Dynamic Federalism and the Implementation of the Affordable Care Act
28 Pages Posted: 22 Aug 2013
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
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