Attempts to repeal and replace Obamacare (the Affordable Care Act) and the failure of policymakers to adopt the American Health Care Act, which would benefit future voters, all contribute to the formulation of healthcare policy politics. The Patient Protection and Affordable Care Act (ACA) of 2010 was a progressive plan; It made a concerted effort, maybe for the first time, to address social justice issues in American healthcare. However, the policy’s implementation was plagued by political overtones, as the legislation was openly unfriendly to Republican members. When the Trump administration took office, they prioritized repealing and replacing the Affordable Care Act.  ACA supporters assert that the president’s actions mirror his words, that he is deliberately “sabotaging

Hi Lakosha,

I enjoyed reading your post. Repealing the ACA would substantially negatively impact many Americans and affect the voter’s decisions in election/reelection. Dismantling the ACA could thus eliminate those savings and increase Medicare spending by approximately $350 billion over the ten years of 2016- 2025; This would accelerate the insolvency of the Medicare Trust Fund(Mshepard, 2022). 

The Trump administration tried to repeal the ACA by building ACHA, but it was not enacted or passed. Trump had problems getting the bill passed because the promises Trump made about cutting costs and improving care rang hollow to many Americans, Even more so after a report by the Congressional Budget Office estimated that the bill would cut $880 billion from Medicaid over a decade, and would eventually cost 53 million Americans their health insurance

Response 2 to Lakosha

From your post, I can deduce that the Affordable Care Act helps strengthen the existing health care system, both public and private. It expands health coverage or cost-sharing subsidies to adults with low income, mandates large employers to provide health care coverages and let parent keep their children under their health plan until 26-year-old (Bussing et al., 2022). It also inhibits health plans from charging more or denying their pre-existing health conditions (Silberman, 2020). The people who benefit the most are nonelderly uninsured individuals and the ones that have pre-existed health problems. For example, the ACA has provided health coverage to 54 million people with pre-existing health conditions and almost 20 million uninsured people, which decreased from 46.8 million in 2010 to 26.9 million in 2016 (Silberman, 2020). The Republican Party tried to repeal/replace the ACA due to the worry that the ACA’s expansion led to increased health care expenditure for the United States (Bussing et al., 2022).

If the ACA were repealed or replaced, approximately 17 million people would lose Medicaid coverage, more than 10 million will lose their cost-sharing subsidies, and about 54 million will lose coverage due to pre-existed health conditions (Silberman, 2020). Legislators always need a lot of money for reelection campaigns. They get millions of dollars from special interest groups and wealthy people. They spend three days out of five days working to raise funds for their reelection campaigns. For example, in Pennsylvania, senate competition cost more than 46 million the U.S dollars. That money primarily came from particular interests and rich people and, in return for providing money for reelection; it benefits those who support them (Bussing et al., 2022). It seems the positions of Medicare and Medicaid policies based on who gives the most money will win the case. However, voters as grassroots lobbyists can significantly affect legislators through their votes, especially if grassroots lobbyists are nurses who have health care specialties. They can be valuable resources for the reelected legislators, and they are the most effective in lobbying efforts (Silberman, 2020). Thank you!

References

Bussing, A., Patton, W., Roberts, J. M., & Treul, S. A. (2022). The electoral consequences of roll call voting: Health care and the 2018 election. Political Behavior, 44(1), 157–177. https://doi.org/10.1007/s11109-020-09615-4

Hi Amber,

Good post. Older voters have the most percentage of voters than any age group (Brandon, 2020). Medicare recipient’s out-of-pocket spending was 41% in 2013 and is projected to increase to 50% in 2030 (Cubanski et al., 2018). It is an even greater expense for older Medicare recipients (Cubanski et al.,2018). These are some of the most vulnerable Americans. If Medicare is not 100% funded, will these costs go up for older Americans?

Dr. Robin

Brandon, E. (2020, October 5). Why Older Citizens are More Likely to Vote:  Retirees have valuable government benefits to protect. https://money.usnews.com/money/retirement/aging/articles/why-older-citizens-are-more-likely-to-vote

Cubanski J., Neuman, T., Damico, A., & Smith, K. (2018, January 26). Medicare beneficiaries’ out-of-pocket health care spending as a share of income now and projections for the future. https://www.kff.org/medicare/report/medicare-beneficiaries-out-of-pocket-health-care-spending-as-a-share-of-income-now-and-projections-for-the-future/

I agree with you that legislators withdrew their support to ACA to increase the chances of getting re-elected to their political position in the 2018 elections. Which I believe some republican join the democrats for their own gain and democrats join the republican for their own good. And use the issue to stay in power. 

