Back to Results
Cover image of A Government of Insiders
Cover image of A Government of Insiders
Share this Title:

A Government of Insiders

The People Who Made the Affordable Care Act Possible

William Genieys

Publication Date
Binding Type

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...

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.

Reviews

Reviews

Carefully researched and full of novel insight about the genesis of the Affordable Care Act, A Government of Insiders is a unique and highly compelling contribution to the analysis of policy elites. This fascinating book should be of interest to students of health care policy and, more generally, to scholars working on the role of experts in policy development, in the United States and beyond.

Genieys focuses on a technocratic policy elite whose expertise and political savoir faire have been under-appreciated in the design and implementation of Obamacare. Like Tocqueville, he views the US from an implicitly comparative perspective. Although his interviews and sociographic analysis are more formal in style, the result is equally insightful.

About

Book Details

Publication Date
Status
Available
Trim Size
6
x
9
Pages
336
ISBN
9781421447681
Table of Contents

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

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

Author Bios
Featured Contributor

William Genieys, PhD

William Genieys is a research director at the Centre for European Studies and Comparative Politics.