Discussion: Politics and the Patient Protection

Discussion: Politics and the Patient Protection

Discussion: Politics and the Patient Protection

Health Policy and Politics: The Affordable Care Act

The Affordable Care Act (ACA) was enacted in 2010, and it considerably changed the U.S. health care landscape. The goals of the ACA were to make insurance coverage more affordable, reduce the number of uninsured, and expand access to care. To attain these goals, the ACA expanded eligibility for Medicaid and established new marketplaces where Americans without employer coverage could purchase policies directly from insurers (Oberlander, 2017). The ACA faced strong opposition from Republicans, who described it as unrealistic because it required every American to have medical insurance (Oberlander, 2017). When the Trump administration took power in 2017, the president and Congress members of the Republican Party vowed to replace the ACA. However, one year after taking office, Republicans could not agree on whether to repeal the ACA immediately, repeal right away and replace it later, or repeal it later after establishing a replacement strategy (Oberlander, 2017).  Although the Republicans repealed parts of the ACA, including the budgetary and fiscal provisions, they did not replace it.

The Senate Republicans’ failure to honor their promise of passing a bill to replace ACA, can be attributed to the unpopularity of this bill to the public. The legislators had to assess the political impact of repealing the ACA with no replacement on their chances of being reelected (McCarthy, 2017). They had to perform a cost-benefit analysis on the cost of repealing the ACA on the future chance of being reelected and the benefits of repealing it. For instance, if the Senate replaced the ACA right away, with no replacement, the number of uninsured Americans would increase drastically, which would be opposed by their voters (McCarthy, 2017). This would negatively affect the public view of the lawmakers on their constituents, and lower their odds of being reelected if they did not have a better plan to replace the ACA.  Besides, the cost-benefit analysis can explain why the Republicans had two canceled votes in March 2017 and had to introduce a new amendment to the American Health Care Act to unite the party behind the bill (McCarthy, 2017). The failure to replace the ACA as promised shows that lawmakers can be unwilling to support bills that are a potential threat to their election results in upcoming elections.

Legislative leaders’ decisions regarding recommending or positioning national policies are often influenced by their voters’ views. Voters are known to influence legislators’ policy choices and are at times forced to compromise their choices including partisan politicians (Pacheco & Maltby, 2017). Lawmakers have to consider their voters’ views before making a policy decision that affects their constituents to maintain a positive public image (Pacheco & Maltby, 2017). In the case the voters’ views contradict a legislator’s decision regarding a policy, the lawmaker is forced to compromise their position on the policy and move to the center.

Failing to take the voters’ views can have negative consequences on the law maker’s future elections. Furthermore, to continue supporting and voting for a legislator in future elections constituents must remain convinced that their lawmaker is listening to them and consider their views (Pacheco & Maltby, 2017). For instance, members of congress had to assess the voters’ view on repealing the ACA provisions that would cut funding for Medicaid or change Medicaid to a block grant program. Since many Americans benefited from the expansion of Medicaid, it affected Congress’ decision to pass bills that would hinder their voters’ access to the program and ultimately affect their public image.

Discussion: Politics and the Patient Protection References

McCarthy, M. (2017). U.S Republican attempt to repeal and replace Affordable Care Act collapses. https://doi.org/10.1136/bmj.j3508

Oberlander, J. (2017). Repeal, replace, repair, retreat—Republicans’ health care quagmire. New England Journal of Medicine377(11), 1001-1003.

Pacheco, J., & Maltby, E. (2017). The role of public opinion—does it influence the diffusion of ACA decisions?. Journal of Health Politics, Policy and Law, 42(2), 309-340. https://doi.org/10.1215/03616878-3766737

The Affordable Care Act (ACA), famously known as Obamacare, sought to enhance universal healthcare access by making health insurance to be inexpensive for all Americans. ACA targeted individual market, employer-provided benefits, and non-Medicare-eligible population to ensure they accessed affordable and comprehensive insurance coverage without any discrimination on the basis of their health status (Nadash, Miller, Jones, Gusmano, & Rosenbaum, 2018). The Republican Party seeks to stop government interference in the insurance market. It has spearheaded efforts to repeal and replace the ACA through the courts terming it as unconstitutional. Additionally, several states have shown open hostility to the law since it expanded the Medicaid coverage. Besides, House and Senate Republicans have sponsored several repeal initiatives such as Better Care Reconciliation Act (BCRA) and Graham-Cassidy bills (Nadash et al., 2018). The constant onslaught of the ACA from President Trump and Republicans has led to an increase in premiums and several insurers withdrawing from selling the insurance plans in the recent past. The early success of the ACA, whereby millions of Americans secured insurance coverage through the individual markets, subsidies for low-income individuals, and Medicaid, have been eroded.

