Unequal Coverage

The Experience of Health Care Reform in the United States

336 pages

10 hts, 2 fg, 1 map

December, 2017

ISBN: 9781479848737



Add to Cart Available: 12/1/2017

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Jessica Mulligan is Associate Professor of Health Policy and Management at Providence College. Her current research explores insurance, financial security, and health reform from the perspective of the newly insured and those who continue to lack coverage. She is the author of Unmanageable Care: An Ethnography of Health Care Privatization in Puerto Rico (NYU Press, 2014), as well as multiple journal articles. 

All books by Jessica M. Mulligan

Heide Castañeda is Associate Professor in the Department of Anthropology at the University of South Florida. Her primary research areas include medical anthropology, law and society, migration, migrant health, health policy, and constructs of citizenship. 

All books by Heide Castañeda

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.


  • "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."


  • 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

  • "This insightful and timely volume foregrounds individuals’ lived experiences of health reform—whether 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 law’s 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