Association for Public Policy Analysis & Management

The Affordable Care Act is one of the largest national mandates in United States history. Beginning in 2010 and continuing to present day, states and municipalities have been tasked with the job of implementing the law and making it accessible to their citizens. Past scholars have studied this implementation, focusing on widespread factors such as institutional design and interest groups. While these large governmental institutions have certainly had their impact on ACA implementation, I study a much smaller element: the community. Inspired by Putnam’s Making Democracy Work: Civic Traditions in Modern Italy (1994), I study the role of the community and its impact on the success of health care institutions in the United States. I investigate this question using county-level data from the County Health Rankings. Preliminary results show that community factors such as number of membership associations per 10,000 people and income inequality have a significant impact on the success of the Affordable Care Act. Success is measured using the change in uninsured population in an individual county. I also use qualitative interviews with canvassers from an important health implementation interest group to get a first-hand account of the community’s role in this process. Ultimately, this project is important in that it examines a current debate in the health literature and it has wide-ranging implications for institutions.