After decades of failed efforts to overhaul American health care, the Affordable Care Act's 2010 enactment was the most important health reform achievement since Medicare and Medicaid's passage. But ten years later, ACA politics are more tenuous than triumphal, and the ACA has not escaped the controversy that surrounded its enactment. This article explores why the ACA has been so divisive despite its considerable accomplishments. The ACA contains an array of controversial policies that contravene policy principles and political priorities held by the contemporary Republican party. It also imposes costs on stakeholder groups whose opposition, in many cases, to measures that altered the status quo has never ceased. Moreover, ACA benefits often have been obscured, partly because of the law's complex structure and incoherent programmatic identity. Additionally, the ACA's performance on its central promise-to make health insurance affordable-has been mixed. The law also confers benefits on populations that command less political sympathy than those previously favored with public coverage, and it has surfaced perennial racial/ethnic tensions related to who receives government benefits. I argue that the ACA's turbulent political journey ultimately reflects the larger trends in American politics of growing partisanship and polarization that continue to shape US health policy.
Keywords: Affordable Care Act; Costs and spending; Health insurance exchanges; Health policy; Health reform; Medicaid; Medicare; Politics; Private health insurance; government programs and policies.
Fulton BD, Hollingshead A, Karaca-Mandic P, Scheffler RM. Fulton BD, et al. Inquiry. 2015 Sep 21;52:0046958015604164. doi: 10.1177/0046958015604164. Print 2015. Inquiry. 2015. PMID: 26396089 Free PMC article.
Manchikanti L, Helm Ii S, Benyamin RM, Hirsch JA. Manchikanti L, et al. Pain Physician. 2017 Mar;20(3):111-138. Pain Physician. 2017. PMID: 28339427 Review.
Béland D, Rocco P, Waddan A. Béland D, et al. Health Policy. 2014 May;116(1):51-60. doi: 10.1016/j.healthpol.2014.01.010. Epub 2014 Jan 22. Health Policy. 2014. PMID: 24508181 Review.
Callaghan TH, Jacobs LR. Callaghan TH, et al. J Health Polit Policy Law. 2017 Apr;42(2):215-246. doi: 10.1215/03616878-3766710. Epub 2016 Dec 22. J Health Polit Policy Law. 2017. PMID: 28007795
Jacobs LR, Mettler S. Jacobs LR, et al. J Health Polit Policy Law. 2020 Aug 1;45(4):581-593. doi: 10.1215/03616878-8255505. J Health Polit Policy Law. 2020. PMID: 32186336