of the American Medical Association, and the Journal of Health Politics, Policy and Law.

Citation:
Rocco, Phillip and Simon F. Haeder. 2018. “How Intense Policy Demanders Shape Post-Reform Politics: Evidence from the Affordable Care Act.” Journal of Health Politics, Policy and Law 43(2).
Abstract: The implementation of the Patient Protection and Affordable Care Act (ACA) has been a politically volatile process. The ACA’s institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, post-enactment politics depends on more than policy feedback alone. Rather, it is shaped by the partisan and interest-group environment (Weir 2006; Maltzman and Shipan 2008; Berry et al. 2010). Building on the work of Bawn et al. (2012), we argue that “intense policy demanders” played an important role in defining the policy alternatives that comprised congressional Republicans’ efforts to “repeal and replace” the ACA. To test this argument, we draw on an original dataset of bill introductions in the House of Representatives between 2011 and 2016. Our analysis suggests that business contributions and political ideology affected the likelihood that House Republicans would introduce measures repealing significant portions of the ACA. A secondary analysis shows that intense policy demanders also shaped the vote on House Republicans’ initial ACA replacement plan. These findings highlight the role intense policy demanders can play in shaping the post-reform political agenda.
Citation:
Haeder, Simon F., David L. Weimer, and Dana B. Mukamel. 2016. "Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans." Health Affairs 35 (7):1160-1166.
Abstract: The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? We conducted a “secret shopper” survey of 743 primary care providers from five of California’s nineteen insurance Marketplace pricing regions in the summer of 2015. Our findings indicate that obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate. Problems accessing services for patients with acute conditions were particularly troubling. Effectively addressing issues of network adequacy requires more accurate provider information.
URL: http://content.healthaffairs.org/content/35/7/1160.abstract
Citation:
Haeder, Simon F. and Susan Webb Yackee. 2015. “Influence and the Administrative Process: Lobbying the U.S. President's Office of Management and Budget.” American Political Science Review 109 (3):507–522.
Abstract: All administrative processes contain points of entry for politics, and the U.S. president's use of the Office of Management and Budget (OMB) to review government regulations is no exception. Specifically, OMB review can open up a pathway for interest groups to lobby for policy change. We theorize that interest group lobbying can be influential during OMB review, especially when there is consensus across groups. We use a selection model to test our argument with more than 1,500 regulations written by federal agencies that were subjected to OMB review. We find that lobbying is associated with change during OMB review. We also demonstrate that, when only business groups lobby, we are more likely to see rule change; however, the same is not true for public interest groups. We supplement these results with illustrative examples suggesting that interest groups can, at times, use OMB review to influence the content of legally binding government regulations.
URL: http://journals.cambridge.org/action/displayAbstract?aid=9894779&fileId=S0003055415000246
Citation:
Haeder, Simon F., David L. Weimer, and Dana B. Mukamel. 2015. “California Marketplace Hospital Networks Are Narrower Than Commercial Plans, But Access And Quality Are Comparable.” Health Affairs 34 (5):741–748.
Abstract: Do insurance plans offered through the Marketplace implemented by the State of California under the Affordable Care Act restrict consumers’ access to hospitals relative to plans offered on the commercial market? And are the hospitals included in Marketplace networks of lower quality compared to those included in the commercial plans? To answer these questions, we analyzed differences in hospital networks across similar plan types offered both in the Marketplace and commercially, by region and insurer. We found that the common belief that Marketplace plans have narrower networks than their commercial counterparts appears empirically valid. However, there does not appear to be a substantive difference in geographic access as measured by the percentage of people residing in at least one hospital market area. More surprisingly, depending on the measure of hospital quality employed, the Marketplace plans have networks with comparable or even higher average quality than the networks of their commercial counterparts.
URL: http://content.healthaffairs.org/content/34/5/741.abstract
Citation:
Haeder, Simon F. and David L. Weimer. 2015. “Inching towards Universal Coverage: State-Federal Healthcare Programs in Historical Perspective.” Journal of Policy History 27 (3):746–770.
