Despite its historic nature, passage of federal healthcare reform in March of 2010 represented only one step forward in a multistep policy-making process. The locus of policy-making has now shifted to the states, a key venue for implementing health care exchanges and other central provisions of the law. Yet, rather than moving forward on implementation of the law, the majority of states have resisted federal reform in one form or another. This paper examines this state-level resistance to “ObamaCare” during its first two years and considers potential explanations, identifying a much larger role for political factors than for economic considerations.
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