The Dysfunctional Politics of the Affordable Care Act
by Greg M. Shaw
May 2017, 208pp, 6 1/8x9 1/4
1 volume, Praeger

Hardcover: 978-1-4408-4002-9
$75, £58, 66€, A103
eBook Available: 978-1-4408-4003-6
Please contact your preferred eBook vendor for pricing.

The percentage of America’s gross domestic product spent on health care is rising faster than the GDP itself, meaning costs are on an unsustainable trajectory.

While analyzing the contentious debate over health care reform, this much-needed study also challenges the argument that treating medical patients like shoppers can significantly reduce health expenditures.

This revealing work focuses on the politics surrounding the Affordable Care Act (ACA), explaining how and why supporters and opponents have approached the issue as they have since the act’s passage in 2010. The first book to systematically examine public knowledge of the ACA across time, it also documents how that knowledge has remained essentially static since 2010, despite the importance of health-policy reform to every American.

An important book for anyone concerned about the skyrocketing costs of health care in the United States, the work accomplishes three main tasks intended to help readers better understand one of the most important policy challenges of our time. The early chapters explain why congressional Democrats designed the Affordable Care Act of 2010 as they did, clarifies some of the consequences of the act’s features, and examines why Republicans have fought the implementation of the law so fiercely. The study then looks at how the intersection of economics and politics applies to the ACA. Finally, the book details what the public knows—and doesn’t know—about the law and discusses the prospects for citizens gaining the knowledge they should have about the overall issue of health-policy reform.


  • Explains why the two political parties have staked out such different positions on health care reform
  • Documents what the public knows about the Affordable Care Act and how individuals' party identification significantly affects their knowledge
  • Challenges the arguments for consumer-driven health care plans by gathering evidence from numerous studies of consumer behavior under various kinds of insurance plans
  • Offers a well-informed critique of the political arguments surrounding the expansion of Medicaid, showing how this policy diffusion leverages the weak arguments and evidence for consumer-driven health care plans
Greg M. Shaw, PhD, is professor and chair of the Political Science Department at Illinois Wesleyan University. His research focuses on healthcare and welfare politics and American public opinion. Shaw is the author of two previous books published by ABC-CLIO, The Welfare Debate and The Healthcare Debate. His writing on American social policy has appeared in Political Research Quarterly, Political Science Quarterly, and other venues, including Public Opinion Quarterly, where he served on the editorial team. Shaw holds a doctorate in political science from Columbia University.


"A comprehensive and convincing review of the politics of Obamacare. . . . This is an excellent book and well worth the read for those interested in health care or polarization more broadly. Summing Up: Recommended. Lower-division undergraduates through faculty."—Choice, January 1, 2018

“Concise and well written, The Dysfunctional Politics of the Affordable Care Act provides an up-to-date overview of the politics surrounding the largest and most controversial U.S. health care legislation in decades. This book is a must-read for those interested in the recent evolution of, and the ongoing debate over, U.S. health care reform.” —Daniel Béland, Canada Research Chair in Public Policy and Professor at the Johnson-Shoyama Graduate School of Public Policy at the University of Saskatchewan; Coauthor of Obamacare Wars: Federalism, State Politics, and the Affordable Care Act

“This is a compelling book that shows persuasively how bitter partisan conflict and polarization have prevented both political leaders and the American public from thinking and acting in level-headed ways to complete the current major effort at health care reform. It is a story involving political manipulation, partisan bias, and emotion, in which the nation’s leaders have missed an opportunity to engage and educate the American public on the knottiest and most important issue affecting its well-being. Shaw describes how the public, sadly, has not been able to sort this out on its own. Leadership matters.” —Robert Y. Shapiro, Wallace Sayre Professor of Government at Columbia University and coauthor of The Rational Public: Fifty Years of Trends in Americans' Policy Preferences and Politicians Don't Pander: Political Manipulation and the Loss of Democratic Responsiveness
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