An Engine of Change? The Affordable Care Act and the Shifting Politics of Demonstration Projects
Document Type
Article
Publication Date
7-2020
Publisher
Russell Sage Foundation
Source Publication
RSF: The Russell Sage Foundation Journal of the Social Sciences
Source ISSN
2377-8261
Original Item ID
DOI: 10.7758/RSF.2020.6.2.03
Abstract
The Patient Protection and Affordable Care Act (ACA) made a number of institutional investments intended to expand the federal government’s ability to scale successful demonstration projects into national policy. This article considers how the ACA has reshaped the politics of programmatic innovation in Medicare and Medicaid. A qualitative synthesis of demonstration results suggests that, although the ACA has removed several important veto points to the expansion of successful demonstration projects, numerous barriers to the scaling of reforms remain. These barriers include procedures and techniques that make it difficult to certify the “success” of demonstrations yet make their limitations highly legible. From the analysis, this article draws several lessons for future efforts at delivery-system and payment reform, as well as understandings of policy learning and innovation.
Recommended Citation
Rocco, Philip B. and Kelly, Andrew S., "An Engine of Change? The Affordable Care Act and the Shifting Politics of Demonstration Projects" (2020). History Faculty Research and Publications. 334.
https://epublications.marquette.edu/hist_fac/334
Comments
RSF: The Russell Sage Foundation Journal of the Social Sciences, Vol. 6, No. 2 (July 2020): 67-84. DOI.