Political partisanship partly explains states' different responses to the federal Affordable Care Act, which seeks to change fundamentally the U.S. health care system, new research by La Follette School Professor David Weimer finds.
Partisanship is less important in the case of Medicaid expansion, Weimer and Simon F. Haeder, a University of Wisconsin–Madison graduate student, find in research published online this week by the Journal of Health Politics, Policy and Law.
Haeder and Weimer specially examine the decision-making of states concerning the creation of Pre-Existing Condition Insurance Plan programs and insurance marketplaces, as well as the expansion of Medicaid in historical context. They identify characteristics of state-federal grant programs, including slow and uneven implementation, wide variation across states, federal accommodation, ideological conflict, state responses to incentives, incomplete take-up rates of eligible individuals, and programs as stepping-stones and wedges.
Weimer and Haeder conclude by applying the themes to the ACA and offer an outlook for its continuing implementation. "Specifically, we expect a gradual move toward universal participation by states in the ACA, especially with respect to Medicaid expansion," Weimer says.