Additionally, according to Healthline. McDonough said “that if Democrats control the White House and both chambers of Congress in January 2021, we will see “significant legislation” to expand affordability of healthcare and access to financial assistance for people who can’t afford insurance at all today. They think that democrats can do more than republican which Trump is a Republic. 

Reference:

https://www.washingtonpost.com/powerpost/republicans-abandon-the-fight-to-repeal-and-replace-obamas-health-care-law/2018/11/07/157d052c-e2d8-11e8-ab2c-b31dcd53ca6b_story.html

Response 1 to Amber

I agree with you that if Trump was re-elected and able to repeal ACA, it would have hurt the people who can’t afford healthcare. As you mentioned, too, with ACA, people could have insurance even with preexisting conditions. When it comes to saving money for the government, I think they forgot that all these uninsured people would go without healthcare without treating their health conditions. As a result, they end up in the emergency room with expensive complications that can be prevented with the proper treatment. For example, the uncompensated health care costs for the nation’s uninsured had an average of $42.4 billion per year in 2015-2017, which went down with the implementation of ACA as the costs for 2011-2013 were $62.8 billion per year (Coughlin et al., 2021).

Somehow the ACA was helping to reduce healthcare costs as the government provides some funding to hospitals for uncompensated healthcare. Another good point in your discussion is how Covid 19 worsens some of the preexisting conditions. I think the ones who were the more affected are the people with mental health problems as they got worse during the pandemic and imagine them without insurance and not able to take their medicines. The Covid 19 pandemics negatively affect mental illness, creating new barriers for people already who have mental illness and substance use to seek mental health care (Panchal et al., 2021). Stress, no jobs, no insurance, loss of childcare, worry about contracting the virus, and the loss of a family member all together was devastating for people who already have a mental illness.

References

Coughlin, T. A., Jarubos, H., and Garfield, R. (2021). Sources of payments for uncompensated care for the uninsured. https://www.kff.org/uninsured/issue-brief/sources-of-payment-for-uncompensated-care-for-the-uninsured/

Response #2

Hi Amber,

Great post! The Affordable Care Act ensured all Americans had access to quality healthcare. At its enactment in 2010, most of the healthcare system was privately owned, and there were 48 million uninsured non-elderly persons (Carrasco-Aguilar & Carrasco, 2022). The cost analysis of replacing the ACA with the ACHA included a drastic increase in health insurance premiums. Therefore, the underserved and underprivileged populations could not afford to have quality health insurance and quality care. Milstead & Short (2022) discuss that changing how all Americans obtain health insurance is highly complex; any changes enacted by legislators will take years to implement (p. 176). Replacing the ACA would have been an incredible feat that would have left millions without adequate healthcare.

References

Carrasco-Aguilar, A., Galán, J. J., & Carrasco, R. A. (2022). Obamacare: A bibliometric perspective. Frontiers in Public Health, 10, 979064. https://doi.org/10.3389/fpubh.2022.979064

Response Post

Great post!

     Repealing or replacing the Affordable Cares Act (ACA) would devastate our country by raising the uninsured and unemployment. According to the Economic Policy Institute (2020), repealing the ACA causes more than 28 million people not to have insurance. Maryland would lose over two billion dollars in federal health funding (Economic Policy Institute, 2020). According to estimates by Levitt et al. (2017), by 2026, an additional 5.1 million people will be without health insurance. Based on this information, legislators have no choice but to keep this act. Repealing the ACA creates an adverse reaction in our society, decreasing prevention care services which would cause the mortality rate to increase. No alternative proposal addresses real change in the mindset of the American people to take ownership and accountability for good healthy decisions like smoking cessation, maintaining a low BMI, and belonging gym. Vote matters, but lobbyists have more influence over our politicians than just the constituents because of finanial campaign contributions for re-election. Policymakers have one agenda for passing bills: its relationship to being re-electable (Milstead & Short, 2019).

