ABSTRACT
This concluding chapter brings together the findings and lessons from our case studies to reach some broad conclusions about state implementation of the ACA. We identify four emergent themes: federalism matters; partisanship explains some, but not all, state decisions; the “battle” over the ACA is really about the proper role of government in society; state decision-making is both important and unique; and state history and culture matter.
From these themes we list four broad conclusions. First, health care policy highly conflictual in a policy sense. Second, the essence of the debate about health care is about who should pay for health care in the U.S. Third, political and societal values matter, and the conflicts between these values play out differently in each case. Finally, incrementalism in health care policy in the U.S. is thriving, and the ACA is, in the end, an incremental change to existing health care policy.
