The contributors to this issue investigate the complex ways that policies of the Affordable Care Act (ACA) have diffused through the states over seven years of implementation. When the ACA was passed in 2010, states were given the option to set up their own health care exchanges, expand their Medicaid programs, and reform both their local public health and their health care delivery systems. These reforms significantly impacted citizens’ access to insurance. Contributors examine how local conditions account for variation in enrollment across states, analyze the evolution of Medicaid waivers in Republican-led states, show how early-adopting states affected later adopters, explore the role of public opinion in the diffusion of ACA policies, and argue for the importance of rhetorical framing when advocating in favor of the ACA.

Contributors. Frederick J. Boehmke, Timothy Callaghan, Rena Conti, Bruce A. Desmarais, Colleen M. Grogan, Jeffrey J. Harden, Lawrence Jacobs, David K. Jones, Andrew Karch, Elizabeth Maltby, Julianna Pacheco, Aaron Rosenthal, Abigail A. Rury, Phillip McMinn Singer, Craig Volden

David K. Jones is Assistant Professor of Health Law, Policy and Management at Boston University’s School of Public Health.

Julianna Pacheco is Associate Professor of Political Science at the University of Iowa.

Colleen M. Grogan is Professor in the School of Social Service Administration at the University of Chicago, former editor of Journal of Health Politics, Policy and Law, and coauthor of Healthy Voices, Unhealthy Silence: Advocacy and Health Policy for the Poor.