The Administrative Presidency and Fractious Federalism: The Case of Obamacare

Growing executive branch discretion in the U.S. separation-of-powers system has elevated the importance of the administrative presidency. However, research on this topic has paid scant attention to federal policies that rely on the states to implement them. We seek to advance knowledge of the administrative presidency under conditions of fractious federalism by examining the nature and efficacy of the Obama administration’s efforts to secure state cooperation in implementing the Affordable Care Act (ACA). This law sought to assure that nearly all Americans would have health insurance. Despite strong partisan, ideological pressures on Republican policy makers in the states to refrain from implementing the ACA, the Obama administration has had some initial success in overcoming their resistance. Waivers have been a particularly valuable presidential tool.