Federalism, State Politics, and the Affordable Care Act
Daniel Béland, Philip Rocco, & Alex Waddan
Not five minutes after the Affordable Care Act (ACA) was signed into law, in March 2010, Virginia’s attorney general was suing to stop it. And yet, the ACA rolled out, in infamously bumpy fashion, and rolled on, fought and defended at every turn—despite President Obama’s claim, in 2014, that its proponents and opponents could finally “stop fighting old political battles that keep us gridlocked.” But not only would the battles not stop, as Obamacare Wars makes acutely clear, they spread from Washington, DC, to a variety of new arenas. The first thorough account of the implementation of the ACA, this book reveals the fissures the act exposed in the American federal system.
Obamacare Wars shows how the law’s intergovernmental structure, which entails the participation of both the federal government and the states, has deeply shaped the politics of implementation. Focusing on the creation of insurance exchanges, the expansion of Medicaid, and execution of regulatory reforms, Daniel Béland, Philip Rocco, and Alex Waddan examine how opponents of the ACA fought back against its implementation. They also explain why opponents of the law were successful in some efforts and not in others—and not necessarily in a seemingly predictable red vs. blue pattern. Their work identifies the role of policy legacies, institutional fragmentation, and public sentiments in each instance as states grappled with new institutions, as in the case of the exchanges, or existing structures, in Medicaid and regulatory reform.
“A rich and detailed account of how the federal government and the states bargained over the implementation of the ACA. The book illustrates the value of a detailed empirical case study. It is an important contribution to the field of policy implementation and the politics of health policy.”
—Political Science Quarterly
“Béland, Rocco, and Waddan contribute significantly to our understanding of implementation in federal systems by demonstrating convincingly that the politics and strategies of implementing this single piece of health care reform legislation in the American states were myriad and a function not only of partisan polarization but also of the diverse policy issues embedded within the law.”
—Journal of PoliticsSee all reviews...
“Obamacare Wars provides insight into policy and program implementation of a complex and politically contentious law. . . . The strength of the work is that it takes previous theory on implementation, adds to it and applies it to the implementation of the ACA. The results help explain how and why health care reform has been unevenly enacted across the states.”
—Publius: The Journal of Federalism
“Timely, thoughtful, and clearly written, Obamacare Warsoffers penetrating insights into how policy legacies, institutional fragmentation, and public sentiments shape post-reform politics.”
—Eric M. Patashnik, author ofReforms at Risk: What Happens After Major Policy Changes Are Enacted
“Ideal for both graduate and undergraduate courses, as well as law, business, and public health programs, the book should be read by anyone trying to understand the post-enactment struggles that have resulted in millions of Americans obtaining new coverage—and millions more waiting for it as their state leaders resist federal intentions.”
—Jacob S. Hacker, author of Winner-Take-All Politics: How Washington Made the Rich Richer—and Turned Its Back on the Middle Class
“Drawing on and arguing with much of what is written about American federalism and health politics, Obamacare Wars makes sense of an intricate and disputed law and sheds new light on the workings, and costs, of American federalism.”
—Scott L. Greer, author of Territorial Politics and Health Policy
“Obamacare Wars offers a deft, timely analysis of state-level battles over the implementation of the Affordable Care Act.This book is an essential read for anyone interested in health policy, federalism, and the political conflicts engendered by both.”
—Kimberly J. Morgan, coauthor of The Delegated Welfare State: Medicare, Markets, and the Governance of Social Policy
“This exceptional book by three leading policy experts tells the fascinating story of the implementation of Obamacare and the myriad ways this landmark legislation is remaking the health care system in the U.S.”
—Jill Quadagno, author of One Nation, Uninsured: Why the U.S. Has No National Health InsuranceSee fewer reviews...
Looking broadly at national trends and specifically at the experience of individual states, Obamacare Wars brings much-needed clarity to highly controversial but little-understood aspects of the Affordable Care Act’s odyssey, with implications for how we understand the future trajectory of health reform, as well as the multiple forms of federalism in American politics.