Discover the hidden forces that shaped one of the most significant health care reforms in US history.

Winner of the IPPA Best Book Award by the International Public Policy Association and the Louis Brownlow Book Award by the National Academy of Public Administration

In A Government of Insiders, William Genieys traces the winding path from the failed health policy priorities of the Clinton administration to the passage of the Affordable Care Act (ACA). Genieys uncovers the pivotal role of a committed group of unelected governmental elites known as "long-term insiders" who meticulously developed policy ideas and political connections. During George W. Bush's presidency, these insiders reconceptualized the foundations of a far-reaching health coverage reform both within and outside the public sector.

When President Obama took office, these insiders returned to positions of power and ensured that their reform vision took center stage. Genieys highlights how these people were instrumental in crafting and passing the ACA by integrating existing programs like Medicare and Medicaid, engaging market forces with an individual mandate and health care marketplaces, and addressing the crucial issue of cost containment.

By shedding light on the action of these health coverage policy elites and their role as custodians of the public interest, Genieys challenges traditional assumptions about the influence of economic elites and reveals the positive role of unelected professionals in advancing the common good. A Government of Insiders is a groundbreaking exploration of the unseen forces behind major policy reform, providing a fresh perspective on the dynamics of power in American politics.

Prizes

Winner of National Academy of Public Administration Louis Brownlow Award 2025 (United States)

William Genieys is a research professor at the Centre for European Studies and Comparative Politics at Sciences Po Paris.