IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v181y2017icp34-42.html
   My bibliography  Save this article

The problem of choice: From the voluntary way to Affordable Care Act health insurance exchanges

Author

Listed:
  • Mulligan, Jessica

Abstract

This article takes a genealogical and ethnographic approach to the problem of choice, arguing that what choice means has been reworked several times since health insurance first figured prominently in national debates about health reform. Whereas voluntary choice of doctor and hospital used to be framed as an American right, contemporary choice rhetoric includes consumer choice of insurance plan. Understanding who has deployed choice rhetoric and to what ends helps explain how offering choices has become the common sense justification for defending and preserving the exclusionary health care system in the United States. Four case studies derived from 180 enrollment observations at the Rhode Island health insurance exchange conducted from March 2014–January 2017 and interviews with enrollees show how choice is experienced in this latest iteration of health reform. The Affordable Care Act (ACA) of 2010 created new pathways to insurance coverage in the United States. Insurance exchanges were supposed to unleash the power of consumer decision-making through marketplaces where health plans compete on quality, coverage, and price. Consumers, however, contended with confusing insurance terminology and difficult to navigate websites. The ethnography shows that consumers experienced choice as confusing and overwhelming and did not feel “in charge” of their decisions. Instead, unstable employment, changes in income, existing health needs, and bureaucratic barriers shaped their “choices.”

Suggested Citation

  • Mulligan, Jessica, 2017. "The problem of choice: From the voluntary way to Affordable Care Act health insurance exchanges," Social Science & Medicine, Elsevier, vol. 181(C), pages 34-42.
  • Handle: RePEc:eee:socmed:v:181:y:2017:i:c:p:34-42
    DOI: 10.1016/j.socscimed.2017.03.055
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953617302101
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2017.03.055?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Lee, Nancy S., 2015. "Framing choice: The origins and impact of consumer rhetoric in US health care debates," Social Science & Medicine, Elsevier, vol. 138(C), pages 136-143.
    2. Hoffman, Beatrix, 2012. "Health Care for Some," University of Chicago Press Economics Books, University of Chicago Press, number 9780226348032.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Lee, Amanda A. & James, Aimee S. & Hunleth, Jean M., 2020. "Waiting for care: Chronic illness and health system uncertainties in the United States," Social Science & Medicine, Elsevier, vol. 264(C).
    2. Schwarz, Carolyn, 2021. "Freed from insurance: Health care sharing ministries and the moralization of health care," Social Science & Medicine, Elsevier, vol. 268(C).
    3. Dao, Amy, 2020. "What it means to say “I Don't have any money to buy health insurance” in rural Vietnam: How anticipatory activities shape health insurance enrollment," Social Science & Medicine, Elsevier, vol. 266(C).
    4. Ihlebæk, Hanna Marie, 2021. "Time to care - An ethnographic study of how temporal structuring affects caring relationships in clinical nursing," Social Science & Medicine, Elsevier, vol. 287(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Epstein, Steven, 2016. "The politics of health mobilization in the United States: The promise and pitfalls of “disease constituencies”," Social Science & Medicine, Elsevier, vol. 165(C), pages 246-254.
    2. Moysidou, Krystallia & Cohen Chen, Smadar, 2023. "Inducing collective action intentions for healthcare reform through medical crowdfunding framing," Social Science & Medicine, Elsevier, vol. 333(C).
    3. Dong-Shang Chang & Wen-Sheng Wang & Rouwen Wang, 2018. "Identifying Critical Factors of Sustainable Healthcare Institutions’ Indicators Under Taiwan’s National Health Insurance System," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 140(1), pages 287-307, November.
    4. Holloway, Kelly & Miller, Fiona Alice & Simms, Nicole, 2021. "Industry, experts and the role of the ‘invisible college’ in the dissemination of non-invasive prenatal testing in the US," Social Science & Medicine, Elsevier, vol. 270(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:181:y:2017:i:c:p:34-42. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.