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The Health Care CaseThe Supreme Court's Decision and Its Implications$
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Nathaniel Persily, Gillian E. Metzger, and Trevor W. Morrison

Print publication date: 2013

Print ISBN-13: 9780199301058

Published to Oxford Scholarship Online: September 2013

DOI: 10.1093/acprof:oso/9780199301058.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 25 January 2022

Health Policy Devolution and the Institutional Hydraulics of the Affordable Care Act

Health Policy Devolution and the Institutional Hydraulics of the Affordable Care Act

(p.359) Chapter 20 Health Policy Devolution and the Institutional Hydraulics of the Affordable Care Act
The Health Care Case

Theodore W. Ruger

Oxford University Press

This chapter seeks to understand, and tentatively predict, various aspects of the structural interplay between states and the federal government in the early implementation of the ACA, by drawing on lessons from health care federalism in Medicaid and related programs in the recent past. States now face major choices about establishing and operating health insurance exchanges and about expanding and reorganizing the delivery of services to their Medicaid populations. The federal executive is already engaged in a flurry of formal rulemaking explicating the breadth of discretion states will have in implementing the ACA’s statutory terms, and concurrently in informal negotiations with dozens of states already about particular waivers and other forms of policy variation. Predicting the contours of this federalism game is informed by the growing attention scholars have begun to pay to the complex dynamics of federalism within the many policy fields where federal and state authority overlap.

Keywords:   Supreme Court, Constitution, Medicaid, constitutional law, health policy, Affordable Care Act, Commerce Clause, federalism, spending power, NFIB v. Sebelius

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