ABSTRACT
This chapter introduces the major themes of the chapters that follow in this volume. The discussion begins by placing the Affordable Care Act (ACA) into a larger context of health care policy in the U.S., and making a case that the ACA is, in effect, an incremental change from previous health care policy decisions. A brief introduction to the issue of federalism in the context of health care policy follows.
The bulk of the chapter lays out the themes found throughout the book. We identify three prominent themes. First, states are different. By this, we mean that even states that seem similar are often very different in terms of their policy preferences and choices and that to truly understand state dynamics one must examine unique state circumstances. Second, states are policy “laboratories” in the sense that the ways in which states implement national policy will be something of a “trial-and-error” process. Finally, the importance of state history and culture is discussed. We argue that states are both shaped and constrained by their unique histories and cultures and that these factors determine the kinds of policy choices possible in the state.
