The Affordable Care Act (ACA) is the most significant health reform legislation enacted in generations. However, politics does not end after a bill is signed into law. This chapter outlines why states were given such a prominent role in the implementation of core elements of the ACA, including the health insurance exchanges. This sets the stage for the question of this book: given that state leaders say they want flexibility and that Republicans say they prefer market-oriented reforms, why did so many states reject state control over exchanges? I outline the four main insights from the case study chapters: (1) the importance of governors, (2) the power of the Tea Party, (3) the ways in which differences in institutional design and procedures shaped policy outcomes, and (4) the importance of leadership. I ask whether this episode supports or undermines the federalism notion of states as laboratories of learning.
Oxford Scholarship Online requires a subscription or purchase to access the full text of books within the service. Public users can however freely search the site and view the abstracts and keywords for each book and chapter.
If you think you should have access to this title, please contact your librarian.