Reference

Economic Policy Institiute. (2020). How would repealing the Affordable Care Act affect health care and

     jobs in your state? Economic Policy Institute. https://www.epi.org/aca-obamacare-repeal

Franklina, 

Great post! According to Fackleman and Radman (2020), the ACHA was going to be signed at the height of the covid pandemic, which would cause even more people to have preexisting conditions. Health insurer’s would also be able to deny coverage for those with pre-existing conditions if the ACHA would have passed. Because of this, I am sure that many voters in many regions were against this, as having health insurance, especially if you have a pre-existing condition, is important. The theory of delegate representation is an assumption that a politician is in office to be the voice of the people (Krutz, Waskiewicz, n.d.). With that in mind, that is a very good reason why there was a change and the bill was not passed. 

References

Fackleman, K., & Radman, M. (2020).   Repeal of Affordable Care Act Would Devastate Health Care for Millions of Americans and Worsen COVID-19 Pandemic, Says Public Health Amicus Brief. Repeal of affordable care act would devastate health care for millions of Americans and worsen COVID-19 pandemic, says Public Health Amicus Brief. https://www.apha.org/news-and-media/news-releases/apha-news-releases/2020/aca-repeal-would-devastate

Hello,

The Affordable Care Act (ACA) was enacted in 2017 to expand access to health care in the United States. Its options included the establishment of health insurance marketplaces, expansion of Medicaid eligibility, and the implementation of consumer protections. This has been a subject of political debate with lawmakers proposing different alternatives to the ACA. Policymakers are still not necessarily focused on how real people will be affected by the changes but rather than how the changes will influence their re-election chances” (Milstead & Short, 2019) According to the American Health Care Act (AHCA), in 2017 the Republican-controlled House of Representatives passed the AHCA, a bill aimed at replacing the ACA however, it did not receive enough support and did not become a law. In the same year, Senators Lindsay Graham and Bill Cassidy proposed a health care bill aimed at also replacing the ACA this bill though it gained attention, did not pass. It is important to know that political discussions are still ongoing on ways to repeal or modify the ACA (Willison & Singer, 2017)

The beneficiaries of policy implementation vary, in the case of the ACA, this was to benefit a particular target group. To expand their health coverage and reduce the number of uninsured and underinsured individuals. The marketplace was established to allow more people to obtain affordable health insurance. Individuals with pre-existing health conditions had protection to prevent insurance companies from denying them coverage or charging them higher rates. Young adults, and low-income families who were not previously qualified had the opportunity to gain coverage (Obama, 2017).

Voter’s views can have a significant impact on decisions made by legislative leaders. By understanding the references and concerns of their constituent, legislative leaders can get support for their policy proposals which increases their likely hood of gaining popular support and potential re-election. When aware of the specific issues voters care about, they can craft policies that address those concerns. They can make informed decisions about strategy for advocating specific policies.

References

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

Obama B. H. (2017). Repealing the ACA without a Replacement – The Risks to American Health Care. The New England journal of medicine, 376(4), 297–299. https://doi.org/10.1056/NEJMp1616577

Syntyche, I enjoyed reading your discussion post, as you mentioned that voters’ views significantly impact decisions made by legislative leaders. When running for election or re-election, typically, the campaigns are towards the voter’s changes they want to see. Usually, voters may want to change their community, such as building more prominent schools, decreasing crimes, or adding new roads; Voters usually can contact government officials when they want to support or change a law(USCIS, n.d ). These are the benefits of gaining insight into the voter’s ideas, exceptions, and desires, which is excellent for election and campaigning. The voter’s ideas and concerns can help legislative leaders petition for change within their communities, policies, or laws.

 Although Trump tried to replace the ACA with AHCA, This bill, also known as Trumpcare, would amend and partially repeal part of the Affordable Care Act

     The Affordable Care Act has never been stronger.  The platform for health insurance options, initially created by the Obama administration, had record enrollment for the 2023 registration period. According to White House data, more than 16 million Americans elected one of the plans under the Biden-Harris administration.  The care plan received significant challenge but in 2021, the US Supreme Court rejected efforts to shut down the plan and privatize care. This effort was led by Trump and 18 Republican Attorney Generals. Republicans, traditionally, support less government involvement in daily life and lower taxes in upper incomes.

Repealing or replacing the ACA

     The Trump Administration challenged the ACA based on a technicality in the taxation policy.  The ACA has a  requirement that individuals have coverage or pay a penalty, and a 2017 tax law zeroed out that penalty. However, the  National Federation of Independent Business v. Sebelius upheld the policy and rejected efforts to repeal.  The health care platform was aimed to reduce or eliminate premiums based on individual health history and provide coverage to those insured.  This threatens profit margins for large insurance companies, often contributors to the political campaigns.  There was heavy lobbying against the effort to remove the  legislation. There were several lower court arguments on the topic in 2018 and 2019 but the supreme court gave the final judgement.  Had this not occurred, prescription drug prices and insurance premiums would be higher, adults older than 26 would not have coverage when no longer covered by parents, and millions of Americans would not have had coverage during the pandemic. It would have afforded a significant tax cut for the highest income households who were levied higher amounts to pay for the coverage.

