States will also need to decide whether or not to expand Medicaid coverage, according to last summer’s Supreme Court ruling on the legislation.

“The law essentially provided for an expansion of the Medicaid program up to 133 percent of the poverty line. The perception at the time of passage is that all states would eventually expand…[but] the Supreme Court left it to the states,” Burke said.

In their paper, Burke and Kamarck found the decisions regarding Medicaid expansion to be “less partisan” than the exchange decisions. Nevertheless, the majority of Democratic governors have decided to expand the program, while the majority of Republican governors have decided against expansion, or are expected to do so.

Compared with previous health care legislations, Burke thinks that the especially bitter controversy generated by the ACA reflects a deeper political divide over the role of the federal government.