搖而不墜：論川普政權下歐巴馬健保的發展

Wobbled but Never Fell Down: The Development of Affordable Care Act under the Trump Administration

「病患保護及平價醫療法案」（ACA）為何受到川普打擊？又為何打擊失敗？雖如歷史制度論所預期，ACA創造出受益者並產生制度自我增強反饋效果，但該效果並無法解釋其為何仍受到挑戰，但卻又難以被掌握國會與總統優勢的共和黨廢除。本文認為ACA雖有自我增強，也會自我弱化。ACA受害者在政治動員及替代選項出現下，開始改變該制度之設計。然而，川普政權雖一度開啟足以改變制度的關鍵時刻，但由於部分共和黨州長實行ACA、民意態度轉變、利益團體反對，且共和黨議員無法對替代方案有所共識，川普政權最終錯失廢除ACA的關鍵時刻。

Why did the Trump administration try to repeal and replace the Patient Protection and Affordable Care Act (ACA)? And why did the Trump administration’s attack on ACA almost succeed but fail in the end? As Historical Institutionalism expects, a self-reinforcing feedback effect is generated through path dependency, but it cannot fully explain why it was still challenged. Also, Historical Institutionalism cannot explain why the Trump administration, which controlled Congress, failed to repeal and replace ACA. This paper pointed that ACA produced not only self-reinforcing feedback but also self-undermining feedback. Under the political mobilization and the emergence of alternative bills, the victims of ACA started to oppose ACA and created a critical juncture. However, some Republican state governors, public opinion, and interest groups shifted to support ACA. Most importantly, since the Republican senators failed to reach a consensus on alternative bills, the Trump administration missed the critical junction to repeal ACA.