Federalism and State Legislative Opposition to the Affordable Care Act

The research investigated the legislation and related constitutional arguments used by certain state legislatures between 2010-2016 to challenge the constitutionality of the ACA and contributed to the literature on state oppositional strategies in the United States.

Assessing the growing opposition to the Affordable Care Act (ACA), introduced by Barack Obama during his presidency.


Dr Ilaria Di Gioia

Research background

The background to this research was the growing opposition to the Affordable Care Act (ACA), the health reform in the US carried out by President Obama. This research unpicked the legal strategies put forward by conservative states to oppose the implementation of the reform.

In particular, the research drew on that branch of federal studies that investigate the mechanisms by which state governments advance their interests vis- à -vis the national government.

The vast majority of work in this area has interpreted state interests as ‘safeguards of federalism’ and focused on the political and the judicial mechanisms by which states influence national policies.

How was the research been carried out?

Legal databases were interrogated to find state legislation in opposition to the ACA. Legislation was then classified to create a taxonomy that contributed to the study of the states’ rights movement in the United States.

Data were collected using two main databases:

  • The National Conference of State Legislatures databases of legislation filed in response to the ACA (one for 2011-2013, one for 2014 and one for 2015-2016) available to the public on its website.
  • LexisNexis State Net, a 50-state legislation tracking platform available under subscription.

Research outcomes

The research shed light on the interaction of policy interests and constitutional litigation in American federalism.

Dr Di Gioia presented her research at the Library of Congress in Washington, DC and is several academic conferences in the United States and Europe.

Findings of her research have been published in The University of Detroit Mercy Law Review and have shaped two further PhD projects on intergovernmental relations currently being undertaken at Birmingham City University.