Abstract: Much has been written in the popular press and academic journals about the Affordable Care Act (ACA). It has been characterized by its supporters as the biggest expansion of coverage since the Great Society, and by its detractors as government overreach and socialism. Even after the president’ signature, a favorable Supreme Court verdict, and the president’s reelection, opposition to the ACA, almost exclusively confined to Republicans, has shown few signs of abating. Unfortunately, the often shallow public debate about the ACA largely ignores the historical context of the American grant-in-aid system, its evolutionary nature, and its crucial role in expanding access to healthcare. We seek to remedy this lack of context by providing an overview of the development of the U.S. grant system, focused on healthcare-related programs, from the earliest days of the Republic to the ACA. We argue that much of relevance to understanding the current controversy and predicting how it will play out over time can be learned from this history. It follows a large number of works assessing the development of the American welfare state. However, it significantly differs from previous works by focusing exclusively on programs of shared governance, i.e. programs jointly implemented and administered by federal and state governments. Additionally, it differs in its emphasis by exclusively focusing on healthcare-related programs.
URL: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9914748&fulltextType=RA&fileId=S0898030615000330
Citation:
Haeder, Simon F., David L. Weimer, and Dana B. Mukamel. 2015. “Narrow Networks and the Affordable Care Act.” The Journal of the American Medical Association 314 (7):669-670.
Abstract: Much has been written about the Affordable Care Act (ACA) in the 5 years since its inception, both in scholarly journals and the popular press. Initial interest focused on states’ decisions about whether to implement their own insurance marketplaces and accept Medicaid expansion.1 There were countless accounts of dismal enrollment experiences marred by technical glitches during the initial enrollment period in late 2013 and early 2014.1 With implementation issues settled by the Supreme Court, and state and federal websites much improved, attention has recently turned to the operational aspects of the insurance markets. In particular, concerns have been increasing about the often limited hospital and physician networks offered by insurance plans sold in the marketplaces.
URL: http://jama.jamanetwork.com/article.aspx?articleid=2367284
Citation:
Haeder, Simon F., David L. Weimer, and Dana B. Mukamel. 2015. “Narrow Networks and the Affordable Care Act.” The Journal of the American Medical Association 314 (7):669-670.
Abstract: Much has been written about the Affordable Care Act (ACA) in the 5 years since its inception, both in scholarly journals and the popular press. Initial interest focused on states’ decisions about whether to implement their own insurance marketplaces and accept Medicaid expansion.1 There were countless accounts of dismal enrollment experiences marred by technical glitches during the initial enrollment period in late 2013 and early 2014.1 With implementation issues settled by the Supreme Court, and state and federal websites much improved, attention has recently turned to the operational aspects of the insurance markets. In particular, concerns have been increasing about the often limited hospital and physician networks offered by insurance plans sold in the marketplaces.
URL: http://jama.jamanetwork.com/article.aspx?articleid=2367284
Citation:
Haeder, Simon F. and David L. Weimer. 2015. “You Can't Make Me Do It; But I Can Be Persuaded: A Federalism Perspective on the Affordable Care Act.” Journal of Health Politics; Policy and Law. 40 (2):281–323.
Abstract: The Affordable Care Act (ACA) seeks to change fundamentally the US health care system. The responses of states have been diverse and changing. What explains these diverse and dynamic responses? We examine the decision making of states concerning the creation of Pre-Existing Condition Insurance Plan programs and insurance marketplaces and the expansion of Medicaid in historical context. This frames our analysis and its implications for future health reform in broader perspective by identifying a number of characteristics of state-federal grants programs: (1) slow and uneven implementation; (2) wide variation across states; (3) accommodation by the federal government; (4) ideological conflict; (5) state response to incentives; (6) incomplete take-up rates of eligible individuals; and (7) programs as stepping-stones and wedges. Assessing the implementation of the three main components of the ACA, we find that partisanship exerts significant influence, yet less so in the case of Medicaid expansion. Moreover, factors specific to the insurance market also play an important role. Finally, we conclude by applying the themes to the ACA and offer an outlook for its continuing implementation. Specifically, we expect a gradual move toward universal state participation in the ACA, especially with respect to Medicaid expansion.
URL: http://jhppl.dukejournals.org/content/early/2015/01/22/03616878-2882219.abstract
Citation:
Haeder, Simon F. 2014. “Balancing Adequacy and Affordability? Essential Health Benefits under the Affordable Care Act.” Health Policy 118 (2):285–291.
