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.
- © 2020 Russell Sage Foundation. Rocco, Philip, and Andrew S. Kelly. 2020. “An Engine of Change? The Affordable Care Act and the Shifting Politics of Demonstration Projects.” RSF: The Russell Sage Foundation Journal of the Social Sciences 6(2): 67–84. DOI: 10.7758/RSF.2020.6.2.03. Direct correspondence to: Philip Rocco at philip.rocco{at}marquette.edu, Department of Political Science, Marquette University, P.O. Box 1881, Milwaukee, WI 53201.
Open Access Policy: RSF: The Russell Sage Foundation Journal of the Social Sciences is an open access journal. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.