Ensuring equity and sustainability: Government's role in health care

In late 2025, Congress fumbled the Affordable Care Act, failing to move a modest stabilization bill through its own procedures and leaving insurers and families facing renewed uncertainty. As the Congressional Budget Office has warned in multiple analyses over the past decade, policy uncertainty increases premiums and reduces insurer participation (see, for example: https://www.cbo.gov/publication/61734). I examined this episode in an earlier Fulcrum article, “Governing by Breakdown: The Cost of Congressional Paralysis,” as a case study in congressional paralysis and leadership failure. The deeper problem, however, runs beyond any single deadline or decision and into the incentives and procedures that now structure congressional authority. Polarization has become so embedded in America’s governing institutions themselves that it shapes how power is exercised and why even routine governance now breaks down.

From Episode to System

The ACA episode wasn’t an anomaly but a symptom. Recent scholarship suggests it reflects a broader structural shift in how Congress operates. In a 2025 academic article available on the Social Science Research Network (SSRN), political scientist Dmitrii Lebedev reaches a stark conclusion about the current Congress, noting that the 118th Congress enacted fewer major laws than any in the modern era despite facing multiple time-sensitive policy deadlines (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5346916). Drawing on legislative data, he finds that dysfunction is no longer best understood as partisan gridlock alone. Instead, Congress increasingly exhibits a breakdown of institutional capacity within the governing majority itself. Leadership avoidance, procedural delay, and the erosion of governing norms have become routine features of legislative life rather than temporary responses to crisis.