Not five minutes after the Affordable Care Act (ACA) was signed into law, in March 2010, Virginia's attorney general was suing to stop it. And yet, the ACA rolled out, in infamously bumpy fashion, and rolled on, fought and defended at every turn--despite President Obama's claim, in 2014, that its proponents and opponents could finally "stop fighting old political battles that keep us gridlocked." But not only would the battles not stop, as Obamacare Wars makes acutely clear, they spread from Washington, DC, to a variety of new arenas. The first thorough account of the implementation of the ACA, this book reveals the fissures the act exposed in the American federal system.

Obamacare Wars shows how the law's intergovernmental structure, which entails the participation of both the federal government and the states, has deeply shaped the politics of implementation. Focusing on the creation of insurance exchanges, the expansion of Medicaid, and execution of regulatory reforms, Daniel B