Obamacare Wars, Reviewed

9780700621910The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 could easily be considered another example of the partisan rancor that dominates American politics. In fact, not five minutes after ACA was signed into law, in March 2010, Virginia’s attorney general was suing to stop it. And yet, the ACA rolled out, fought and defended at every turn—despite President Obama’s claim, in 2014, that its proponents and opponents could finally “stop fighting old political battles that keep us gridlocked.” But not only would the battles not stop, as Obamacare Wars makes acutely clear, they spread from Washington, DC, to a variety of new arenas. The first thorough account of the implementation of the ACA, this book reveals the fissures the act exposed in the American federal system.

The book, released in January, was recently reviewed by The Journal of Politics. Dr.

“In this interesting and thought-provoking book, Daniel Béland, Philip Rocco, and Alex Waddan attempt to capture that nuance. They set the stage for their primary argument by deftly condensing the long history of health care reform in the United States and the specific conditions at the beginning of the Obama administration into a digestible description that helps the reader to understand the debate leading up to passage. They also demonstrate that the complexity of the ACA made its passage an ‘uncertain legislative victory’ at best and provided many ‘points of leverage’ for a determined set of opponents to obstruct implementation.

Obamacare Wars suggests that in order to understand how the law’s many detractors used that leverage, we must avoid treating the ACA as a monolithic piece of legislation and instead divide it into its three major components: state health insurance exchanges, Medicaid expansion, and insurance regulation. Béland, Rocco, and Waddan argue that each component gave state officials distinct opportunities to obstruct the implementation of the law, creating different ‘post reform politics,’ because of variation in the ‘policy legacies, institutional settings, and public sentiments’ associated with each. The main thesis of the book is that these three factors, and not just partisan polarization, explain how opponents in the American states responded to the ACA.”

Dr. Nicholson-Crotty’s review praises the book’s thorough examination of the topic.

Obamacare Wars is a worthwhile read for scholars interested in federalism and intergovernmental relations and in health policy and politics. Béland, Rocco, and Waddan contribute significantly to our understanding of implementation in federal systems by demonstrating convincingly that the politics and strategies of implementing this single piece of health care reform legislation in the American states were myriad and a function not only of partisan polarization but also of the diverse policy issues embedded within the law.”