Plan generosity in health insurance exchanges: what the Affordable Care Act can teach us about top-down versus bottom-up policy implementation.
The landmark United States healthcare reform law – the Affordable Care Act – provides an opportunity to study the dynamics of implementation for complex, politically contentious policies. Matland’s Ambiguity-Conflict Model suggests that bottom-up models will dominate in such cases. I exploit variati...
| Published in: | Journal of Public Policy Vol. 37; no. 1; pp. 55 - 84 |
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| Format: | Article |
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Cambridge University Press
Mar2017
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=121057029&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 121057029 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 0143814X 41E jtl: Journal of Public Policy issn: 0143814X maglogo: N pubinfo: dt: Mar2017 vid: 37 iid: 1 pid: 15979 pub: Cambridge University Press artinfo: ui: 121057029 10.1017/S0143814X16000015 ppf: 55 ppct: 29 formats: tig: atl: Plan generosity in health insurance exchanges: what the Affordable Care Act can teach us about top-down versus bottom-up policy implementation. aug: au: Yarbrough, Courtney R. affil: Department of Public Administration and Policy, University of Georgia, USA su: Health insurance exchanges Patient Protection & Affordable Care Act Ambiguity Premiums (Retail trade) Deductibles (Insurance) sug: subj: Health insurance exchanges Patient Protection & Affordable Care Act Ambiguity Premiums (Retail trade) Deductibles (Insurance) keyword: Affordable Care Act bottom-up policy implementation top-down Affordable Care Act bottom-up policy implementation top-down ab: The landmark United States healthcare reform law – the Affordable Care Act – provides an opportunity to study the dynamics of implementation for complex, politically contentious policies. Matland’s Ambiguity-Conflict Model suggests that bottom-up models will dominate in such cases. I exploit variation across states in the implementation of online health insurance marketplaces to test whether the federal- (top-down) or state-managed (bottom-up) implementation model produced better outcomes. Specifically, the study examines if state, federal or partnership exchanges were most effective at offering generous plans for consumers based on premiums, deductibles and copayments in 2014, the first year of operation. The results unambiguously indicate that state exchanges were most successful. The findings provide evidence for what Matland suspected – that bottom-up models, by providing more discretion to local implementers to adapt to contexts and build coalitions, are superior for high-conflict, high-ambiguity policies. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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