Robert Saldin's When Bad Policy Makes Good Politics: Running the Numbers of Health Reform reveals how long-term care advocates leveraged the cost estimates from the Congressional Budget Office (CBO) to cajole and steer the Community Living Assistance Service and Support Act (CLASS) through the US Congress's arcane processes and rules. Supporters of CLASS embedded it in the 2010 Patient Protection and Affordable Care Act (ACA). Despite worthy goals, CLASS's policy flaws, particularly its voluntary enrollment and consequent vulnerability to adverse selection, would have rendered it unsustainable. At the same time, and counterintuitively, CLASS's design and financing provided approximately $72 billion in deficit reduction. Saldin argues this “accounting victory” was essential to Congress incorporating and retaining CLASS in the ACA.

Saldin's policy tracing is first-rate and is a core strength of When Bad Policy Makes Good Politics. CLASS was to collect premiums...

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