Against All Odds: How Health Reform Endures

A groundbreaking examination of how the Affordable Care Act built public trust, withstood opposition, and redefined civic engagement.

Can a bold new social program cultivate a supportive constituency, even as it is buffeted by political turbulence? In Against All Odds, Lawrence R. Jacobs, Ling Zhu, and Suzanne Mettler track the improbable journey of the Affordable Care Act, from its launch and fraught implementation, through years of fiery resistance to today, when it stands accepted as a pillar of U.S. health policy. Expanding coverage to millions, the law gradually softened polarization--even amongst Republicans--by delivering tangible benefits and restoring confidence that government can meet public needs. By 2025, sweeping budget cuts left the ACA's core protections intact, ensuring future coalitions can strengthen and expand them. Departing from the usual winner-loser narrative of lawmaking, Against All Odds reveals how health reform has nurtured a sense of shared responsibility for community well-being and illuminated a path toward renewal in American politics.

Lawrence R. Jacobs is an American political scientist and founder and director of the Center for the Study of Politics and Governance (CSPG) at the University of Minnesota. He is the McKnight Presidential Chair in Political Science and the Walter F. and Joan Mondale Chair for Political Studies in Humphrey School of Public Affairs at the University of Minnesota. Jacobs has written or edited, alone or collaboratively, 18 books and over 100 scholarly articles in addition to numerous reports and media essays on American democracy, health care reform, national elections, political communications, and economic inequality. His latest books are Picking Winners: Citizenship, Central Banks, and Consumer Finance and Democracy Under Fire: Donald Trump and the Breaking of American History. He is a Fellow of the National Academy of Social Insurance and was elected a Fellow of the American Academy of Arts and Sciences.

Ling Zhu is Professor of Political Science at the University of Houston. Her research has appeared in American Political Science Review, American Journal of Political Science, American Journal of Public Health, Journal of Public Administration Research and Theory, and Policy Studies Journal, among others.

Suzanne Mettler is the John L. Senior Professor of American Institutions in the Government Department at Cornell University. She is the author or co-author of eight books, most recently Rural Versus Urban: The Growing Divide that Threatens Democracy, co-authored with Trevor Brown and Four Threats: The Recurring Crises of American Democracy, with Robert C. Lieberman. She has published numerous articles in refereed journals, including the American Political Science Review and Perspectives on Politics, and op-eds and essays for popular outlets. Mettler has been elected to the American Academy of Arts and Sciences and awarded Guggenheim and Radcliffe Fellowships. She is the Academic Director of the Scholars Strategy Network.