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The Affordable Care Act (ACA) of 2010--the U.S.'s first major health care reform in over half a century-has sparked new debates in the United States about individual responsibility, the collective good, and the social contract. Although the ACA aims to reduce the number of the uninsured through the simultaneous expansion of the private insurance industry and government-funded Medicaid, critics charge it merely expands rather than reforms the existing fragmented and costly employer-based health care system. Focusing in particular on the ACA's individual mandate and its planned Medicaid expansion, this statement charts a course for ethnographic contributions to the on-the-ground impact of the ACA while showcasing ways critical medical anthropologists can join the debate. We conclude with ways that anthropologists may use critiques of the ACA as a platform from which to denaturalize assumptions of "cost" and "profit" that underpin the global spread of market-based medicine more broadly.

In this article, we narrate and analyze the historical configuration that a group of female workers and a collective of social organizations made about the Hospital San Juan de Dios (HSJD) and Instituto Materno Infantil (IMI) in Bogotá, Colombia, within the neoliberal crisis in health. Our ethnographic research intersects the Latinamerican traditions of collaborative ethnography and historic anthropology. The research was conducted in two sites. In the first one, from 2005 until 2015, we had informal conversations and conducted workshops and semi-structured interviews with IMI workers. The second site corresponds to our participation in the deliberations of the Mesa Jurídica por el San Juan de Dios (2008-2009), which aimed to elevate a class action to defend the hospitals. We found that workers and social organizations made use of the colonial origin of the hospitals and their institutionalization as center of welfare policies in the country as a way to highlight their patrimonial, historical, educational and social importance. This historical construction critiques efforts that negate or transform the public character of the hospitals and helped them carry on different actions to denounce the neoliberal health care reform as the cause of the hospitals most important crisis and closing. The different actors denounce the change in the hospitals-state relationship, which transited from being central for the development of social policies to reflecting a symbolic and material elimination of the hospitals. Such transition benefits the market interests established by the neoliberal model.

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