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Hybrid Federalism, Partisan Politics, and Early Implementation of State Health Insurance Exchanges

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  • Elizabeth Rigby
  • Jake Haselswerdt

Abstract

A central provision of the Affordable Care Act is establishment of state-level health exchanges. While states are given the opportunity to develop and administer these private insurance marketplaces, their plans must meet certain minimum standards or risk preemption by the federal government. This policy design establishes a hybrid model of intergovernmental policy making, which may serve to heighten conflict during implementation and further polarize states' policies. Using new data on states' efforts to establish exchanges and repeated-events duration modeling, we examine states' early exchange implementation--identifying a key role for ideological and partisan considerations, as well as the implications of a federal policy design that puts conservative states in the difficult political position of choosing between resisting a law they oppose and preventing further federal intrusion. Copyright 2013, Oxford University Press.

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  • Elizabeth Rigby & Jake Haselswerdt, 2013. "Hybrid Federalism, Partisan Politics, and Early Implementation of State Health Insurance Exchanges," Publius: The Journal of Federalism, CSF Associates Inc., vol. 43(3), pages 368-391, July.
    • Handle: RePEc:oup:publus:v:43:y:2013:i:3:p:368-391
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    File URL: http://hdl.handle.net/10.1093/publius/pjt012
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    Cited by:

    1. Timothy Callaghan & Lawrence R. Jacobs, 2014. "Process Learning and the Implementation of Medicaid Reform," Publius: The Journal of Federalism, CSF Associates Inc., vol. 44(4), pages 541-563.
    2. Timothy Callaghan & Steven Sylvester, 2019. "Autism spectrum disorder, politics, and the generosity of insurance mandates in the United States," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-22, May.
    3. Shannon Conley & David M Konisky & Megan Mullin, 2023. "Delivering on Environmental Justice? U.S. State Implementation of the Justice40 Initiative," Publius: The Journal of Federalism, CSF Associates Inc., vol. 53(3), pages 349-377.
    4. Jennifer M. Jensen, 2017. "Governors and Partisan Polarization in the Federal Arena," Publius: The Journal of Federalism, CSF Associates Inc., vol. 47(3), pages 314-341.
    5. John Dinan, 2014. "Implementing Health Reform: Intergovernmental Bargaining and the Affordable Care Act," Publius: The Journal of Federalism, CSF Associates Inc., vol. 44(3), pages 399-425.

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