     My family uniquely appreciates both sides of the ACA argument.  Having lived in Toronto and England, both had a national healthcare platform.  Our taxes were nearly 40% of income and we paid for a more general level of care.  It was more difficult to get basic nebulizer treatments or antibiotics, but the level of preventative care was good.  We knew people who waited much longer for cancer diagnostics and treatment, even with private care, than in the US.  But everyone had access to medical attention.  The sector that particularly benefited was mental health services.  It was easier to get treatment and less money was required out of pocket.

One sector of the public affected by ACA was small business owners. Businesses with 50 or more employees were required to provide medical coverage, greatly impacting profit margins. My uncle is a small business owner who votes democratic in elections.  He voted on the oppisite side of the ballot strongly guided by the health care policy.  It was a a top issue affecting voters in the 2020 polls and elections.

The Republican party currently has an agenda to repeal the ACA and amend medicaid.  This is a link to their formal agenda: FACT SHEET: Congressional Republican Agenda ACA & Medicaid

Fariba,

     I agree that it’s fascinating to research the way different countries approach health management. One of the best overviews was on the following PBS Frontline special.  One interesting comment focuses on a standard rate card for treatment and drug costs.  That effort, regardless of whether healthcare has governmental oversight or is privatized, helps everyone seeking care.

PBS Frontline: Sick Around the World

Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA. Then, explain how analyses of the voters views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid). Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria.

Formulation of the Politics of Healthcare Policy: Attempts to repeal and replace Obamacare (Affordable Care Act) and Policymakers’ inability to pass the American Health Care Act that disadvantages future voters. It is widely agreed that the Obama administration’s Patient Protection and Affordable Care Act of 2010 (ACA) was a progressive strategy. For the first time, it severely aimed to discuss social justice in American healthcare. The policy, however, was dogged with political undertones from the outset, with the legislation being overtly hostile to Republican lawmakers. Repealing and repealing the Affordable Care Act became one of their numberone priorities as the Trump administration came to power. Republican attempts quickly encountered a lack of support across the board when lawmakers realized that the latest proposals to ‘repeal and replace’ were going to affect the average American voter. Many Republican legislators started seeing the chances of their reelection becoming slim if they continued with their support for the repeal and replacement of the ACA or Obamacare. This paper is about this political angle to the important healthcare legislative policies that have been implemented in America lately. Politics and the Patient Protection and Affordable Care Act sample essay.

Repealing and replacing the ACA

The first stab at repealing and replacing the ACA was taken in May 2017 when the American Health Care Act (AHCA) was passed in the House of Representatives. It is the AHCA that the Trump administration and Republican legislators sought to use to repeal and replace Obamacare. However, it soon became apparent that under the AHCA, 24 million Americans were going to lose health insurance coverage. A tax credit not based on income but based on age was suggested by the AHCA. This alone would have increased the cost of healthcare for many Americans. A Patient and State Stabilization Fund was also implemented that would reduce premiums by twenty percent after 2026. However the effect of this will be higher premiums for Americans who already have pre-existing medical conditions. In addition, the new law replacing the ACA will grant states the power, given certain conditions, to suspend certain rules currently in the ACA. This will also result in higher premium rates for health care coverage for Americans with chronic diseases.

How Re-election prospects affected efforts to repeal and replace the ACA.

A costbenefit analysis by the lawmakers, including Republicans, soon showed them that because of the farreaching negative aspects of ‘repeal and replace’ they risked not getting reelected. The new strategy would as noteabove, deprive many Americans of access to quality healthcare. Yet this is the very issue discussed by Obamacare in the sample essay on Politics and the Patient Protection and Affordable Care Act.

The American Academy of Family Physicians, for instance, opposed the AHCA proposals because they increased health insecurity among Americans. This new approach, according to the AAFP, has raised premiums and refused patients insurance coverage due to age, health status or socioeconomic status. Senate Majority Leader Mitch McConnell found it hard to get support for the AHCA as it was for these reelection purposes. A fault with the AHCA was noticed by none other than the Congress Budget Office (CBO). In the end, the senators created their own revision plan, called the Better Care Reconciliation Act of 2017, for their own interests.

