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 BEland, 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.
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