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Making Federalism Work? The Politics of Intergovernmental Collaboration and the PPACA

JHHSA, Vol. 37 No. 4, (2015)

The Patient Protection and Affordable Care Act (PPACA) is a complex piece of legislation that requires a high level of collaboration between actors at multiple levels of government, federal and state, to successfully implement its provisions. However, the polarized political environment in which the law was passed has created roadblocks for implementation, with Republican governors claiming that they will not negotiate with federal agencies over many of the law’s key details. Though the decisions of governors and of state legislatures are critical for policy implementation, much of the effort will require administrators at multiple levels of government, and often with different preferences, to collaborate with one another to set policy priorities and oversee the operation of key features of the law. This paper reports on the results of a recent in-depth survey of state-level administrators that examines the extent of state-federal collaboration to implement health reform. Using qualitative and quantitative indicators, I find that state administrators’ engagement in collaborative activity is generally robust. Even so, state administrators’ perceptions of their relationship with federal agents appear to vary by the partisan compositions of their respective states, suggesting that political conflict over the reform may pose some dilemmas for future implementation efforts.

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