Unequal Coverage: The Experience of Health Care Reform in the United States

Description

The Affordable Care Act set off an unprecedented wave of health insurance enrollment as the most sweeping overhaul of the U.S. health insurance system since 1965. In the years since its enactment, some 20 million uninsured Americans gained access to coverage. And yet, the law remained unpopular and politically vulnerable. While the ACA extended social protections to some groups, its implementation was troubled and the act itself created new forms of exclusion.  Access to affordable coverage options were highly segmented by state of residence, income, and citizenship status. Unequal Coverage documents the everyday experiences of individuals and families across the U.S. as they attempted to access coverage and care in the five years following the passage of the ACA.It argues that while the Affordable Care Act succeeded in expanding access to care, it did so unevenly, ultimately also generating inequality and stratification. The volume investigates the outcomes of the ACA in communities throughout the country and provides up-close, intimate portraits of individuals and groups trying to access and provide health care for both the newly insured and those who remain uncovered. The contributors use the ACA as a lens to examine more broadly how social welfare policies in a multiracial and multiethnic democracy purport to be inclusive while simultaneously embracing certain kinds of exclusions. Unequal Coverage concludes with an examination of the Affordable Care Act’s uncertain legacy under the new Presidential administration and considers what the future may hold for the American health care system. The book illustrates lessons learned and reveals how the law became a flashpoint for battles over inequality, fairness, and the role of government. Contents List of Illustrations Acknowledgments Introduction • Jessica M. Mulligan and Heide Castañeda Section I: Inclusions and Exclusions 1. Stratification by Immigration Status: Contradictory Exclusion and Inclusion after Health Care Reform • Heide Castañeda 2. Stratified Access: Seeking Dialysis Care in the Borderlands • Milena Andrea Melo 3. Stratification and “Universality”: Immigrants and Barriers to Coverage in Massachusetts • Tiffany D. Joseph 4. Stratification through Medicaid: Public Prenatal Care in New York City • Elise Andaya Section II: Implementation along the Red/Blue Divide 5. Segmented Risks: Eligibility and Resentment on Insurance Exchanges • Jessica M. Mulligan 6. Uninsured in America: Before and After the ACA • Susan Sered 7. “Texans Don’t Want Health Insurance”: Social Class and the ACA in a Red State • Emily K. Brunson Section III: The ACA’s Accountability Contradictions 8. The Responsibility to Maintain Health: Pharmaceutical Regulation of Chronic Disease among the Urban Poor • Susan J. Shaw 9. Outsourcing Responsibility: State Stewardship of Behavioral Health Care Services • Cathleen E. Willging and Elise M. Trott 10. Increasing Access, Increasing Responsibility: Activating the Newly Insured • Mary Alice Scott and Richard Wright Conclusion • Jessica M. Mulligan and Heide Castañeda About the Editors About the Contributors Index