The Patient Protection and Affordable Care Act, often referred to as the ACA or Obamacare, was enacted in 2010 in the wake of the Great Recession. The law transformed the way that Americans access healthcare, nearly halving the ranks of the 49 million uninsured Americans. Edited by political scientist Andrea Louise Campbell and economist Lara Shore-Sheppard, this issue of RSF examines the social, political, and economic effects of this landmark legislation.
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This journal issue explores the political dimensions of the rollout of the ACA and the attendant backlash. Contributors Helen Levy, Andrew Ying, and Nicholas Bagley argue that despite repeated efforts at repeal, over 80 percent of the Act has been implemented as it was originally intended.  Julianna Pacheco, Jake Haselswerdt, and Jamila Michener show that when Republican governors support Medicaid expansion, Republican voters become more favorable toward the ACA, and polarization between Republican and Democrat voters decreases. Yet Charles Courtemanche, James Marton, and Aaron Yelowitz find little impact of the ACA on voter participation. Lisa Beauregard and Edward Miller examine states’ adoption of the ACA’s home and community-based care services for the elderly and people with disabilities, finding that states with more liberal elected officials and more fiscal capacity were more likely to adopt these provisions. Paul Shafer, David Anderson, Seciah Aquino, Laura Baum, Erika Franklin Fowler, and Sarah Gollust probe the role of different types of health insurance and political advertising on insurance enrollment.  Richard Fording and Dana Patton explain the emergence of contentious Medicaid work requirements and patient co-pays that limit access to Medicaid. 

Other contributors address how the ACA affects marginalized populations. Carrie Fry, Thomas McGuire, and Richard Frank link Medicaid expansion to lower rates of recidivism among the formerly incarcerated. Radhika Gore, Ritu Dhar, Sadia Mohaimin, Priscilla Lopez, Anna Divney, Jennifer Zanowiak, Lorna Thorpe, and Nadia Islam study primary care practices serving South Asian immigrants in New York City and highlight the importance of social context and organizational constraints in designing population health interventions. The issue also examines the economic effects of the ACA, especially on access to private and public health insurance. Both Mark Hall and Jean Abraham study instability in ACA health insurance markets, with Hall focusing on uncertainty arising from political factors and Abraham examining the factors that lead local markets to face high premiums and low insurer participation. Philip Rocco and Andrew Kelly explore the mechanisms included in the ACA to try to spur innovations in care delivery that both improve health and generate long-term cost savings.
As the COVID-19 pandemic affects healthcare in unprecedented ways, affordable healthcare access is critical. This RSF journal issue offers a timely, thoughtful consideration of one of the most pressing issues in American life.