TY - JOUR
T1 - The secretary shall...
T2 - Implementing the affordable care act's private insurance expansions
AU - Glied, Sherry
AU - Khalid, Aryana
AU - Tavenner, Marilyn B.
N1 - Publisher Copyright:
© 2020 by Duke University Press
PY - 2020/8
Y1 - 2020/8
N2 - The federal bureaucracy played a critical role in implementing most aspects of the Affordable Care Act's private insurance coverage expansion. Through brief case studies, the authors review three dimensions of this role: the development of the Center for Consumer Information and Insurance Oversight, rulemaking in the formulation of the essential health benefits package, and the implementation of the federal website. They relate these to themes in the public administration literature. Politics-both through state decisions and through continuing congressional action (and inaction)-pervaded the implementation process. The challenges of staffing and situating the new bureaucracy effectively changed vertical boundaries within the Department of Health and Human Services, with long-lasting consequences. Finally, the complex design of the policy itself made passage of the legislation easier but implementation much more difficult. Ultimately, however, implementation was remarkably successful, achieving improvements in coverage consistent with the Congressional Budget Office's projections.
AB - The federal bureaucracy played a critical role in implementing most aspects of the Affordable Care Act's private insurance coverage expansion. Through brief case studies, the authors review three dimensions of this role: the development of the Center for Consumer Information and Insurance Oversight, rulemaking in the formulation of the essential health benefits package, and the implementation of the federal website. They relate these to themes in the public administration literature. Politics-both through state decisions and through continuing congressional action (and inaction)-pervaded the implementation process. The challenges of staffing and situating the new bureaucracy effectively changed vertical boundaries within the Department of Health and Human Services, with long-lasting consequences. Finally, the complex design of the policy itself made passage of the legislation easier but implementation much more difficult. Ultimately, however, implementation was remarkably successful, achieving improvements in coverage consistent with the Congressional Budget Office's projections.
KW - Affordable Care Act
KW - Implementation
KW - Public management
UR - http://www.scopus.com/inward/record.url?scp=85087528758&partnerID=8YFLogxK
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U2 - 10.1215/03616878-8255457
DO - 10.1215/03616878-8255457
M3 - Review article
C2 - 32186329
AN - SCOPUS:85087528758
VL - 45
SP - 517
EP - 532
JO - Journal of Health Politics, Policy and Law
JF - Journal of Health Politics, Policy and Law
SN - 0361-6878
IS - 4
ER -