Dynamic Federalism and the Implementation of the Affordable Care Act

28 Pages Posted: 22 Aug 2013

See all articles by Timothy Callaghan

Timothy Callaghan

University of Minnesota - Minneapolis

Lawrence Jacobs

University of Minnesota - Twin Cities

Date Written: 2013


Political maneuvering over health care reform continues and will likely persist. The reality, however, is that health reform is now proceeding in Washington and in states across the country after the Supreme Court’s affirmation of the Affordable Care Act of 2010 (ACA) and President Barack Obama’s reelection. The pace and scope of health reform is, however, varying across states. This paper investigates four potential explanations for the variation in state decisions to implement the Medicaid expansion – state party control, economic affluence, the trajectory of established policy, and the process of learning about intergovernmental bargaining. Our analysis of 50 states finds that party control is a dominating influence on state decisions; but economic affluence and process learning impacted states with Democratic governors. The findings suggest that while party casts a long shadow over states, states that extensively interact with federal agencies develop skills and expectations to treat new programs from Washington as an opening bid subject to negotiation rather than as a fixed “take-it-or-leave-it” proposition. The paper concludes by underscoring the value of moving beyond partisanship to explore additional influences including the lasting effects of state interaction with federal policy making.

Keywords: Health reform, Medicaid, ACA, Federalism

Suggested Citation

Callaghan, Timothy and Jacobs, Lawrence, Dynamic Federalism and the Implementation of the Affordable Care Act (2013). APSA 2013 Annual Meeting Paper; American Political Science Association 2013 Annual Meeting. Available at SSRN: https://ssrn.com/abstract=2301530

Timothy Callaghan (Contact Author)

University of Minnesota - Minneapolis ( email )

308 Harvard Street SE
No Address Available

Lawrence Jacobs

University of Minnesota - Twin Cities ( email )

420 Delaware St. SE
Minneapolis, MN 55455
United States

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