Why is there a Differentiation Between States in the Implementation of Obamacare?
Literature Review Assignment #3 for Week/Module Seven
Nicholas Merritt
Dr. William Bowen
Liberty University
PLCY 804-B04-Subterm B Summer 2022
June 26, 2022
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Abstract
There was not one singular event that led to the original colonies rebelling against the
British crown and declaring an independence that led to a fierce Revolutionary War. A common
theme underlying the motivations for the revolt was freedom from a tyrannical government. A
tyranny so great that the founding fathers enshrined layer after layer of protection throughout the
Constitution. To form a more perfect union, those brave revolutionaries designed an entirely new
governmental system known as Federalism. Over time Federalism has shifted, branching out into
different variations, adapting to societal changes and revolving leaders. One thing remained the
same; a checks and balances system at the federal level, and a state sphere of power to check the
federal government. The power struggle between the two governments has led stark variations in
how federal policy is administered at the state or local government level. The federal government
can create legislation to achieve the goals of the administration, but ultimately it is up to the
states to implement them how they see fit. The Affordable Healthcare Act (ACA), commonly
known as Obamacare, was signed into law in 2010 and became the most sweeping healthcare
reform in the country since Medicare and Medicaid (Sage, 2011). Since the bill was signed into
law, some states have implemented the entire policy, others only portions, and some not at all.
This paper will explain why there is a differentiation between states in the implementation of
Obamacare. Through a theoretical framework, the Federalist model and Christian worldview will
be analyzed alongside findings from relevant literature on the same topic. Employing Federalism
in policy can seem counterproductive to progress, however, understanding why there is a
differentiation in state implementation is imperative to preserve the system that the founders
risked their freedom and their lives for.
Why is there a Differentiation Between States in the Implementation of Obamacare?
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Introduction
Federalism is a political organization that creates spheres of power for state and national
governments separating them from one another. Each sphere is representative of the
government’s presumptive responsibility. For example, the federal government is responsible for
national defense, something state governments have no business in. State governments hold the
power to appropriate private property and define and enforce their criminal system (Deep, 2012).
The Federalist model, though integral to our foundational Democracy, creates a power struggle
when policy is implemented at the federal level with the notion it will be implemented as such at
the state level and in reality the end result is not a clear cut. We see this struggle with issues such
as marijuana usage, same-sex marriage, and the Affordable Healthcare Act. The reason behind
these disparities is Federalism, and the founders used this model to prevent a government from
wielding too much power. The ACA is the most sweeping form of federal healthcare since
Medicaid, and because of the Federalist model, there are a variety of different ways it has been
implemented at the state level (Sage, 2011).
In the first literature assignment, I provided a theoretical framework questioning the
validity of the Electoral College. Upon further analysis, I saw more of a policy connection to
Federalism as it pertains to the implementation of the ACA. For the second literature
assignment, I synthesized findings from ten peer-reviewed articles reporting original research on
various aspects of the ACA and provided an evaluation of those articles in light of my research
question. The theoretical framework led me to the question “Why is there a Differentiation
Between States in the Implementation of Obamacare?” My research in the second assignment
provided several different explanations for these variations. In this assignment, I will use the
ACA as a policy example to enforce the role Federalism plays in the states implementation of
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national policy, as well as explain how the importance to maintaining this model of government
in keeping in line with the intention of the founding fathers.
Theoretical Framework
Federalism most closely follows the Biblical idea of the covenant. This covenantal
agreement mandates that power be shared amongst governing bodies to ensure the citizens are
protected from too powerful of a government (Elazar, 1980). The Federalist model provides
these protections, separating state and national governments, each with their own sphere of
authority or sovereignty. 1 Peter 2:13-14 tells us “submit yourselves for the Lord’s sake to every
human authority: whether to the emperor, as the supreme authority, or to governors, who are sent
by him to punish those who do wrong and to commend those who do right’. It is the Biblical
covenant of power sharing between governments that Federalism satisfies. When the Federal
government mandated the ACA, the states implemented it in various degrees based on what was
most constructive in their individuals spheres of power; thus upholding their Biblical covenant.