References

Affordable care act (ACA) – glossary. Glossary | HealthCare.gov. (n.d.). https://www.healthcare.gov/glossary/affordable-care-act/

The Affordable Care reform law was first introduced in 2010 by President Obama. The main purpose was to provide healthcare insurance for the uninsured and make it easy for all Americans to access affordable healthcare. It focused on making health insurance affordable for all. It offered lower costs for households with income between 100%-400% of the federal poverty level (FPL), expanded Medicaid, and supported innovative medical care methods that seek to reduce the cost of healthcare (HHS, n.d.). Since the introduction of the reform by Democratic President Obama, it has been met with resistance from mainly Republican. President Trump ran his Presidential campaign on the promise to repeal the Affordable Care Act, although all efforts made in this regard failed. According to a white house report in February 2023, most budgets plan over the years following the ACA have been aimed at repealing it. It is important to note that repealing the ACA will lead to higher healthcare costs and a lack of coverage for preexisting conditions (White House, 2023).

One of the main reasons why Republicans have not been able to repeal the Affordable Care Act is because the cost of doing so will be significant both for the American people and might end the political careers of legislators that seek to repeal it. This is because this reform has been beneficial to most Americans and many republican legislators like certain parts of it. Thus, the reform has been more successful than Republicans want to admit. Moreover, it is the fear that if a legislator votes to repeal the ACA, their constituents might hold that against them and vote for someone else in coming elections since the ACA has helped millions of Americans to secure health Insurance, including coverage for preexisting conditions (Scott & Kliff, 2017). It is also worth mentioning that voting information is public, and anyone can find out how their legislators voted on issues.

The cost of repealing the ACA would be massive and affect millions of Americans. If the ACA is repealed, 24 million more people will lose insurance coverage, less than 14.5 million people will qualify for Medicaid/Chip, less than 8.8 million people will have private non-group coverage, and less than 700 thousand people will have health coverage through their Jobs (Buettgens et al., 2016). With this many people losing their health care benefits, it will affect re-election. Thus, when legislators analyze voters’ views, it dramatically impacts their positions on national policies, especially since their goal is to get reelected into an office and not be outed by a new politician with a better stance on national policies such as the ACA and Medicaid.

References

Buettgens, M., Blumberg, L. J., Holahan, J., & Ndwandwe, S. (2016). The Cost of ACA Repeal. Retrieved from https://www.urban.org/site/default/files/publication/81296/2000806-The-Cost-of-the-ACA-Repeal.pdf

Hi Sarah, thank you for the in-depth insight on ACA. Trump’s plan to repeal and replace the ACA with the American Health Care Act (AHCA) would result in the loss of health insurance for millions of people and discrimination against those with preexisting conditions who later choose to purchase private insurance in the form of higher premiums, fewer benefits, or no coverage at all (Sommers et al., 2017)

I agree with you that it will cost more to repeal and replace it and might lead to lose of political careers to some politicians against it. Since the cost of employer-sponsored health insurance is rising daily, I believe the ACA should be revised to include coverage for those in the middle class.  Some workers choose not to enroll into employer-sponsored insurance programs so they can save some money, and as a result, they may face end-of-year fines in their home states.

Sommers, B. D., Maylone, B., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2017, June). Three-Year Impacts Of The Affordable Care Act: Improved Medical Care And Health Among Low-Income Adults. Health Affairs, 36(6), 1119–1128. https://doi.org/10.1377/hlthaff.2017.0293

Main Question Post

The Affordable Care Act

Enacted into law in March 2010, the Affordable Care Act, famously known as “Obamacare,” is by far the single most significant legislative achievement of the Obama-Biden administration. With the passing of this massive healthcare package, all Americans are required to have some health insurance either through their employer, the state, or the federal government through the open enrollment periods, and those that do not have health insurance due to unemployment are given free health insurance. Proponents and architects of this law, they will say that with the passing of this bill into law, this landmark law makes medical insurance easily accessible to lots of Americans and that healthcare is now a right and not a privilege. The ACA also makes healthcare affordable to everyone and not just something the rich can afford. This law was also intended to expand Medicaid to cover adults whose annual income is well below the federal poverty level, provides subsidies through tax credits to low-income earners, and support changes and innovations in healthcare, leading to lower prices and lower prescription costs (hhs.gov). As a result of this law, millions who lived without medical insurance for many years could seek and secure specialist services for chronic, acute, and life-threatening illnesses and would not have to worry about the massive bill they would have received after their visits if it was not for ACA.                                                  

