scholarly journals The Affordable Care Act in the States: Fragmented Politics, Unstable Policy

2020 ◽  
Vol 45 (4) ◽  
pp. 647-660
Author(s):  
Daniel Béland ◽  
Philip Rocco ◽  
Alex Waddan
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Political Polarization ◽  
Successful Implementation ◽  
Political Struggle ◽  
Health Care Politics ◽  
Quality Health ◽  
The Law ◽  
Institutional Fragmentation ◽  
Trump Administration

Abstract Many argue that the frustrated implementation of the 2010 Affordable Care Act (ACA) stems from the unprecedented level of political polarization that has surrounded the legislation. This article draws attention to the law's “institutional DNA” as a source of political struggle in the 50 states. As designed, in the context of US federalism, the law fractured authority in ways that has opened up the possibility of contestation and confusion. The successful implementation of the ACA varies not only across state lines but also across the various components of the law. In particular, opponents of the ACA have experienced their greatest successes when they could take advantage of weak preexisting policy legacies, high levels of institutional fragmentation, and negative public sentiments. As argued in this article, the fragmented patterns of health care politics in the 50 states identified in previous research have largely persisted during the Trump administration. Moreover, while Republicans were unsuccessful at repealing the legislation, the administration has taken advantage of its structural deficiencies to further weaken the legislation's capacity to expand access to affordable, quality health insurance.

Diminishing Democracy in Health Policy: Partisanship, the Courts, and the End of Health Politics as We Knew It

2020 ◽  
Vol 45 (5) ◽  
pp. 757-769
Author(s):  
James A. Morone
Keyword(s):  
Health Care ◽  
New Deal ◽  
Affordable Care Act ◽  
Federal Court ◽  
Legislative Process ◽  
Court System ◽  
New Era ◽  
Health Politics ◽  
Health Care Politics ◽  
Slow Rise

Abstract Despite unprecedented partisanship, the Affordable Care Act (ACA) traced a familiar political arc: a loud debate full of dramatic symbols, a messy legislative process, clashes over implementation, a slow rise in popularity, entrenchment as part of the health care system, and growing support that blocked Congress from repealing. The politics of the ACA looked, from one angle, like a louder version of health politics as usual. But something new was stirring. Opponents pushed the debate outside the elected branches of government and into the courts—a move that reflects past eras of highly racialized conflict. A federal court marked the ACA's tenth anniversary by doing what Congress could not: it struck down the law, although the litigation continues to wend its way through the court system. The ongoing challenge to the ACA rests on a fundamental critique of the entire New Deal dispensation in jurisprudence. The consequence could be a new era in health care politics.

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.

Stabilizing and Strengthening the Affordable Care Act: Opportunities for a New Administration

2021 ◽  
Author(s):  
Stacey McMorrow
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Health Care Access ◽  
Health Care Services ◽  
Federal Law ◽  
The Past ◽  
Care Access ◽  
Care Services ◽  
The Affordable Care Act ◽  
The Law

Abstract Over the past decade, the Affordable Care Act (ACA) has successfully reduced uninsurance and improved access to and affordability of health care services for millions of Americans. But the law has been weakened over the past four years as the Trump administration shortened the open enrollment period in the federal Marketplace, reduced outreach and enrollment funding, and revised the public charge rule, among other actions. The incoming Biden administration will have the chance to reverse some of these changes and further strengthen the law to improve health care access and affordability. In this paper, I explore options to expand access to affordable coverage and care for those who do not qualify for Medicaid or Marketplace financial assistance, and further discuss opportunities to increase enrollment among those who are already eligible. I also examine opportunities to expand access to specific services, including reproductive health care, among those with insurance. Any attempts to modify or build upon the ACA will likely be complicated by the ongoing coronavirus pandemic as well as a divided Congress, but regulatory solutions will likely be easier to achieve than those that require changes to federal law or state policy.

Learning While Caring

2016 ◽  
Author(s):  
Samuel B. Hellman
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
The United States ◽  
Quality Health Care ◽  
Health Security ◽  
Us Economy ◽  
Major Subject ◽  
The Us ◽  
Quality Health ◽  
Developed World

Learning While Caring is about what the author has learned during his half-century career as a cancer doctor. During this time, medicine has changed greatly. It has become more scientifically based, more institutionally located, and now comprises almost one-fifth of the US economy. Despite these changes, much remains the same, especially the primary obligation of the doctor to the patient. Also during this period, most of the developed world has recognized health care as a right for all its members. This has been resulted in greatly improved care for many, but not for all. For the last 25 years the United States has been experimenting on how this should be achieved, beginning with the proposed but not enacted Clinton Health Security proposal and currently with the Affordable Care Act. While efficiency and cost control are essential, cost cannot be the only parameter of success. Access to high-quality health care must be made available to all. Proper education for an informed public must include an understanding of the general principles of biology, while that of a doctor must result in a familiarity with the humanities and social sciences. An academic physician has three responsibilities: patient care, teaching, and research. These latter two, while essential, must not conflict, compromise, or limit the doctor-patient relationship. This book is about the author’s activities in all three endeavors. Since his specialty is oncology, this is the major subject, but most of the information is applicable to all caring physicians.

