Unequal Coverage

The Experience of Health Care Reform in the United States

By: Heide Castaneda, Jessica M. Mulligan (Editor)

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Paperback | 25 January 2018

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336 Pages

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15.2 x 22.8 x 2.5

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The Affordable Care Act's impact on coverage, access to care, and systematic exclusion in our health care system

The Affordable Care Act set off an unprecedented wave of health insurance enrollment as the most sweeping overhaul of the U.S. health insurance system since 1965. In the years since its enactment, some 20 million uninsured Americans gained access to coverage. And yet, the law remained unpopular and politically vulnerable. While the ACA extended social protections to some groups, its implementation was troubled and the act itself created new forms of exclusion. Access to affordable coverage options were highly segmented by state of residence, income, and citizenship status.

Unequal Coverage documents the everyday experiences of individuals and families across the U.S. as they attempted to access coverage and care in the five years following the passage of the ACA.It argues that while the Affordable Care Act succeeded in expanding access to care, it did so unevenly, ultimately also generating inequality and stratification. The volume investigates the outcomes of the ACA in communities throughout the country and provides up-close, intimate portraits of individuals and groups trying to access and provide health care for both the newly insured and those who remain uncovered. The contributors use the ACA as a lens to examine more broadly how social welfare policies in a multiracial and multiethnic democracy purport to be inclusive while simultaneously embracing certain kinds of exclusions.

Unequal Coverage concludes with an examination of the Affordable Care Act's uncertain legacy under the new Presidential administration and considers what the future may hold for the American health care system. The book illustrates lessons learned and reveals how the law became a flashpoint for battles over inequality, fairness, and the role of government.

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Industry Reviews

Unequal Coverage,edited by Mulligan and Castan~eda, is an excellent group of ethnographic studies describing the lived experiences of unfair health insurance in the United States. It is must-reading for anyone interested in understanding the Affordable Care Act and how it has impacted the population and health care providers. * Choice *
Unequal Coverage will be of interest to medical anthropologists and sociologists, as well as their students, as it is a book that captures the lived experience of health reform. But this book should not be missed by those of us who are students of policy and politics, as it is a fascinating study in implementation. It captures the many layers of unintended consequences that invariably flow from incremental policy strategies designed to shore up gaps in insurance coverage within complex, market-based health care systems. Readers will come away appreciating that the unintended consequences of the ACA have been far-reaching, extending well beyond the health care system. -- Medical Anthropology Quarterly
This insightful and timely volume foregrounds individuals lived experiences of health reformwhether they were included in the reform or excluded. By attending to the nuances of political subjectivities, the complexity of regional variation, and the messiness of the laws implementation on the ground, the contributors help illuminate how a middle-of-road reform became one of the most politically contentious issues of our time. -- Sarah Horton, author ,They Leave Their Kidneys in the Fields: Illness, Injury, and "Illegality" among U.S. Farmworkers

"If there was ever a time to shed light on the policies fostering health care inequality in the United States, that time is now. The contributors to this volume invite us to consider how healthcare reform creates often contradictory inclusions and exclusions for different populations across the country, and documents the real-world impacts of policies that foster stratification and specific notions of risk and responsibility. This book will appeal to health policy students and scholars, but is also an engaging ethnographic work accessible to any reader interested in understanding the inequalities created by the U.S. healthcare system."

-- Mark Nichter,Regents Professor of Anthropology, Public Health and Family Medicine University of Arizona

Unequal Coverage presents telling ethnographic studies of how the Affordable Care Act is explained in the distinctive local moral worlds that constitute inequality in America. It is the most important effort by anthropologists that I have come across to describe the lived experience of inequality in health insurance. Timely and salient!

-- Arthur Kleinman, MD,Professor of Anthropology and Psychiatry, Harvard University

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