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Implementing Health Reform: Intergovernmental Bargaining and the Affordable Care Act

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  • John Dinan

Abstract

Implementation of the insurance-exchange and Medicaid-expansion provisions of the Affordable Care Act offers an opportunity to analyze the sources and extent of state and federal government leverage in bargaining over the rollout of a major federal program. What stands out from this study is state officials’ ability to leverage their administrative capacity and policy expertise as well as their power to decline participation in federal programs in order to influence implementation of a federal initiative. State officials’ influence is heightened when the program depends on state participation to achieve key federal objectives, when state threats to decline participation are meaningful, and when state nonparticipation threatens the success of a signature item on a president’s policy agenda.

Suggested Citation

  • John Dinan, 2014. "Implementing Health Reform: Intergovernmental Bargaining and the Affordable Care Act," Publius: The Journal of Federalism, CSF Associates Inc., vol. 44(3), pages 399-425.
    • Handle: RePEc:oup:publus:v:44:y:2014:i:3:p:399-425.
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    File URL: http://hdl.handle.net/10.1093/publius/pju008
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    References listed on IDEAS

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    1. Frank J. Thompson & Michael K. Gusmano, 2014. "The Administrative Presidency and Fractious Federalism: The Case of Obamacare," Publius: The Journal of Federalism, CSF Associates Inc., vol. 44(3), pages 426-450.
    2. Elizabeth Rigby & Jake Haselswerdt, 2013. "Hybrid Federalism, Partisan Politics, and Early Implementation of State Health Insurance Exchanges," Publius: The Journal of Federalism, CSF Associates Inc., vol. 43(3), pages 368-391, July.
    3. John Dinan, 2011. "Shaping Health Reform: State Government Influence in the Patient Protection and Affordable Care Act," Publius: The Journal of Federalism, CSF Associates Inc., vol. 41(3), pages 395-420, Summer.
    4. Bradley W. Joondeph, 2011. "Federalism and Health Care Reform: Understanding the States' Challenges to the Patient Protection and Affordable Care Act," Publius: The Journal of Federalism, CSF Associates Inc., vol. 41(3), pages 447-470, Summer.
    5. John Dinan, 2008. "The State of American Federalism 2007-2008: Resurgent State Influence in the National Policy Process and Continued State Policy Innovation," Publius: The Journal of Federalism, CSF Associates Inc., vol. 38(3), pages 381-415, Summer.
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    Cited by:

    1. Carol S. Weissert & Benjamin Pollack & Richard P. Nathan, 2017. "Intergovernmental Negotiation in Medicaid: Arkansas and the Premium Assistance Waiver," Publius: The Journal of Federalism, CSF Associates Inc., vol. 47(3), pages 445-466.

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