Dual Federalism perhaps best describes the relationship between biblical principles of
government and the covenant in regards to the ACA or federal policy in general. Biblical
principles serve as the foundation for Dual Federalism, and include God’s ultimate authority,
being made in God’s image, and the sinfulness of man. Since God is the ultimate authority,
government must be limited. Man is made in God’s image, created with inherent rights;
therefore, government must be limited. Mankind is also sinful, leading to injustice in all levels of
government, and because of this government must be limited (Fischer, 2013). Whether it be with
the separation of powers or the checks and balance system, the founders saw the necessity of
limiting government. Dual Federalism creates sovereign powers within the state and federal
governments respectively. The separation of power forcing the two government to not only share
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power, but restrain them, essentially dividing them amongst themselves (Cameron and Falleti,
2005). Their greatest protection from too strong of a federal government was the implementation
of Dual Federalism.
Dual Federalism rose to prominence as a result of the failure of the Articles of
Confederation which was ratified in 1781. The federal government was very weak and unable to
pay its debts from the American Revolution, leading to Shay’s Rebellion (Warren, 1905). Led by
Alexander Hamilton, the Federalists called for dissolution of the Articles of Convention, and
created the Constitution, which created the spheres of power for state and national government,
essentially creating a Dual Federalist system (Brown, 2017). Critical to the execution of Dual
Federalism is that state and national governments retain their individual sovereignty, having
authority in their own fields, but not the others (Feeley and Rubin, 2008). Dual Federalism,
coined by Edward Corwin, paired with Competitive Federalism are perhaps the most prominent
type of Federalism when implementing national policy like the ACA.
While Corwin would argue that Dual Federalism is dead, the governmental response to
the COVID pandemic is proof that it is alive and well. The national government enacted
mandates during the crisis that sought to put an end to the virus, but instead pit some state
governments against the federal government. Kincaid and Leckrone found that the crisis raised
questions about interpretations of “federal inaction” since party divisions led some to regard the
federal government’s response as inadequate while others viewed it as appropriate (Kincaid and
Leckrone, 2020). Dual Federalism played a major role in how the states capitulated or fought
back against national government mandates.
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The importance of Dual Federalism has led to numerous definitions that have been
refined over the years. Duke Professor Ernest Young defines it as, “connotating separate and
exclusive spheres of state and federal authority” (Young, 2014). The Yale Law Journal defines it
as the “division of authority between the states and the federal government” (Ablavsky, 2019).
However it is defined, the meaning of federalism remains the same; there is a clear separation of
power between the state and national government. This “layer-cake” form of Federalism
separates power, constructing two spheres of influence. Federalism comprises four major
components according to Corwin, the first of which is the sovereignty and equality of the two
centers of government. The powers between both centers of government retain sovereignty and
therefore are equal. The authority of the federal government prevails over all, except for when it
interferes with state law (Corwin, 1950).
Second, the federal government’s power is enumerated. Essentially, their powers are
limited to what the Constitution allows them to do. Regulating commerce, levying and collecting
taxes, and producing currency are some examples of those powers. By limiting what the federal
government can do, both Federalism and the Biblical mandate of a limited government are
accomplished (Calabresi, 1995). Third, the relationship between both the state and the national
government is more confrontational than collaborative. In contrast to Cooperative Federalism,
where the two governments work in a collaborative manner, Dual Federalism often puts the two
at odds (Farnsworth, 1999). Finally, the federal government has the capability of promoting only
a few purposes (Corwin, 1950). In other words, the federal government can levy and collect
taxes, but only use those funds for authorities within their sphere of power (Corwin, 1950).
