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  • Print publication year: 2019
  • Online publication date: September 2019

8 - Policy Design, Polarization, and the Affordable Care Act


In 2010, the Democratic Congress narrowly passed and President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA) – the most significant expansion of health coverage since the enactment of Medicare and Medicaid in 1965. In addition to mandating that individuals have qualifying health coverage or pay a tax penalty, the law imposed a host of regulations on insurance companies concerning the plans offered, premiums charged, and denial of coverage. Two additional provisions directly implicated the states. First, the ACA expanded eligibility for Medicaid (the subject of Chapter 4) to include all able-bodied adults under the age of 65 up to 133 percent of the federal poverty level.

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