Policy drift and its reversal: The case of prescription drug coverage in the United States

AuthorIlana Shpaizman
Date01 September 2017
Published date01 September 2017
Policy drift and its reversal: The case of
prescription drug coverage in the United States
Ilana Shpaizman
Federmann School of Public Policy and
Government, Hebrew University of Jerusalem,
Ilana Shpaizman, Federmann School of Public
Policy and Government, Hebrew University of
Jerusalem, Mount Scopus, Jerusalem 91905,
Email: ilana.shpaizman@mail.huji.ac.il
Policy drift occurs when actors block attempts to adjust policies to
changing realities, thereby changing policy impact. We know much
about the conditions for policy drifting, but lack theorization of
the conditions for reversing the drift by updating the policy. This
article examines when and how actors favouring drift decide to
reverse it. These actors have different characteristics from those
favouring policy update. Based on the case of prescription drug
coverage in the US, the article argues that actors promote drift
reversal when maintaining the current drift becomes politically
risky. Even then, they will act only when able to limit the scope of
the reversal. In addition, in order to implement the policy update,
actors will use blame avoidance strategies to gain the support of
their constituency and soften opposition.
To remain relevant, policies must be constantly adjusted to changes in their environment. Otherwise, they may be
subject to drift, defined as change in policy impact without significant policy change. Drift occurs when actors take
advantage of veto points in the political process to maintain the policys stability despite changes in its real-life con-
text (Hacker 2004a).
Drift focuses attention on change in the status quo that takes place through inaction. It also transforms the way
we examine policy, revealing that nothing is automatic and straightforward about policy update and that stability can
conceal significant political struggle. Moreover, in the last couple of decades, drift has become prominent worldwide
due to rapid socioeconomic changes and growing political polarization and instability; both have expanded the possi-
bilities for policy drift and the range of policies that can be subject to it (Hacker et al. 2015). Lastly, the fact that poli-
cies are not updated due to drift has major societal consequences, such as growing social risks (Hacker 2004a).
Research has thoroughly examined the conditions for drift and its consequences (Hacker 2004a; Gildiner 2007;
Hacker et al. 2015). However, to date, we lack sufficient theorization of the conditions for its reversal for breaking
the stalemate and adjusting policy to narrow the gap with reality (Béland et al. 2016), inter alia, because drift rever-
sal is rare due to the high status quo bias enabling it in the first place.
When we think about drift reversal, what usually comes to mind are situations in which actors finally manage
to update a policy after much effort; one example is the Affordable Care Act (ACA) (Hacker 2010; Béland
DOI: 10.1111/padm.12315
698 © 2017 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/padm Public Administration. 2017;95:698712.

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