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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. 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.
After a great deal of discussion and debate across all levels of government, President Obama signed the Affordable Care Act (ACA) into law in March 2010. Since President Trump's election into office, the ACA has stayed in the headlines. Trump has continued to call for the replacement and repeal of the ACA, and several efforts have spawned in both the House and the Senate to accomplish this goal. Unlike welfare reform, which was generally embraced by all states, the ACA has proven very divisive in some states, with some states actively seeking to block implementation. Alternative solutions continue to prove elusive. To better understand the major factors driving decision-making process and state-level dynamics influencing state support or opposition of the ACA, this book examines the initial implementation through established support and opposition factors across four states: Alabama, Michigan, California, and New Hampshire. The choices made by states are a direct consequence of long-term forces, and the choices made at the national level. State Politics and the Affordable Care Act will be of interest to scholars researching in public administration, policy formulation and implementation, and policy analysis.
Jonathan Cohn's The Ten Year War is the definitive account of the battle over Obamacare, based on interviews with sources who were in the room, from one of the nation's foremost healthcare journalists. The Affordable Care Act, better known as “Obamacare,” was the most sweeping and consequential piece of legislation of the last half century. It has touched nearly every American in one way or another, for better or worse, and become the defining political fight of our time. In The Ten Year War, veteran journalist Jonathan Cohn offers the compelling, authoritative history of how the law came to be, why it looks like it does, and what it’s meant for average Americans. Drawn from hundreds of hours of interviews, plus private diaries, emails and memos, The Ten Year War takes readers to Capitol Hill and to town hall meetings, inside the West Wing and, eventually, into Trump Tower, as the nation's most powerful leaders try to reconcile pragmatism and idealism, self-interest and the public good, and ultimately two very different visions for what the country should look like. At the heart of the book is the decades-old argument over what’s wrong with American health care and how to fix it. But the battle over healthcare was always about more than policy. The Ten Year War offers a deeper examination of how our governing institutions, the media and the two parties have evolved, and the dysfunction those changes have left in their wake.
The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
1. Introduction -- 2. Mississippi -- 3. Michigan -- 4. Idaho -- 5. New Mexico -- 6. Exchange politics and the future of health reform
In 1965, the United States government enacted legislation to provide low-income individuals with quality health care and related services. Initially viewed as the friendless stepchild of Medicare, Medicaid has grown exponentially since its inception, becoming a formidable force of its own. Funded jointly by the national government and each of the fifty states, the program is now the fourth most expensive item in the federal budget and the second largest category of spending for almost every state. Now, under the new, historic health care reform legislation, Medicaid is scheduled to include sixteen million more people. Laura Katz Olson, an expert on health, aging, and long-term care policy, unravels the multifaceted and perplexing puzzle of Medicaid with respect to those who invest in and benefit from the program. Assessing the social, political, and economic dynamics that have shaped Medicaid for almost half a century, she helps readers of all backgrounds understand the entrenched and powerful interests woven into the system that have been instrumental in swelling costs and holding elected officials hostage. Addressing such fundamental questions as whether patients receive good care and whether Medicaid meets the needs of the low-income population it is supposed to serve, Olson evaluates the extent to which the program is an appropriate foundation for health care reform.
This is the first reference book to provide a detailed assessment of the Affordable Care Act, explaining the realities and myths surrounding one of the most divisive political struggles in recent U.S. history. The Affordable Care Act—also known as Obamacare—is one of the most controversial and politicized topics in the United States today. This timely book examines prominent claims about the legislation's drafting, debate, passage, and implementation, and discerns what is true and false about the law. Each of the text's eight chapters delves into the common beliefs, misinterpretations, and myths surrounding the act, tracing the history of the assertion and supporting or challenging its veracity through nonpartisan research and analyses. Chapters begin with an objective look at the claim's origins—with a brief focus on the person or group that conceived it and why—then set about clarifying or debunking it using evidence from research studies and reports from authoritative sources. Entries feature primary documents, a further reading section, and tables and graphs. Topics include the impact on health care costs for families, states, and the federal government; the effect of the Affordable Care Act on employer-sponsored insurance; and the role of health status on coverage under the Affordable Care Act.
This book situates comparative-historical analysis within contemporary debates in political science and explores the latest theoretical and conceptual advances.
An incisive biography of the Supreme Court's enigmatic Chief Justice, taking us inside the momentous legal decisions of his tenure so far. John Roberts was named to the Supreme Court in 2005 claiming he would act as a neutral umpire in deciding cases. His critics argue he has been anything but, pointing to his conservative victories on voting rights and campaign finance. Yet he broke from orthodoxy in his decision to preserve Obamacare. How are we to understand the motives of the most powerful judge in the land? In The Chief, award-winning journalist Joan Biskupic contends that Roberts is torn between two, often divergent, priorities: to carry out a conservative agenda, and to protect the Court's image and his place in history. Biskupic shows how Roberts's dual commitments have fostered distrust among his colleagues, with major consequences for the law. Trenchant and authoritative, The Chief reveals the making of a justice and the drama on this nation's highest court.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.