During the 2008 federal campaign, Democratic presidential candidate Barack Obama placed comprehensive health care reform at the centre of his platform. In the light of the growing problems facing the US health care system, the time seemed ripe for another attempt to control health costs while expanding insurance coverage. Elected in the context of the deepest recession since World War II, President Obama nonetheless decided to reform the US health care system at the beginning of his presidency. Drawing on the historical institutionalist perspective, which stresses the effects of existing institutions and policy legacies on social policy development, this article analyzes health politics during the first fifteen months of the Obama administration before assessing the impact of the legislation enacted in March 2010. Although it does not radically break from the past, this legislation should bring about crucial changes to the US health care system.
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