About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

108 Geo. L.J. 495 (2019-2020)
Affordable Care Act Entrenchment

handle is hein.journals/glj108 and id is 503 raw text is: ARTICLES Affordable Care Act Entrenchment ABBE R. GLUCK* & THOMAS SCOTT-RAILTON** The Affordable Care Act (ACA) is the most challenged-and the most resilient-statute in modern American history. Through and despite hun- dreds of court challenges, scores of congressional repeal efforts, unex- pected state resistance, gutting by the Supreme Court, unprecedented administrative strangulation, and criticism from the beginning that the statute did not go far enough to embrace the principle of universal healthcare, the ACA has changed the way many Americans and the polit- ical arena think about healthcare and the entitlement to it. Over its ten-year lifespan, the ACA went from being the rallying cry of the GOP in 2010, to the center of the Democratic platform in 2018, cata- pulting universal healthcare to the top of the 2020 Democratic presiden- tial primary agenda. It began as a statute criticized for its practical compromises and its incrementalism-including leaving most insurance in the private market and retaining state control over large swaths of health policy-but those very compromises have, surprisingly, proved key to the ACA's resilience. They have also been instrumental in the ACA's entrenchment of not only its own reforms but also a broader, emerging principle of a universal right to healthcare. The idea of health- care for all Americans administered through the federal government was long viewed as political suicide, including as recently as the 2016 presi- dential election. In an astonishingly fast turnaround, that idea has now been considered and debated by every Democratic presidential hopeful. The ACA's principles have been codified outside of federal law and into state law, voted on in ballot initiatives, and advocated for on late- night TV. The Supreme Court has treated the ACA differently from other laws. Core features of the ACA-a law that Republicans have sought to repeal scores of times-are now mainstream positions in the Republican Party. This Article offers a comprehensive account of the ACA's structure, the challenges it survived, and how a law that itself evinces a philosophi- cal ambivalence about the right to government-provided healthcare has * Professor of Law and Faculty Director, Solomon Center for Health Law and Policy, Yale Law School; Professor of Medicine, Yale Medical School. 0 2020, Abbe R. Gluck & Thomas Scott-Railton. We thank Erica Turret, Yale Law School Class of 2020, for her extraordinary assistance and expertise. Thanks also to Bruce Ackerman, Jack Balkin, Lawrence Gostin, Sumer Ghazala, Nicole Huberfeld, Tim Jost, Eugene Rusyn, Sara Rosenbaum, Kristin Underhill, participants at workshops at Emory, Seton Hall, and Yale law schools, and the terrific editors at The Georgetown Law Journal. ** Yale Law School, J.D. 2018. 495

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most