In the United States, the arc of health reform is long. But in what direction—and propelled by which political forces—is it bending? In a country ravaged by a pandemic that was only exacerbated by a fragmented health system, these are research questions with high stakes. If they are difficult to answer, it is in part because the stupefying tangle of layered and patchwork reforms that make up the U.S. health regime has produced a scholarship that is, by turns, equally fragmented. Even efforts to analyze the passage and implementation of a single reform like the Patient Protection and Affordable Care Act (ACA) are scattered across disciplinary journals and tucked into books that focus narrowly on one policy dimension or another.

James Brasfield’s The Affordable Care Act: At the Nexus of Politics and Policy cuts through this thicket. Rather than focusing on a single set of political dynamics or theoretical debates, Brasfield synthesizes an array of scholarship across multiple disciplines, investigating the forces that drove the ACA’s passage and inflected its implementation. Brasfield complements his analysis of the ACA’s political development with several helpful chapters condensing appraisals of the law’s effects on coverage expansion and cost control.

Brasfield’s subtitle—At the Nexus of Po