Shaping Health Reform: State Government Influence in the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act has significant implications for state governments and its passage presents an opportunity to contribute to inquiries into ways that state officials wield influence in the national legislative process. State officials were occasionally influential when they drew on state experience and expertise and congress members were willing to benefit from this knowledge. State officials were also influential when a member of their congressional delegation was in a position to cast a pivotal vote on the bill and willing to withhold support unless state interests were addressed. State officials were also influential when they elevated their concerns in the public consciousness to the point that the bill's supporters were forced to accommodate them or risk the bill's defeat. Copyright 2011, Oxford University Press.