You Can't Make Me Do It, but I Could Be Persuaded: A Federalism Perspective on the Affordable Care Act.
The Affordable Care Act (ACA) seeks to change fundamentally the US health care system. The responses of states have been diverse and changing. What explains these diverse and dynamic responses? We examine the decision making of states concerning the creation of Pre-existing Condition Insurance Plan...
| Published in: | Journal of Health Politics, Policy & Law Vol. 40; no. 2; pp. 281 - 324 |
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| Main Authors: | , |
| Format: | Article |
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Duke University Press
Apr2015
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| Subjects: | |
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=102836781&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 102836781 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 03616878 HPP jtl: Journal of Health Politics, Policy & Law issn: 03616878 maglogo: N pubinfo: dt: Apr2015 vid: 40 iid: 2 pid: 154 pub: Duke University Press artinfo: ui: 102836781 10.1215/03616878-2882219 ppf: 281 ppct: 43 formats: tig: atl: You Can't Make Me Do It, but I Could Be Persuaded: A Federalism Perspective on the Affordable Care Act. aug: au: Haeder, Simon F. Weimer, David L. affil: University of Wisconsin-Madison su: United States Federal government Health maintenance organizations Insurance Medicaid Medical care research Health policy Practical politics State governments Government aid Government programs Government regulation Human services programs Health insurance laws Chi-squared test Endowments Medically uninsured persons Logistic regression analysis Eligibility (Social aspects) Patient Protection & Affordable Care Act Descriptive statistics State health plans Health insurance exchanges Preexisting medical condition coverage Health care reform sug: subj: Federal government Health maintenance organizations Insurance Medicaid Medical care research Health policy Practical politics State governments Government aid Government programs Government regulation Human services programs United States Grantmaking Foundations HMO Medical Centers Community health centres Other Insurance Funds Third Party Administration of Insurance and Pension Funds All Other Insurance Related Activities Direct group life, health and medical insurance carriers Direct individual life, health and medical insurance carriers Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs) Administration of Public Health Programs Health insurance laws Chi-squared test Endowments Medically uninsured persons Logistic regression analysis Eligibility (Social aspects) Patient Protection & Affordable Care Act Descriptive statistics State health plans Health insurance exchanges Preexisting medical condition coverage Health care reform keyword: Affordable Care Act (ACA) health care reform health insurance marketplaces Pre-existing Condition Insurance Plan (PCIP) Affordable Care Act (ACA) health care reform health insurance marketplaces Pre-existing Condition Insurance Plan (PCIP) ab: The Affordable Care Act (ACA) seeks to change fundamentally the US health care system. The responses of states have been diverse and changing. What explains these diverse and dynamic responses? We examine the decision making of states concerning the creation of Pre-existing Condition Insurance Plan programs and insurance marketplaces and the expansion of Medicaid in historical context. This frames our analysis and its implications for future health reform in broader perspective by identifying a number of characteristics of state-federal grants programs: (1) slow and uneven implementation; (2) wide variation across states; (3) accommodation by the federal government; (4) ideological conflict; (5) state response to incentives; (6) incomplete take-up rates of eligible individuals; and (7) programs as stepping-stones and wedges. Assessing the implementation of the three main components of the ACA, we find that partisanship exerts significant influence, yet less so in the case of Medicaid expansion. Moreover, factors specific to the insurance market also play an important role. Finally, we conclude by applying the themes to theACAand offer an outlook for its continuing implementation. Specifically, we expect a gradual move toward universal state participation in the ACA, especially with respect to Medicaid expansion. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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