Callaghan Timothy H, Jacobs Lawrence R
Texas A&M University.
University of Minnesota.
J Health Polit Policy Law. 2017 Apr;42(2):215-246. doi: 10.1215/03616878-3766710. Epub 2016 Dec 22.
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.
在持续存在运营挑战、保险市场动荡以及党派之争不断的背景下，《平价医疗法案》（ACA）项目的参保人数飙升，各州在医保覆盖范围扩大的速度方面出现了显著差异。我们的文章探讨了为何ACA参保人数在各州之间存在如此巨大的差异。我们探究了政党控制、总统引导、行政能力、ACA政策决策的回响效应、富裕程度和失业率对参保人数的潜在影响。我们的多变量分析发现，政党控制在早期的州决策中占据主导地位，但保险交易所的相对参保人数以及医疗补助扩大计划是由不断变化的政治和行政因素组合驱动的。随着共和党人取代ACA并将大量管理医疗补助和其他项目的自由裁量权下放给各州，卫生政治正在进入一个新时代。我们的研究结果为卫生改革以及学习和传播的未来方向提供了见解。