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There are many forms of Federalism that have similarities to Dual Federalism in public
policy, but the one that differs the most in ideology is Creative Federalism. Creative Federalism
bypasses state government and gives the majority of the power to the federal government (Inman
and Rubinfeld, 1997). Many scholars promulgate that Dual Federalism is no longer a practice in
the country. Sotirios Barber argues that defending Dual Federalism is a self-defeating act
(Barber, 2014). Barber proposes that the US practices Marshallian Federalism which holds that
the national government can freely disregard the reserved power of the states (Barber, 2014). The
leaked draft decision on Roe v. Wade from the Supreme Court supports the argument that Dual
Federalism is still relevant, and rejects Barber’s opinion. Roe v. Wade is the federal law of the
land and has been for fifty years. Overturning it, and returning the power to the states on the
issue of abortion would uphold the Dual Federalist practice that satisfies the founders original
intent. Edward Rubin and Malcolm Feeley argue the same, that the decentralization model is the
most effective. According to them, states should not be guaranteed autonomy from
Constitutionally rooted laws (Rubin and Feeley, 2008).
Christian Worldview
Federalism in general calls for a limited government. Cooperative Federalism to a small
degree, Dual Federalism to a larger degree, and Elazar’s model to what I believe is the right
amount of limited government. Elazar creates a structurally protected state government that has
the power and authority to limit the federal government (Elazar, 1987). It also functionally
allows the two governments to work together. Ecclesiastes 4:9 declares “Two are better than one,
because they have a good reward for their toil”; when governments work together in a shared
rule system, the country flourishes and God’s will is fulfilled. Collaboration is critical, but there
must be restrictions to power. As Romans tells us, God is the ultimate authority, and he has
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bestowed authority upon man, therefore mankind must be limited in governmental power. When
governments are non-centralized they become limited.
The original sin of Adam and Eve have created a world of wickedness and evil, requiring
our government to be controlled and limited to prevent sin from overcoming good. The three
branches of government are imperative to control centralized power, but unless those branches of
government are checked, they could be overruled by sin (Fischer, 2013). “For all have sinned
and fall short of the glory of God”, in Romans, is one of the many verses that discusses the
sinfulness of mankind. Finally, we come to the covenant between man and God. Psalm 105 tells
us that “He remembers his covenant forever, the word that he commanded, for a thousand
generations, the covenant that he made with Abraham, his sworn promise to Isaac, which he
confirmed to Jacob as a statute, to Israel as an everlasting covenant”. Federalism includes this
covenant, or the contractual agreement that lies within the governmental relationship solidifying
shared power. God’s covenant calls for the love of one another through mutual respect and
accountability. Just as God made the covenant with us forever starting with Abraham, Federalism
fulfills this covenant by holding the governments accountable while also allowing for
collaboration through shared power (Fischer, 2013).
Theory/Model-Dual Federalism
Federalism in many of its forms best describe the Christian worldview of government. It
provides the most effective form of limitation on government as mandated by Biblical principles.
Moreover, Dual Federalism provides additional limitations on the national government by
empowering state governments. The sinfulness of man also calls for the restriction on
governmental powers. Legislation such as the ACA is seen by many as the federal government
overstepping their authority with the new mandate. Many states challenged the law, citing the
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federal government overreached their power. The Medicaid provision was a key factor in the
challenge, and while the Supreme Court ruled the expansion was Constitutional, they did bar the
federal government from penalizing states who did not follow the expansion procedure in the
ACA (Blake, 2012). The states response as well as the Supreme Court’s, display the limitations
on government required by Biblical mandate.
When the federal government passed the ACA, there was a wide range of implementation
practices between all the states. The reason for this differentiation is the continuation of the
Federalist system that the founding fathers created. Dual Federalism specifically, where both
state and federal governments maintain their own sphere of power and authority best follows the
Christian worldview of government and best explains why the states implemented the ACA in
different ways. The government financially acknowledges this relationship by incentivizing the
ACA (Katch et al., 2021). By February 2021, twelve states had yet to adopt the Medicaid
expansion under the ACA. Realizing the existence of Dual Federalism, the government had to
become creative in getting these states on board with the ACA. The American Rescue Plan Act of
2021 provided these non-compliant states with additional financial incentives should they
implement the Medicaid expansion (Corallo, 2021).