Partisanship, Polling, and the Affordable Care Act

2019 ◽  
Vol 83 (2) ◽  
pp. 423-449 ◽  
Author(s):  
Mollyann Brodie ◽  
Elizabeth C Hamel ◽  
Ashley Kirzinger ◽  
Bianca Dijulio
Keyword(s):  
Health Care ◽  
Public Opinion ◽  
Health Care System ◽  
Affordable Care Act ◽  
Political Polarization ◽  
Major Health ◽  
The Public ◽  
The Us ◽  
The Affordable Care Act ◽  
Public Views

AbstractIn an age of increasing political polarization, the Affordable Care Act (ACA) stands out as one of the most politically divisive pieces of legislation in recent history. Unlike previous laws making changes to the US health care system, public views of the ACA did not improve measurably as people gained experience with the program, but remained deeply divided on a partisan basis in the more than eight years since its passage. In this article, we examine how the complexity of the law, lack of understanding by the public, and elite partisan messaging have contributed to this enduring partisan divide, and discuss what the future may hold for the measurement of public opinion on major health care legislation.

scholarly journals Repeal and Replace of Affordable Care: A Complex, but Not an Impossible Task

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. E1109-E1113
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Insurance Companies ◽  
Patient Centered ◽  
President Obama ◽  
Comprehensive Health ◽  
President Elect ◽  
The Law ◽  
Narrow Networks

The Affordable Care Act (ACA), signature legislation of President Obama, was arguably the most consequential and comprehensive health care reform since Medicare was introduced as part of President Lyndon B. Johnson’s great society. It has been claimed that many of the law’s reforms are now so integrated in the health system that full repeal would be impractical, while others including President Elect Trump have rejected that idea and called for full repeal and replacement claiming ACA law cannot be fixed. A tsunami of increasing regulatory burden over the past 8 years, the current health care milieu has moved independent practitioners towards hospital employment in great numbers. In addition, public opinion has been slowly climbing against ObamaCare with 54% of Americans now opposing the law. President Obama has indicated that the law has accomplished many of its goals, including increasing accessibility, affordability, and quality of health care. However, others have contradicted these assertions and described the ACA as “insurance for many with coverage for few.” Some believe that the ACA might be more appropriately labeled the “Medicaid Expansion Act.” There are multiple plans developed over the years by republican members of the congress; however, of significant consequence and importance are President-elect Trump’s proposals and the plan developed by Speaker Paul Ryan to repeal and replace the ACA. The President-elect has described the problems he perceives with the ACA; rapidly rising premiums and deductibles, narrow networks, and limits of coverage imposed by health insurance companies. The Presidentelect has indicated that his goal will be to create a patient-centered health care system that promotes choice, quality, and affordability with health insurance and health care, and take any needed action to alleviate the burdens imposed on American families and businesses by law. Key words: Affordable Care Act, ObamaCare, Medicaid, exchanges, Trump plan, repeal, replace

The Patient Protection and Affordable Care Act, Public Health, and the Elusive Target of Human Rights

2011 ◽  
Vol 39 (3) ◽  
pp. 340-354 ◽  
Author(s):  
Lance Gable
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Patient Protection ◽  
The Law ◽  
The Impact

The passage of the Patient Protection and Affordable Care Act (ACA) in March 2010 represents a significant turning point in the evolution of health care law and policy in the United States. By establishing a legal infrastructure that seeks to achieve universal health insurance coverage in the United States, the ACA targets some of the major impediments to accessing needed health care for millions of Americans and by extension attempts to strengthen the health system to support key determinants of health. Yet, like many newly passed legislative provisions, the ultimate effects and significance of the ACA remain uncertain. Those charged with implementing the ACA face formidable obstacles — indeed, some of the same obstacles that have been erected to impede other major pieces of social legislation in the past — including entrenched political opposition, constitutional challenges, and what will likely be a prolonged struggle over the content and direction of how the law is implemented. As these debates continue, it is nevertheless important to begin to assess the impact that the ACA has already had on health law in the United States and to consider the likely effects that the law will have on public health going forward.

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