Abstract

Universal health care coverage has long been seen as an unattainable goal for Americans. With the Affordable Care Act, the Obama administration addressed the issue with a complex system of mandates, subsidies, and state marketplaces. The implementation of the reform encountered many obstacles including legal challenges, a congressional shut down, system failure, and, recently, a growing number of state legislatures (23 to date) enacting measures to nullify or opt out of the reform. This paper examines the resistance to the Act in two interrelated dimensions: legal challenges and state legislative opposition. These two dimensions of resistance are explored in order to speculate on the legal and political sustainability of the reform. Ultimately, the discussion on the sustainability of health care reform sheds considerable light on the broader sustainability of federal intervention in social policies (gun control, abortion, immigration, death penalty, drug control).