Lost in the ACA: Bit Parts in a Landmark Law

2020 ◽  
Vol 45 (4) ◽  
pp. 533-545
Author(s):  
John E. McDonough
Keyword(s):  
Health Policy ◽  
Affordable Care Act ◽  
Health Reform ◽  
Comprehensive Health ◽  
The Affordable Care Act ◽  
The Law

Abstract The Affordable Care Act (ACA) is a mosaic across a spectrum of health policy domains. The law contains hundreds of smaller and mostly unnoticed reforms aimed at nearly every segment of American health policy. Ten years later, these provisions include successes, failures, and mixed bags, which should be considered in any full assessment of the ACA. This article examines 11 from each of these 3 categories, drawn from 9 of the ACA's 10 titles. These mininarratives deepen recognition that the ACA is our best example of comprehensive health reform and defies simplistic judgments.

What Health Reform Tells Us about American Politics

2020 ◽  
Vol 45 (4) ◽  
pp. 581-593
Author(s):  
Lawrence R. Jacobs ◽  
Suzanne Mettler
Keyword(s):  
Medical Care ◽  
Affordable Care Act ◽  
Health Reform ◽  
American Politics ◽  
Political Debate ◽  
Initial Implementation ◽  
The Affordable Care Act ◽  
The Law ◽  
The Right ◽  
Over Time

Abstract The passage and initial implementation of the Affordable Care Act (ACA) were imperiled by partisan divisions, court challenges, and the quagmire of federalism. In the aftermath of Republican efforts to repeal the ACA, however, the law not only carries on but also is changing the nature of political debate as its benefits are facilitating increased support for it, creating new constituents who rely on its benefits and share intense attachments to them, and lifting the confidence of Americans in both their individual competence to participate effectively in politics and that government will respond. Critics from the Left and the Right differ on their favored remedy, but both have failed to appreciate the qualitative shifts brought on by the ACA; this myopia results from viewing reform as a fixed endpoint instead of a process of evolution over time. The result is that conservatives have been blind to the widening network of support for the ACA, while those on the left have underestimated health reform's impact in broadening recognition of medical care as a right of citizenship instead of a privilege earned in the workplace. The forces that constrained the ACA's development still rage in American politics, but they no longer dictate its survival as they did during its passage in 2010.

Ten Years of Messaging about the Affordable Care Act in Advertising and News Media: Lessons for Policy and Politics

2020 ◽  
Vol 45 (5) ◽  
pp. 711-728 ◽  
Author(s):  
Sarah E. Gollust ◽  
Erika Franklin Fowler ◽  
Jeff Niederdeppe
Keyword(s):  
Affordable Care Act ◽  
News Media ◽  
Health Reform ◽  
Access To Health ◽  
The Us ◽  
Political Ads ◽  
The Affordable Care Act ◽  
The Law ◽  
And Behavior ◽  
Attitudes And Behavior

Abstract Messaging about the Affordable Care Act (ACA) has seemingly produced a variety of outcomes: millions of Americans gained access to health insurance, yet much of the US public remains confused about major components of the law, and there remain stark and persistent political divides in support of the law. Our analysis of the volume and content of ACA-related media (including both ads and news) helps explain these phenomena, with three conclusions. First, the information environment around the ACA has been complex and competitive, with messaging originating from diverse sponsors with multiple objectives. Second, partisan cues in news and political ads are abundant, likely contributing to the crystallized politically polarized opinion about the law. Third, partisan discussions of the ACA in political ads have shifted in volume, direction, and tone over the decade, presenting divergent views regarding which party is accountable for the law's successes (or failures). We offer evidence for each of these conclusions from longitudinal analyses of the volume and content of ACA messaging, also referencing studies that have linked these messages to attitudes and behavior. We conclude with implications for health communication, political science, and the future outlook for health reform.

