Remodeling the Model: Policy Transfer and the Implementation of the Affordable Care Act in Massachusetts

Abstract

Scholarship on policy transfer has readily described the movement of policy from states to the national government and, vice versa, from the national government to the states. However, little is known about the interaction between these processes or instances in which a state inspires national reform but is then required to implement the national government’s version of the same policy. This paper considers the extent to which policy remodeling—the recalibration of an existing policy in the face of national demands—leads to changes in how a policy is implemented in “model” states. We specifically examine Massachusetts’s implementation of the Patient Protection and Affordable Care Act, the 2010 national health reform law that borrowed heavily from the near-universal insurance system created in Massachusetts in 2006. Although policy remodeling did not upend model policy arrangements, it did necessitate a blend of policy maintenance and reinvention, which, in turn, posed distinctive political and administrat...