TY - JOUR
T1 - The future of health care reform
T2 - What is driving enrollment?
AU - Callaghan, Timothy H.
AU - Jacobs, Larry
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Against a backdrop of ongoing operational challenges, insurance market turbulence, and the ever present pull of partisanship, enrollment in the ACA's programs has soared and significant variations have developed across states in terms of their pace of coverage expansion. Our article explores why ACA enrollment has varied so dramatically across states. We explore the potential influence of party control, presidential cueing, administrative capacity, the reverberating effects of ACA policy decisions, affluence, and unemployment on enrollment. Our multivariate analysis finds that party control dominated early state decision making, but that relative enrollment in insurance exchanges and the Medicaid expansion are driven by a changing mix of political and administrative factors. Health politics is entering a new era as Republicans replace the ACA and devolve significant discretion to states to administer Medicaid and other programs. Our findings offer insights into future directions in health reform and in learning and diffusion.
AB - Against a backdrop of ongoing operational challenges, insurance market turbulence, and the ever present pull of partisanship, enrollment in the ACA's programs has soared and significant variations have developed across states in terms of their pace of coverage expansion. Our article explores why ACA enrollment has varied so dramatically across states. We explore the potential influence of party control, presidential cueing, administrative capacity, the reverberating effects of ACA policy decisions, affluence, and unemployment on enrollment. Our multivariate analysis finds that party control dominated early state decision making, but that relative enrollment in insurance exchanges and the Medicaid expansion are driven by a changing mix of political and administrative factors. Health politics is entering a new era as Republicans replace the ACA and devolve significant discretion to states to administer Medicaid and other programs. Our findings offer insights into future directions in health reform and in learning and diffusion.
KW - ACA enrollment
KW - Diffusion
KW - Health reform
UR - http://www.scopus.com/inward/record.url?scp=85015856568&partnerID=8YFLogxK
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U2 - 10.1215/03616878-3766710
DO - 10.1215/03616878-3766710
M3 - Article
C2 - 28007795
AN - SCOPUS:85015856568
SN - 0361-6878
VL - 42
SP - 215
EP - 246
JO - Journal of health politics, policy and law
JF - Journal of health politics, policy and law
IS - 2
ER -