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40 J. Legal Med. 421 (2020)
The Trillion Dollar Revolution: How the Affordable Care Act Transformed Politics, Law, and Health Care in America

handle is hein.journals/jlm40 and id is 442 raw text is: 


JOURNAL OF LEGAL MEDICINE                                          T     r     a
2020, VOL. 40, NOS. 3-4, 421-423                                      y  r     a
https://doi.org/10.1080/01947648.2020.1856568                       Taylor&Francis Group

BOOK   REVIEW


The  Trillion Dollar  Revolution:   How   the  Affordable   Care  Act  Transformed
Politics, Law,  and  Health   Care  in America,   Ezekiel J. Emanuel   and  Abbe   R.
Gluck, eds. (Public Affairs, 2020, pp. 464), ISBN-13: 9781541797772,   paperback


Reviewed  by  Erin C. Fuse Brown,  J.D., M.P.H.*

In the midst of an historic election, with the Supreme Court considering another exist-
ential challenge to the Affordable Care Act (ACA) and  with the nation plunged into a
public health and economic  crisis from the 2020 coronavirus pandemic, the ACA  is as
important  as ever. The ACA   matters. It matters to many  millions who  count on its
protections to access health coverage, particularly as they lose their job-based insurance
in the pandemic. It matters to voters and to their representatives tasked with the next
generation of health reform. It matters to states, the health care industry, and busi-
nesses who  have sunk innumerable  resources and time into making the ACA   work.
   The Trillion Dollar Revolution assesses the ACA  at 10 years, marking  its achieve-
ments,  trade-offs, shortfalls, impacts, and lessons for future reforms. The ACA was
both monumental and paradoxical. It   was  the single biggest social welfare legislation
enacted in 50 years and touched  every aspect of our sprawling health care system. Yet
the narrow  political window  for its passage meant  that the ACA   was  incremental,
building on, rather than fundamentally restructuring, our fragmented health care sys-
tem. The  ACA   was  imperfect because it inherited many  flaws of the existing health
care  system. Nevertheless,  the  ACA   achieved  something   quite revolutionary-it
changed  the minds of the American  public, who have since embraced notions of health
care access as a right and preexisting condition protections as a given.
   Edited by Ezekiel Emanuel and  Abbe Gluck, the book  reads like an insider's account
and  assessment of the ACA.  The  contributors are a veritable Who's Who  of lawyers,
health law scholars, health economists, health policy experts, and political leaders with
a front-row view of the ACA.  Divided into five parts, the essays discuss the ACA's (I)
policy goals, (II) implementation, (III) legal challenges, (IV) impacts, and (V) lessons
for the future.
   The book  is well suited for health law and policy students in college or graduate-
level courses, as well as for academics, journalists, health policymakers, and wonks.
Fittingly, the book  opens   with  a chapter  by  Timothy   Stoltzfus Jost and  John
McDonough, perhaps the two most knowledgeable individuals in the country about
the law and  policy of the ACA. This chapter  could stand by itself for its concise his-
tory of the ACA, what  drove it, what it did, what worked, and what it did not do.
   Historians and policy scholars will appreciate the first-person accounts of the diffi-
cult trade-offs in passage and challenges of implementation by those who were  in the
room  where  it happened, including Kathleen Sebelius, who was the Secretary of Health
&  Human   Services for the passage and implementation;  Nancy-Ann   DePearle, senior
health policy advisor to President Obama;  Peter Orszag, the director of the Office of

*Erin C. Fuse Brown, J.D., M.P.H., is the director of the Center for Law, Health & Society and an associate profes-
sor at Georgia State University College of Law. Her research focuses on the regulation of health care markets,
health reform, and consumer protections in health care.  efusebrown@gsu.edu
C 2021 American College of Legal Medicine

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