Bureacracies tend to be bad at new things, get better over time if given stable goals. That's what has happened with the ACA. Huge new task, bad rollout, but learning led to improvement. But hard to get better if org leaders want policy to fail & actively create problems 1/
This is one basic difference between public and private organizations. Sometimes public organizations are led by people who oppose the underlying mission. As Terry Moe has put it, public orgs rely on political rationality, not technical rationality 2/
There are some basic norms about how far executive branch political leadership can undermine public goals. Basically, you can't violate statutory goals. But that is precisely what Trump admin has been doing with ACA 3/
Good summary of Trump admin efforts to sabotage the ACA here. Highlights: gut outreaching funding thereby increasing confusion and learning costs, reduce time for signing-up, block staff from participating in outreach, passing rules that increase costs 4/
cbpp.org/sabotage-watch…
cbpp.org/sabotage-watch…
Trump admin has increased compliance costs by encouraging work requirements to get health insurance, passing new rules that would increase likelihood of bad insurance plans, which also increase learning costs 5/ 
Constitutional protection against executive branch deliberately screwing up policy implementation is Congressional oversight. But GOP Congress supports undermining ACA, so no oversight. At the same time, unable to legislate a better alternative. Hence, #dysfunctionbydesign 6/
The other constitutional protection is to go to the courts. Here again, executive branch actions matters a lot. DoJ refuses to defend the constitutionality of the ACA. CMS is selectively responding to court decisions to further undermine ACA 7/
The point of all of this: ACA is actually popular and Trump & GOP failed to overturn it b/c its politically costly to do so. Instead, they seek to undermine law of the land it through opaque executive actions that increase #administrativeburdens on citizens. 8/
People will become frustrated with confusing & onerous administrative processes so health insurance. They will blame government. This is a central part of a #dysfunctionbydesign strategy. Make government so ineffectual that it undercuts faith that govt can do anything 9/
There is an old joke about Republicans saying government is ineffective, and then working to prove that point once they are in power. In the case of the ACA, its a pretty accurate description of their approach to governing. 10/
Members of the executive branch take an oath to uphold the constitution. Using their discretion to undermine the law runs contrary to that oath. But that is precisely what the Trump admin has been doing with the ACA. Its a strategy of #dysfunctionbydesign. Fin 11/
How is the Trump admin using executive authority to relitigate its failure to overturn the ACA? @sangerkatz counts the ways nytimes.com/interactive/20…
