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.

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.

Simon F. Haeder is a doctoral student in political science and a master's student in agricultural and applied economics at the University of Wisconsin-Madison. His research interests include health care policy, regulatory policy making, and theories of the policy process. He is currently working on several research projects in health policy focusing on the implementation of the Affordable Care Act and insurance regulation. He is also investigating the incidence and effect of regulatory lobbying.

California hospital networks are narrower in marketplace than in commercial plans, but access and quality are similar 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.

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.