Abstract: The Essential Health Benefits provisions under the Affordable Care Act require that eligible plans provide coverage for certain broadly defined service categories, limit consumer cost-sharing, and meet certain actuarial value requirements. Although the Department of Health and Human Services (HHS) was tasked with the regulatory development of these EHB under the ACA, the department quickly devolved this task to the states. Not surprisingly, states fully exploited the leeway provided by HHS, and state decision processes and outcomes differed widely. However, none of the states took advantage of the opportunity to restructure fundamentally their health insurance markets, and only a very limited number of states actually included sophisticated policy expertise in their decisionmaking processes. As a result, and despite a major expansion of coverage, the status quo ex ante in state insurance markets was largely perpetuated. Decisionmaking for the 2016 revisions should be transparent, included a wide variety of stakeholders and policy experts, and focus on balancing adequacy and affordability. However, the 2016 revisions provide an opportunity to address these previous shortcomings.
URL: http://www.healthpolicyjrnl.com/article/S0168-8510(14)00260-7/abstract
Citation:
Mukamel, Dana B., Simon F. Haeder, and David L. Weimer. 2014. "Top-Down and Bottom-up Approaches to Health Care Quality: The Impacts of Regulation and Report Cards." Annual Review of Public Health 35 (1).
Abstract: The high cost of the US health care system does not buy uniformly high quality of care. Concern about low quality has prompted two major types of public policy responses: regulation, a top-down approach, and report cards, a bottom-up approach. Each can result in either functional provider responses, which increase quality, or dysfunctional responses, which may lower quality. What do we know about the impacts of these two policy approaches to quality? To answer this question, we review the extant literature on regulation and report cards. We find evidence of both functional and dysfunctional effects. In addition, we identify the areas in which additional research would most likely be valuable. Expected final online publication date for the Annual Review of Public Health Volume 35 is March 18, 2014.
URL: http://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-082313-115826
Citation:
Haeder, Simon F. 2013. "Making the Affordable Care Act Work: High-Risk Pools and Health Insurance Marketplaces." The Forum 11 (3):499-511.
Abstract: As the Affordable Care Act is likely to persist, we should shift our attention toward actually making it work. However, this may be even more challenging than overcoming the initial political opposition. One of the most daunting problems is to make fifty-one insurance exchanges (marketplaces)1 across the country into viable, self-sufficient, and effective entities. Consumer demographics pose a significant challenge to these marketplaces, one that may lead to their demise. Ultimately, it may be prudent to continue high-risk pools as a supplement to marketplaces in order to offer lower premiums in the marketplaces and provide an opportunity for learning. This strategy could be made acceptable to both Republicans and Democrats.
URL: http://www.degruyter.com/view/j/for.2013.11.issue-3/for-2013-0056/for-2013-0056.xml
Citation:
Haeder, Simon F., and David L. Weimer. 2013. "You Can't Make Me Do It: State Implementation of Insurance Exchanges under the Affordable Care Act." Public Administration Review 73 (1):S34-S47.
Abstract: The Patient Protection and Affordable Care Act (ACA) of 2010 has been one of the most controversial laws in decades. The ACA relies extensively on the cooperation of states for its implementation, offering opportunities for both local adaptation and political roadblocks. Health insurance exchanges are one of the most important components of the ACA for achieving its goal of near-universal coverage. Despite significant financial support from the federal government, many governors and legislatures have taken actions that have blocked or delayed significant progress in developing their exchanges. However, many state commissioners of insurance have played constructive roles in moving states forward in exchange planning through their expertise, leadership, and pragmatism, sometimes in spite of strong political opposition to the ACA from governors and legislatures.
URL: http://dx.doi.org/10.1111/puar.12065
Citation:
Haeder, Simon F. 2012. "Beyond Path Dependence: Explaining Healthcare Reform and Its Consequences." Policy Studies Journal 40 (1):65-86.
Abstract: This essay reviews recent developments in the field of health policy. It identifies a variety of frameworks brought forward to explain the enactment of health reform, including pivotal politics, path dependence, and multiple streams. It further identifies various challenges for the implementation of reform with a particular focus on state–federal relations and cost containment.
URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1541-0072.2012.00446.x/full
DOI: 10.1111/j.1541-0072.2012.00446.x

Substantive Focus:
Governance
Health Policy PRIMARY
Social Policy SECONDARY

Theoretical Focus:
Policy History
Policy Process Theory SECONDARY
Agenda-Setting, Adoption, and Implementation
Policy Analysis and Evaluation PRIMARY

Keywords

REGULATION HEALTH POLICY INSURANCE POLICY PROCESS EXPERTISE