ABSTRACT
Health care reform in Michigan, much like across the country, was fraught with challenges. The issue impassioned citizens and inflamed lawmakers on each side of the aisle, and while partisanship was the primary dividing line, in Michigan it was not a firm one. The case of Michigan is unique and informative because it highlights the sheer complexity of federal policy implementation. It highlights the partisan divisiveness that has become increasingly common in our society, and it highlights the interplay among citizens, third-party actors, and local and state government officials.
Few states were as divided as Michigan over the ACA. What seemed like a simple math problem, tallying Republicans and Democrats became so much more than that. The chaotic nature with which the state was split on support of the ACA, both joining lawsuits and attempting to push forward the law; the slow struggle toward Medicaid expansion that resulted in many conservatives voting to expand Medicaid; and the perfectly timed obstructionist effort to implode the state exchange that resulted in Michigan missing out on both jobs and funding. The case of Michigan illustrates the complexity, partisanship, and bitterness that go into policymaking and implementation.
