A Government of Insiders

The People Who Made the Affordable Care Act Possible

William Genieys, Melanie Mauthner

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English

Johns Hopkins University Press
12 February 2024

Central government policies; Medical & healthcare law; Public health & preventive medicine; Medicolegal issues

"Discover the hidden forces that shaped one of the most significant health care reforms in US history.

In A Government of Insiders, William Genieys traces the winding path from the failed health policy priorities of the Clinton administration to the passage of the Affordable Care Act (ACA). Genieys uncovers the pivotal role of a committed group of unelected governmental elites known as ""long-term insiders"" who meticulously developed policy ideas and political connections. During George W. Bush's presidency, these insiders reconceptualized the foundations of a far-reaching health coverage reform both within and outside the public sector.

When President Obama took office, these insiders returned to positions of power and ensured that their reform vision took center stage. Genieys highlights how these people were instrumental in crafting and passing the ACA by integrating existing programs like Medicare and Medicaid, engaging market forces with an individual mandate and health care marketplaces, and addressing the crucial issue of cost containment.

By shedding light on the action of these health coverage policy elites and their role as custodians of the public interest, Genieys challenges traditional assumptions about the influence of economic elites and reveals the positive role of unelected professionals in advancing the common good. A Government of Insiders is a groundbreaking exploration of the unseen forces behind major policy reform, providing a fresh perspective on the dynamics of power in American politics."

By: William Genieys
Translated by: Melanie Mauthner
Imprint: Johns Hopkins University Press
Country of Publication: United States
Dimensions: Height: 229mm, Width: 152mm, Spine: 22mm
Weight: 454g
ISBN: 9781421447681
ISBN 10: 1421447681
Pages: 336
Publication Date: 12 February 2024
Audience: General/trade , ELT Advanced
Format: Paperback
Publisher's Status: Active

"Foreword, by Larry Brown Acknowledgments List of Tables Acronyms and Abbreviations Introduction Part I. The Custodianship of State Policies: A Government Out of Sight Chapter 1. A Government of Insiders: Unelected Governmental Elites Acting as Custodians of State Policies Chapter 2. Variations in the Custodian Role: From the NHI Project to the Clinton Plan Part II. The Making of Long-Term Health Insiders Chapter 3. Mapping the Health Coverage Policy Elites Chapter 4. The Clinton Plan Veterans: Career Paths Marked by a Collective Failure Chapter 5. From Late Clintonism to Obama: Shared Career Paths? Part III. The Hidden Origins of the Affordable Care Act: Elite Configurations and Programmatic Changes Chapter 6. The Clinton Plan: Programmatic Fragmentation and Divided Elites Chapter 7. The Impossible Government of ""Strangers"" Chapter 8. The George W. Bush Years: Clinton Plan Veterans Make the Next Reform Possible Chapter 9. Behind the Congressional Votes: Custodianship and the Politics of Accommodation Conclusion Appendix 1. Methodology: A Programmatic Elite Framework Appendix 2. Interviews for the OPERA (2009-2012) and PRoAcTA (2018-2021) Research Programs Notes Bibliography Index"

William Genieys is a research professor at the Centre for European Studies and Comparative Politics at Sciences Po Paris.