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The state of American health coverage: the 2022 elections and the Affordable Care Act

Published online by Cambridge University Press:  16 October 2023

Mickael K. Gusmano Open the ORCID record for Mickael K. Gusmano [Opens in a new window]  and
Frank J. Thompson
Mickael K. Gusmano*
Affiliation:
Community and Population Health, Lehigh University, Bethlehem, PA, USA
Frank J. Thompson
Affiliation:
Public Affairs and Policy, Rutgers University, Newark, NJ, USA
*
Corresponding author: Mickael K. Gusmano; Email: Mig321@lehigh.edu
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Abstract

The Affordable Care Act of 2010 (ACA) was the most significant policy breakthrough to expand health insurance coverage in the USA in 45 years. Culminating a decade-long effort by Republicans to repeal and undermine the ACA, the Trump administration launched a panoply of executive initiatives to sabotage the law. Benefitting from Democratic control of both the House and Senate during its first 2 years, the Biden administration through legislative and executive initiatives made substantial headway in reversing Trump's sabotage and further reinvigorating the ACA. The 2022 elections witnessed a shift in the partisan milieu. Republicans gained control of the House of Representatives; Democrats scored modest gains in state elections. Emphasising two pivotal features of American governance – federalism and the outsized role of the courts – this essay examines the implications of this new partisan context for Biden's efforts to bolster ACA durability prior to the 2024 presidential election.

Keywords

ACAhealth reformBiden
Type
Perspective
Information
Health Economics, Policy and Law , First View , pp. 1 - 15
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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