After the Affordable Care Act: Health Reform and the Safety Net

2016 ◽  
Vol 44 (4) ◽  
pp. 585-588
Author(s):  
Peter Shin ◽  
Marsha Regenstein
Keyword(s):  
Health Care ◽  
Community Health ◽  
Affordable Care Act ◽  
Health Reform ◽  
Community Health Centers ◽  
Safety Net ◽  
Public Hospitals ◽  
Health Centers ◽  
Safety Net Providers ◽  
The Affordable Care Act

Two major safety net providers – community health centers and public hospitals – continue to play a key role in the health care system even in the wake of coverage reform. This article examines the gains and threats they face under the Affordable Care Act.

Introduction

2017 ◽  
Author(s):  
Jessica M. Mulligan ◽  
Heide Castañeda
Keyword(s):  
Health Policy ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Demographic Characteristics ◽  
Social Identities ◽  
Immigration Status ◽  
Anthropological Approach ◽  
The Law

In this chapter, Jessica M. Mulligan and Heide Castañeda provide an overview of the Affordable Care Act focused on the coverage expansions that were at the heart of the law. The authors outline the ethnographic methods used in the book, arguing that an anthropological approach provides an experience-near perspective on implementation that too often is absent in mainstream treatments of health policy. The central theoretical concerns of the book are also introduced: stratified citizenship, risk, and responsibility. The term stratified citizenship describes how certain social identities and demographic characteristics—such as immigration status, income, gender, race, and state of residence—mediated how people were included or excluded from health insurance coverage through the ACA. Exposure to risks as well as inclusion in the new responsibilities created by the law were also unequally distributed.

scholarly journals Sources of Success in California's Individual Marketplace under the Affordable Care Act

2019 ◽  
Vol 44 (4) ◽  
pp. 679-706
Author(s):  
Petra W. Rasmussen ◽  
Gerald F. Kominski
Keyword(s):  
Affordable Care Act ◽  
The United States ◽  
Community Partners ◽  
Early Adoption ◽  
Individual Market ◽  
The Affordable Care Act ◽  
The Law ◽  
The Stability ◽  
The Individual ◽  
Trump Administration

Abstract When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. However, the ACA has not been uniformly embraced, and states differ in their implementation of the law and in their individual health insurance marketplace's successfulness. Furthermore, under the Trump administration the law's future and the stability of the individual market have been uncertain. Throughout, however, California has been a leader. Today, the state's marketplace, known as Covered California, offers comprehensive, standardized health plans to over 1.3 million consumers. California's success with the ACA is largely attributable to its historical receptiveness to health reform; its early adoption of the law; its decision to have Covered California operate as an active purchaser, help shape the plans sold through the marketplace, and design a consumer-friendly enrollment experience; its engagement with stakeholders and community partners to encourage enrollment; and Covered California's commitment to continually innovate, improve, and anticipate the needs of the individual market as the law moves forward.

Health Policy by Litigation

2020 ◽  
Vol 48 (3) ◽  
pp. 443-449 ◽  
Author(s):  
Katie Keith ◽  
Joel McElvain
Keyword(s):  
Health Policy ◽  
Affordable Care Act ◽  
Executive Branch ◽  
Executive Power ◽  
Future Health ◽  
Legal Challenges ◽  
History Of ◽  
Potential Impact ◽  
The Law ◽  
Trump Administration

Since its enactment, the Affordable Care Act (ACA) has faced numerous legal challenges. Many of these lawsuits have focused on implementation of the law and the limits of executive power. Opponents challenged the ACA under the Obama Administration while supporters have turned to the courts to prevent the Trump Administration from undermining the law. In the meantime, Congress remains gridlocked over the ACA and many other critical health policy issues, leaving the executive branch to adopt its preferred policy approach and ultimately leading to lawsuits. This article briefly discusses the history of litigation over the ACA and some reasons why this litigation has been so enduring. The article then identifies other areas of health policy that are or could be future targets for litigation. Finally, the article comments on the potential impact of the courts on future health reform efforts.

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