1st Edition

State Politics and the Affordable Care Act Choices and Decisions

    188 Pages
    by Routledge

    186 Pages
    by Routledge

    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.

    1. Why Do States Matter? Contemporary State Policy Choice

    2. Getting to Obamacare: A History of Health Care Reform in the U.S.

    3. The "Nuts and Bolts" of the ACA

    4. A National Look at ACA Implementation Choices

    5. Opposing the ACA: An Alabama Case Study

    6. Dueling Sentiments: Michigan and the ACA

    7. Live Free or Die: New Hampshire and the ACA

    8. Taking the Lead: California’s Endeavor for Universal Health Care

    9. The Broader Lessons of State Implementation of the ACA


    John C. Morris is Professor of Public Administration in the School of Public Service, and Professor of Political Science at Old Dominion University. He holds a PhD from Auburn University, and has studied collaboration and public-private partnerships for more than 20 years. Dr. Morris has published widely in public administration and public policy. 

    Martin K. Mayer received his Ph.D. from the School of Public Service at Old Dominion University in the fall of 2016. Martin’s research interests include healthcare policy, local government innovation, and environmental policy. His work has been published in Social Science Quarterly, Politics and Policy, The Social Science Journal, and Politics and the Life Sciences.

    Robert C. Kenter holds an MPA from Troy University, Alabama, and a PhD from the School of Public Service, Old Dominion University, Norfolk Virginia. His research interest includes collaboration, privatization, and southern politics. His work has appeared in several journals and edited books.

    Luisa M. Lucero graduated with a PhD from the School of Public Service at Old Dominion University in 2017. Her dissertation focused on state-level health policy design, and she is currently working on additional research projects examining health policy.

    "To truly understand policy change in the American context, we must look to the states. This book adds to our understanding of the importance of economic, historic, political, and social context in shaping policy development and implementation. Morris, Mayer, Kenter, and Lucero’s careful look at the experiences of four diverse states sheds light on ACA’s turbulent and dynamic history. The lessons drawn here are important to the study of health policy, and provide new insights on the character of the American intergovernmental system."Christopher Plein, Eberly Family Professor for Outstanding Public Service, West Virginia University

    "At a time when health care is at the forefront of political discussion, State Politics and the Affordable Care Act: Choices and Decisions is a welcome addition that broadens our knowledge of this contentious debate. With this book, Morris, Mayer, Kenter, and Lucero provide foundational knowledge of health care reform and policy in the United States from the early 1900’s through the signing and implementation of the 2010 Affordable Care Act. This work fills a vital gap in the current body of literature by providing detailed examples of states’ support of, and opposition to, implementation of this policy. I am certain this book will become a must-read for those interested in health care policy and the political and societal tensions surrounding this topic."Katrina Miller-Stevens, Colorado College

    "This book examines the reasons behind the differences in states’ policy decisions about implementing the ACA within the U.S. federalism framework. By focusing on four states, Morris and his colleagues are able to dig deeply into underlying political, economic, and socio-cultural differences that have affected often-surprisingly different policy approaches. The result is a fascinating examination of state policy-making that will capture the interest of many beyond students of healthcare and the ACA."J. Steven Ott, University of Utah