JHPPL ACA Symposium Paper.pdf (538.64 kB)

The Affordable Care Act in the States: Fragmented Politics, Unstable Policy

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journal contribution
posted on 08.04.2020, 16:16 by Daniel Beland, Philip Rocco, Alexander Waddan
Many argue that the frustrated implementation of the 2010 Affordable Care Act (ACA) stems from the unprecedented level of political polarization that has surrounded the legislation. This article draws attention to the law's "institutional DNA" as a source of political struggle in the 50 states. As designed, in the context of US federalism, the law fractured authority in ways that has opened up the possibility of contestation and confusion. The successful implementation of the ACA varies not only across state lines but also across the various components of the law. In particular, opponents of the ACA have experienced their greatest successes when they could take advantage of weak preexisting policy legacies, high levels of institutional fragmentation, and negative public sentiments. As argued in this article, the fragmented patterns of health care politics in the 50 states identified in previous research have largely persisted during the Trump administration. Moreover, while Republicans were unsuccessful at repealing the legislation, the administration has taken advantage of its structural deficiencies to further weaken the legislation's capacity to expand access to affordable, quality health insurance.

History

Citation

Journal of Health Politics, Policy and Law, 2020, Vol. 45, No. 4

Author affiliation

Politics and International Relations

Version

AM (Accepted Manuscript)

Published in

Journal of Health Politics, Policy and Law

Volume

45

Issue

4

Publisher

Duke University Press

Acceptance date

01/11/2019

Copyright date

2020

Available date

11/03/2020

Publisher version

https://doi.org/10.1215/03616878-8255565

Language

en

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