Signed into law by President Obama in late March 2010, the Affordable Care Act (ACA) is the most ambitious and impactful federal health care legislation enacted in the United States since the adoption of Medicaid and Medicare in 1965. Highly controversial and politically contentious, the advent of the ACA is so closely associated with the president who signed it into law that it is widely known as Obamacare. Considering this, it is understandable that University Press of Kansas commissioned a book on the ACA for its Landmark Presidential Decisions series. Its eighth installment, Pragmatic Vision: Obama and the Enactment of the Affordable Care Act, by Meena Bose (Hofstra University), is, like the other books available in the series, a concise attempt to analyze key presidential decisions while putting them in their broader historical and political context.

Despite its short length, Pragmatic Vision covers a lot of ground; Bose discusses how health care reform moved onto the policy agenda over time before turning to the debate over this issue during the 2008 presidential campaign. This is followed by an overview of the legislative efforts and the involvement of President Obama. After explaining how the ACA was finally enacted after a protracted legislative process, the book turns to the implementation and survival of the legislation over the pas