Case Studies of Healthcare Reform in Neoliberal Capitalism

Using Social Structure of Accumulation (SSA) theory, I analyze how structural economic changes shaped two cases of US healthcare legislation: the Clinton Health Security Act (HSA) of 1994 and the Patient Protection and Affordable Care Act (ACA) of 2010. I argue that the failure of the HSA and the passage of the ACA must be understood in relation to their contemporary SSA—the set of dominant institutions and ideas that facilitates capitalist accumulation. In each case of reform, the structures of the proposed policies, as well as their support, opposition, and ultimate legislative outcomes, all reflect the concurrent restructuring of US capitalism. This analysis clarifies the interplay of neoliberal capitalism and US healthcare and contributes to our understanding of the connections between capitalist economic relations and the provision of healthcare.