When State Policy Makes National Politics: The Case of “Obamacare” Marketplace Implementation

Abstract

Context: State governments have been powerful sites of Republican resistance to the implementation of the Affordable Care Act (ACA), the Democratic Party's signature 2010 law. By influencing how citizens experience the ACA, state-level implementation can affect the national-level political implications of the law. Methods: I examine three largely unstudied areas of marketplace implementation: navigator laws, transitional plan termination, and rating area configurations. For each policy area, I use linear probability models to investigate the determinants of state lawmakers bolstering or eroding marketplaces. Findings: In each case, Democrat-controlled states were more likely to bolster marketplaces than Republican-controlled states were, with decisions more polarized in those policy areas—navigator laws and transitional plan termination—and with greater potential for national-level feedback. For navigator laws, where Republican state lawmakers were most cross-pressured by national party interests and local interests, marketplace eroding policy was highly associated with strength of conservative networks. Conclusion: Crafters of federal legislation cannot expect state lawmakers to universally implement federal law to maximize the direct benefits to their constituents. Rather, we should expect state lawmakers to, in many instances, implement federal law in ways that benefit their parties.

Association of Funding Cuts to the Patient Protection and Affordable Care Act Navigator Program With Privately Sponsored Television Advertising

“…Funding Cuts to the ACA Navigator Program and Privately Sponsored Television Advertising people in marketplace coverage, advertising may be a substitute for public funding of the navigator program, albeit an imperfect one. Despite evidence of the association between outreach and health insurance enrollment, including direct enrollment assistance via navigators 25,[34][35][36] and television advertising, 16,24,[37][38][39][40] little research has explored the interplay between public and private sector sources of outreach. To assess the repercussions of recent developments and inform policy decisions, this study examined the association between the Trump-era cuts in navigator program funding and the volume of private sector advertising.…”

Subsidized Marketplace Purchases Reduced Racial Disparities in Private Coverage Under the Affordable Care Act

“…Vigorous implementation also included aggressive advertising, which was associated with greater Marketplace shopping and enrollment in a Marketplace plan [ 33 ]. Overall, Marketplace functions have enjoyed varying levels of support from states depending on the state’s political climate and hesitancy about the ACA [ 34 ]. More research is needed to understand Marketplace policies and operations to guide federal regulation seeking to steer Marketplaces to adopt best practices.…”

OECD Ülkelerinin Covid 19 Pandemisi ile Mücadele Performansı: Kesitsel Bir Araştırma

“…Bu durum özellikle gelir düzeyi düşük kişilerin özel sağlık sigortası primlerini ödeyememesine neden olmaktadır. Obamacare olarak bilinen sağlık sigortası paketi özellikle bu kesimin sağlık hizmetlerine erişimi kolaylaştırmak için getirilmiştir (Trachtman, 2020). Ancak bu paket bütün eyaletlerde uygulanamamıştır.…”