The Impact of Cost-Benefit Analysis

Milstead and Short (2019) argue that the supporters and critics of ACA include the members of Congress whose main objective is to be re-elected during the election cycles. The opponent’s debates and efforts to repeal and replacement of ACA in both President Obama and Trump’s administrations are deliberate for political expediency as opposed to promoting public health and well-being. Furthermore, the political elites do not perform a cost-benefit analysis of the effectiveness of the ACA to enable them to compromise on a bipartisan basis about the contentious issues contained in the law, such as the insurance mandates, Medicaid, insurance plans, and tax credits.

Analysis of Votes

Notably, the ACA resulted in a progressive American tax system whereby the wealthy individuals were obligated to pay higher federal taxes, 3.8% more on taxes on unearned income and a 0.9% increase in Medicare payroll taxes. The new tax revenue was earmarked to fund the expansions proposed by the ACA (Grogan, 2017). Additionally, the law delimited the out-of-pocket costs for marketplace insurance coverage, specifically $13,200 and $6,600 for family and individual plans (Grogan, 2017). The subsidies and financing options of ACA ensured equitable access to healthcare and lowered the financial burden of healthcare costs for the majority of low-income Americans. According to Congressional Budget Office, The Joint Committee on Taxation, and The Center on Budget and Policy Priorities, repealing and replacing the ACA will increase Medicaid costs by over $370 billion over the next decade, which would be covered by the states (Grogan, 2017). Besides, eliminating tax directives will benefit the wealthiest people since they will be able to save almost $600 billion through 2026 (Grogan, 2017). Despite such cost-benefit analysis being conducted to determine the effect of repealing and replacing ACA, the legislators focus on their re-election prospects while discussing the merits and demerits of Obamacare. The lawmakers’ support for ACA must be consistent with the views of their electorates and donors. For instance, voting against the Act would have been contrary to the desires of most Republicans, and they risked losing their elective seats in the House or Senate.


It is evident that ACA not only resulted in national Medicaid expansions and subsidized Marketplace coverage, but it also reduced the cost of medical care and improved access to health services for patients in various age groups. These results would be what any leader would like to experience in their country, that is easy access to affordable and quality care for all people. Nevertheless, legislators would be willing to disregard these benefits to the society if all their chances of re-election would not be increased by them supporting the ACA. It is on the same basis that members of Congress will make decisions on whether to reject or recommend national policies concerning Medicaid/Medicare. Politicians rely on donors and lobbyists for financial support to win their elections. In healthcare, these funders could be medical organizations that are negatively affected by the particular policy under deliberation. As such, to ensure that they continue to receive support from these agencies, legislators have to cater to the interest of their donor and vote to reject a policy that could otherwise, benefit the society. However, this does not mean that they do not believe passing such a proposal into law would be in the best interest of the public. The members of the U.S. Congress usually align with their left- or right-wing political affiliation and support legislations to appease their electorates, lobbyists, and sponsors purposely to ensure they retain their Senate or House seats as opposed to promoting public good in a bipartisan manner.

Discussion: Politics and the Patient Protection References

Grogan, C. M. (2017). How the ACA addressed health equity and what repeal would mean. Journal of Health Politics, Policy and Law42(5), 985-993.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Nadash, P., Miller, E. A., Jones, D. K., Gusmano, M. K., & Rosenbaum, S. (2018). A series of unfortunate events: implications of Republican efforts to repeal and replace the Affordable Care Act for older adults. Journal of Aging & Social Policy30(3-4), 259-281.

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Discussion Post.. 350 words.. APA format..3 reference that are scholar writers. I Due by 12/10/19 by 7pm

Discussion: Politics and the Patient Protection and Affordable Care Act

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

Consider for example that the number one job of a legislator is to be reelected. Cost can be measured in votes as well as dollars. Thus, it is important to consider the legislator’s perspective on either promoting or not promoting a certain initiative in the political landscape.

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To Prepare:

· Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).

· Consider who benefits the most when policy is developed and in the context of policy implementation.

By Day 3 of Week 3

Post an explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).

Discussion: Politics and the Patient Protection Resources

Please Ask a Librarian if you have any questions about the links.

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