While Dual Federalism fuels the implementation process of the ACA, the ACA itself
enacts and reinforces Dual Federalism. The ACA grants an enormous amount of state autonomy
in how the law can be implanted. As a result, state politics tend to produce different choices in
implementation. States can copy practices from other states and choose the best implementation
process catered to their population (Gluck and Huberfeld, 2018). The government on the national
level wanted the legislation to work, and due to the unpopularity of the bill on the Republican
side, the ACA was designed to placate these complaints by allowing the states to implement it as
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they saw fit. This led to disparities across the country in coverage under the ACA, but there was
an increase in overall coverage thanks to Dual Federalism (Collins and Lambrew, 2019).
Findings from the Literature Search
The Dual Federalism model provides the best explanation for federal health policies
implemented at the state level, specifically the ACA. In light of this, the two areas of literature
that are most relevant to my research question are the states autonomy to choose, and politics and
polarization in healthcare implementation.
Literature Area #1 States Autonomy to Choose
States have historically been responsible for the healthcare process as a whole within
their sphere of power. In light of this, states have the capacity to fully implement the ACA health
exchanges themselves, or default to the federal exchange, the latter having a possible negative
exchange on the outcome of implementation (Noh and Krane, 2016). Prior to the ACA, the states
had a diverse Medicaid program in terms of eligibility requirements. Whether or not states decide
to expand Medicaid under the ACA is dependent on their participation in exchanges. Tax credits
are available in non-expansion states which is the reason for this difference (Frean et al., 2016).
The researchers found that factors such as the type and degree of state involvement, the state’s
choice in expanding Medicaid, and the state’s administrative capacity, determined the percentage
of eligible individuals who enrolled under the ACA (Noh and Krane, 2016). In these
circumstances, Federalism produced ACA outcomes due to prior polices, and then state choice
was exacerbated more by the ACA. The national government acknowledges Dual Federalism’s
effect on this instance and tries to enact Cooperative Federalism by offering waivers to states
choosing not to expand Medicaid, and continue to negotiate with the states to implement their
priorities (Noh and Krane, 2016).
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Rocco provides evidence that supports the hypothesis that Federalism plays the primary
role in the states dissimilar implementations of the ACA (Rocco, 2015). Using surveys from state
health officials across all fifty states, Rocco identifies two key points from those surveys. First,
Cooperative Federalism has been the reason states have implemented a large amount of the ACA,
but Medicaid expansion and health insurance exchanges remain an obstacle. The national
government realizes Dual Federalism is an obstacle in implementing all aspects of the ACA, and
as a result, make attempts to collaborate with the states, offering concessions or benefits simply
to advance the legislation. Second, partisanship in passing the ACA is correlated with which
states implement the law. This aspect will be covered in detail in the next literature area.
Garthwaite et al. found support for the hypothesis that Medicaid expansion under the
ACA varies across state lines based on the size of the expansion and the preexisting levels of
uncompensated healthcare (Garthwaite et al., 2019). It was also identified that even the slightest
deviation in implementation by the states can equal a meaningfully different outcome.
Geography, population size, finances, and capacity of the state are also factors determining how
the ACA is implemented and are integral reasons states should and do maintain autonomy in
ACA implementation. A uniform federal policy cannot be implemented equally in every state.
States had different healthcare policies before the ACA, some states have higher populations of
uninsured, other states simply do not have the finances to implement some of the ACA
provisions (Garthwaite et al., 2019). In light of this, the states must have autonomy in ACA
implementation, the national government know this, and Dual Federalism enforces it.
According to Kowalski, state policy decisions on ACA implementation had a direct effect
on the health insurance market (Kowalski, 2014). Kowalski found that market participants in the
five direct enforcement states were worse off by $245 dollars per participant compared to other
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states. These states ceded all authority on the ACA to the national government, joining in
Centralized Federalism. Generally, states tend to mirror their polices based on what other states
do or do not do. Seeing the negative impact the ACA had on the direct enforcement states
certainly played a role in how other states implemented the ACA. Because of Dual Federalism,
states are allowed to use the wait and see approach, observing the results of ACA implementation
in other states, adjusting policy in their state, or not implementing a provision at all.
