Delegated Governance in the Affordable Care Act

• Published in: Journal of health politics, policy and law policy and law, 2011-06, Vol.36 (3), p.387-391
• Main Authors: Morgan, Kimberly J., Campbell, Andrea Louise
• Format: Article
• Language: English
• Subjects: Employees' benefit plans; Federal Government; Governance; Government Agencies; Health care; Health Care Services; Health Insurance; Humans; Insurance; Law; Legislation; Managed care; Managed Care Services; Medicaid program; Medicare; Medicine and Health; National Health Programs - legislation & jurisprudence; National Health Programs - organization & administration; Participation; Patient Protection and Affordable Care Act - legislation & jurisprudence; Patient Protection and Affordable Care Act - organization & administration; Patients; Politics; Public Health and Health Policy; Public Policy; Regulation; Small Businesses; Social Programs; Sociology; State Government; U.S.A; Uninsured persons; United States; Welfare state
• ISSN: 0361-6878; 1527-1927
• DOI: 10.1215/03616878-1271000

One of the many claims made about the Patient Protection and Affordable Care Act (ACA), signed into law in March 2010, was that it represented a massive "takeover" of the health care sector by the federal government (Boehner 2010). To the contrary: the ACA pursues many of its goals with only a limited increase in federal governing authority: Building upon the existing system of employer-sponsored insurance, the law subsidizes coverage for the uninsured through either private insurers or state Medicaid programs, many of which already contract with private managed care companies to provide insurance. States bear the main responsibility for setting up temporary high-risk pools and health plan exchanges for individuals and small businesses, and they will be responsible for enforcing new federal standards for insurer policies (Nichols 2010). However, direct federal government involvement is truncated. Federal agencies will have to write a mountain of regulations, oversee the actions of state governments, serve as a fallback if states fail or refuse to perform their assigned tasks, and of course pay much of the bill. Nevertheless, this is a far cry from national health insurance, Medicare for all, or even a national public option for the uninsured. The ACA is hence the latest example of delegated governance -- a pervasive and long-standing feature of the American welfare state in which responsibilities for administering and delivering social programs are shifted away from the federal government to private agents or lower levels of government. Adapted from the source document.