Jessica M. Mulligan and Heide Castañeda’s conclusion evaluates why the ACA remained so controversial years after its passage and presents four lessons learned from the ethnographic studies collected in the book. The authors conclude that people in the United States want and need affordable health insurance coverage. However, stratified approaches to expanding access have the result of generating resentment. Coupled with difficult enrollment processes and barriers to accessing coverage, the law became unpopular and unusable for many. Finally, the outright exclusion of groups such as immigrants—to appeal to nationalists—had direct impacts on the law’s success. These lessons are best understood through the frameworks of stratified citizenship (how different groups are viewed as deserving based on a gradation of rights and opportunities), notions of risk, and the devolution of responsibility onto individuals.
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