Literature Area #2 Politics And Polarization In Healthcare Implementation
Polarization, politics, and partisanship play another key factor in the implementation of
the ACA at the state level. Barrilleaux and Rainey provide evidence to suggest politics, not
economics or state needs drives the decisions Governors make in implementing aspects of the
ACA (Barrilleaux and Rainey, 2014). Furthermore, their data suggests that Republican
Governors are more like to oppose expansion, and Democratic Governors with Republican led
legislatures are also more likely to oppose expansion. The researchers suggest that customizing
federal laws state by state would provide for a more balanced policy outcome. I think this
solution, though valid, would create a grey area in Federalist policy, and possibly infringe on the
sovereignty of the states. It is important to note that a majority of the research on this topic
highlights partisanship for the implementation of the ACA, while this particular study proves
there is implementation variation across the states, but for different reasons.
Dinan connects the influence state officials have on members of Congress when it
pertains to voting on certain legislation (Dinan, 2011). In the case of the ACA, state officials
offered their experience and expertise in this policy area, while also mobilizing public opinion,
and relying on direct lobbying (Dinan, 2011). In terms of Federalism, the end result of lower-
level government’s influence proves the bottom up approach the founders intended works. I
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would argue the same approach is taken when states initiate implementation of the ACA. State
governments implement the policy in a way that mirrors local government influence, and
ultimately the population of the state. According to Metzger’s research on the government’s
handling of the ACA, political polarization plays a crucial role in the implementation process
from all levels of government (Metzger, 2015). The ACA includes no Medicaid expansion from
the national government perspective if the states decide not to do so. This forces the two
governments to contribute in Cooperative Federalism in order to increase ACA participation.
Ensuring bipartisanship in the creation of laws like the ACA will only serve to aid in the
implementation of it by the states.
Travis et al. found that southern distinctiveness, or the theory that southern states are
unique in their policy choices, drives the decisions behind the policy in those states (Travis et al.,
2016). Based on the findings, the decisions in southern states are driven by politics, rather than
other factors compared to fellow states in ACA implementation (Travis et al., 2016).The southern
distinctiveness theory feeds into the polarization and partisanship of ACA implementation.
Dating back to slavery, southern states who historically lean Republican have been at odds with
northern states and the clash of ideologies leaches into policy implementation (Buttel, 1988). The
ACA was of course a product of the Democratic party, so naturally its implementation in
Republican led states is contested. The same can be said about states with Republican led
legislators (Dinan, 2011).
Discussion
Since the passage of the ACA, there has been a wide variety of implementation practices
at the state level. The direct enforcement states have implemented the entirety of the bill, while
other states have implemented portions to various degrees. The reason for this difference is the
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Federalist system put into place since the founding of the country. Federalism in general allows
for the states to diverge from national government policies, and Dual Federalism empowers the
states to decline federal laws like the ACA all together. The research question I proposed is “Why
is there a Differentiation Between States in the Implementation of Obamacare”? In researching
the answer to this question, there are several explanations why states implement the ACA
differently. All of which lead back to Federalism.
Federalism
There are scholars that assert that the Federalist system the founders put into place is no
longer applicable. Yale law professor Conor Friedersdorf argues that a more Cooperative
Federalism is no commonplace in policy. He writes “Today’s federalism also ensures that red and
blue states are forced to interact. In our highly integrated economic and political system, states
are always knocking into one another as one state’s policies affect citizens in another state.
When California passes climate-change regulation, Detroit carmakers are forced to manufacture
more environmentally friendly cars for everyone lest they lose the California market. When
Texas insists that school textbooks question evolution, school boards across the country find
themselves purchasing textbooks that are considerably more conservative than their population”
(Friedersdorf, 2017). Ernest Young argues that Dual Federalism has made its last stand, not in
domestic affairs, but foreign (Young, 2001).
Through my literature research, I found that Federalism in many forms is absolutely
practiced in today’s government. Moreover, Dual Federalism is also used, especially in the
implementation of the ACA. The ACA is not the exception to Federalism though. From the
legalization of marijuana, to same-sex marriage up until a few years ago, the national
government can pass legislation, but Federalism allows the states to implement or enforce their
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own policies. The framers knew that the separating of powers between the three branches of
government was not enough to prevent a tyrannical government (Thomas, 1999). States must
have the power to combat the federal government if necessary in order to protect the individual
liberty of its citizens. Federalism exists to protect the rights of the people, ensuring there is a
check on the federal government (Thomas, 1999).
