Against All Odds

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.