The state of American health coverage: the 2022 elections and the Affordable Care Act

Mickael K. Gusmano and Frank J. Thompson

Health Economics, Policy and Law, 2024, vol. 19, issue 3, 292-306

Abstract: The Affordable Care Act of 2010 (ACA) was the most significant policy breakthrough to expand health insurance coverage in the USA in 45 years. Culminating a decade-long effort by Republicans to repeal and undermine the ACA, the Trump administration launched a panoply of executive initiatives to sabotage the law. Benefitting from Democratic control of both the House and Senate during its first 2 years, the Biden administration through legislative and executive initiatives made substantial headway in reversing Trump's sabotage and further reinvigorating the ACA. The 2022 elections witnessed a shift in the partisan milieu. Republicans gained control of the House of Representatives; Democrats scored modest gains in state elections. Emphasising two pivotal features of American governance – federalism and the outsized role of the courts – this essay examines the implications of this new partisan context for Biden's efforts to bolster ACA durability prior to the 2024 presidential election.

Date: 2024
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