Federalism does not only protect the individual rights of citizens, it also enforces Biblical
principles of government. Genesis 1:27 declares “So God created man in his own image, in the
image of God he created him; male and female he created them”. Since we are made in God’s
image, we are endowed with inalienable rights such as life, liberty, and property (Fischer, 2013).
Federalism protects these rights by granting states a sphere of authority separate from the
national government. One of the reasons states decided not to implement certain ACA provisions
was to protect the rights of their citizens. The states response to the ACA shows a theme of de-
centralization from the federal government. States are empowered to stand up to the national
government, leading to a weaker federal and stronger state government (Rodden, 2004). This is
not to say the national government does not want to retain dominance over the states, the ACA is
proof of that. Just as our two-party system plays a role in ACA implementation, it also plays a
role in the federal government’s agenda. Had the Republican party passed similar legislation,
surely Democratic states would respond the same.
One theme closely associated with my theory of Dual Federalism is the bottom up
approach used by the states in ACA implementation. Voigt and Blume found that electing
municipal governments locally and empowering federal units to veto some national level
legislation all have effects on economic variables (Voigt and Blume, 2012). Just as the states are
empowered to contest the federal government in regards to legislation, city and county
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governments are empowered as well. For example, Texas is one of the twelve states refusing to
expand Medicaid under the ACA, yet the researchers provide analysis that the city of Houston
exceeded their projected enrolled expectation by over 59,000 (Williams et al., 2015). The success
of the Houston Department of Health and Human Services (HDHHS) enforces the Federalist
idea that the lowest level governments can create change in spite of state and national
governments. It is the lowest level of government that can create policy best suited for their
constituents because of their geographical closeness in the situation.
Research Question
Why is there a Differentiation Between States in the Implementation of Obamacare? That
is the research question I proposed and although there was not one singular reason for the various
implementation practices, there was one overarching theme which was Dual Federalism. Dinan
provides support that policymakers on all levels have influence in what policy is created, how it
is created, and how it is implemented (Dinan, 2011). Rocco supports the hypothesis that
Federalism is alive and well in today’s government. Furthermore, more than one form of
Federalism is used depending on the situation, and in the case of the ACA, multiple forms are
used in one policy (Rocco, 2015). It is this practice that contributes the most to the differentiation
of the ACA. Barrilleaux and Rainey use a variable on politics driving ACA implementation that
is compatible with my dependent variable (Barrilleaux and Rainey, 2014). Their variable is of
course accurate as the two party system often leads to differences in policy implementation. Dual
Federalism in the implementation of the ACA is fueled by state choice and politics. Any
legislation like the ACA is not a one size fits all policy. State capacity, geography, and population
all determine the implementation process. States must have the autonomy to tailor federal policy
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to fit the needs of their constituents, and Dual Federalism provides that. The states autonomy also
feeds into the partisanship of our governmental system.
Garthwaite et al. informs my research question that ACA implementation differs across
state lines due to the fact that certain aspects of the law that do not fall in line with a certain
party’s principles will affect the overall outcome of implementation (Garthwaite et al., 2019).
There is also a connection here with southern distinctiveness. Southern states in general tend to
lean Republican, and the ACA was pushed through by a Democratic administration. Naturally,
the ACA would include policies not agreed with by Republican lawmakers, hence the difference
in implementation. Metzger’s analysis is similar to Garthwaite et al. enforcing my hypothesis
that states implement the ACA differently based on polarization, and politics. The majority of
scholarly literature on this subject focuses on a specific reason that the ACA was implemented
differently across states lines. Through my analysis, I have determined that this difference is due
to two broad aspects, state autonomy, and politics. This is how the Federalist system operates and
the ACA has been implemented to reflect it. The problem lies within the power of the national
government forcing policy on the states. Thanks to Dual Federalism, the states can push back and
implement or not implement federal policy based on what best suits their citizens. This research
question will fill a gap in the existing literature with respect to the importance of Federalism in
implementing the ACA as well as further federal policies.
Appendix
PLCY 804 Literature Review Worksheet
1. Topic: Federalism and State Implementation of Federal Law
2. Research Question: Why is there a Differentiation Between States in the Implementation of Obamacare?
3. Database(s) Searched: JSTOR, SAGE
4. Keywords Used in Search: States, ACA, Federalism, Differences, Implementation, State choices, policy outcomes, Local
leadership, Government, Influence, Intergovernmental, Governors, Oppose, Obamacare, Medicaid, Expansion, Geography,
Polarization, Agencies, State by State, Impact
Author/Date Keywords Notes
Elazar/1980 Political, Covenant,
Biblical
Biblical idea of the covenant, protection against the governments.
Cameron and
Falleti/2005
Federalism,
Separation of Power
How Federalism creates a separation of power
Young/2014 Dual Federalism The origins of Dual Federalism
Warren/1905 Shays’ Rebellion Creation of a new form of Federalism
Brown/2017 Federalism, Hamilton Hamilton and Federalist practices
Feeley and
Rubin/2008
Federalism Federalism defined in political system
Ablavsky/2019 Dual Federalism The coming of Dual Federalism
Corwin/1950 Dual Federalism Dual Federalism in today’s society
Kincaid and
Leckrone/2020
COVID-19,
Federalism
Recent research on Dual Federalism in today’s world
Calabresi/1995 Enumerated Powers The governments enumerated powers
Farnsworth/199
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Decentralized,
Federalism
Federalism and Decentralization in government policy
Inman and
Rubinfeld/1997
Federalism, Creative
Federalism
Why we should rethink the need for Federalism
Barber/2014 Dual Federalism,
Defending
Defending Dual Federalism is self-defeating
Elazar/1987 Federalism, Covenant Biblical principles of government
Blake/2012 Constitutionality,
ACA
How Constitutional is the ACA
Katch et
al./2021
ACA, American
Rescue Plan
Incentivizing Medicaid expansion under the ACA
Gluck and
Huberfeld/2018
Federalism,
Healthcare
How the ACA empowers Federalism
Collins and
Lambrew/2018
Federalism, ACA How the ACA empowers Federalism
Noh and
Krane/2016
Implementing, ACA,
State Choices, Policy
Outcomes
State involvement in choosing implementation practices and policies
Frean et al./2016 Mandate, Medicaid,
Expansion, ACA
Factors influencing state Medicaid expansion
Rocco/2015 Federalism, ACA,
Intergovernmental
Evidence supporting the ACA and its encouragement of Federalism
Garthwaite et
al./2019
Medicaid, Expansion,
ACA
Geography and previous state health polices in ACA implementation
Kowalski/2014 State, Impact, ACA State policies directly affect what provisions if any of the ACA are
implemented
Barrilleaux and
Rainey/2014
Governors, Oppose,
Obamacare, Medicaid
ACA implementation at the state level is affected by the two party system
Dinan/2011 State, Government,
Influence, ACA
Impact of state legislators on ACA implementation
Metzger/2015 Polarization, States,
Agencies
Polarization and lack of federal government Medicaid expansion affect ACA
implementation
Travis et al/2016 State, Differences,
Implementation, ACA
Southern states, who tend to lean more right implement less of the ACA than
other states
Buttel/1988 Sociology, Southern
Distinctiveness
The roots of southern distinctiveness
Young/2001 Dual Federalism Dual federalism is only applicable to foreign affairs
Thomas/1999 Federalism Why federalism is important
Rodden/2004 Federalism,
Decentralization
The empowerment of the state thanks to decentralization
Voigt and
Blume/2012
Federalism,
Decentralization
How federalism supports the bottom up approach
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References
Ablavsky, Gregory. 2019. “Empire States: The Coming of Dual Federalism.” The Yale Law
Journal 128 (1792): 1800. https://www.yalelawjournal.org/pdf/Ablavsky_oytqdr67.pdf.
Barber, Sotirios A. “Defending Dual Federalism: A Self-Defeating Act.” Nomos 55 : 3–21.
http://www.jstor.org/stable/24220372.
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