           However, even though this bill was very popular with the Democrats and their sympathizers, Republicans hated the bill with passion. Its popularity is primarily based along party lines, and one could guess the political leaning of an individual based on their opinion on the ACA at the time. As expected, the votes needed to advance the bill were cast along party lines, and therefore, no US House Democrat or Senator crossed along party lines to vote against the bill, nor were there any US House Republican or Senator who went across party lines to vote in favor of the bill due to party loyalty and regardless of the benefits of the bill to the voters. The original votes in the US House in 2010 were 219 in favor and 212 against the bill, and in December 2009, the Senate vote was 60 in favor and 39 against the bill (Congress. gov,2010).  

Republican’s Efforts to Repeal and Replace the Affordable Care Act                                       

Before, during, and after the vote on this bill and subsequently a law, many Republican governors, Senators, Congressmen, and rank-and-file have all vowed to do everything within their means to ensure that they repeal and replace the affordable care act. As a result, they tried to cripple this law by holding funding for the implementation of this law from their respective states. However, unfortunately for many of them, once this law comes into effect, many people start benefiting from this law, especially patients with pre-existing conditions and those who cannot afford the high cost of healthcare insurance premiums. This puts many Republicans under enormous pressure from their constituents, but they find ways to spin and highlight the weaknesses of the bill to their view, knowing that those pressures are not something they could ignore as they could hurt their chances for reelection in the next election. Since the main aim of politicians is to get themselves reelected into political office, the elected Republicans tried to weather the storm by gauging public opinions and the sentiment of their voters about this new law in their localities. 

For over a decade, republicans continued their fight to repeal and replace the ACA, but all Republican efforts to repeal the ACA were either stalled in Congress or the Senate. The only major legislative win for the Republicans when it came to the ACA, was the Supreme Court moratorium in 2012 that gave States back the power to decide about the Medicaid expansion in their state individually. Like the Republicans, Democrats are not different; they fought tirelessly to ensure that their constituents and voters know their effort in trying to protect the ACA and sometimes use that to raise funds for their party and for their personal reelection. Knowing that this is something that their voters care about and supporting this bill is a no-brainer at the time to substantially increase their chances of reelection. While Republicans persistently tried to repeal ACA, House Democrats have voted on multiple occasions to defend the ACA in court against arguments for total repeal and weakening the law’s essential protections for Americans with pre-existing conditions (clyburn.house.gov, 2021).

Reelection aspirations affecting votes of the Legislature                                               

American politics is shifting far away from what was intended by its founding fathers. In the past, policy discussions/ decisions were primarily influenced by what was best for the country; that is far from being the case now. Recent American politics has seen almost everything being done along party lines and for the purpose of reelection. Regardless of the consequences of their decisions, both Democrats and Republicans tend to almost always vote with their party except for those elected officials representing the opposite party’s leaning states. It looks like no politician is now free to think independently regardless of their political affiliation, as this could cost them votes and hurt their chances of reelection. If a politician’s line of thinking is backed by their policy, votes defer from that of their party; they are either bound to have a challenger from their own party or lose reelection to the other party’s nominee. However, the only ones I have seen defer from their party are those that are not seeking reelection and have no risk at all to worry about; they can speak and vote freely like the case of John McCain, who famously votes down and gives a blow to the Republican’s final push to repeal the ACA in 2017, or those in the opposite party’s leaning state.

Conclusion

To finalize, even though the ACA comes with lots of benefits for millions of Americans without Medical insurance or underinsured, it was also intended to expand Medicaid to the lowest-income individuals across the country. However, this critical provision of the ACA Act to expand Medicaid was short-lived in many Republican states because of politics. It should be remembered that in 2012 the Supreme Court struck down mandatory expansion for Medicaid and instead left the decision to each individual state to decide. For many states, this was a done deal as Medicaid expansion improves access to care, provides financial rewards, and decreases the mortality rate for its beneficiaries. Until now, there are still 11 Republican-leaning states that continue to refuse Medicaid expansion, probably due to politics and to keep themselves in favor of their voters and not to part with their party with their vote. Some of these states mandated that parents can only qualify if household incomes are less than 18% of the federal poverty level and creating huge disparity since most of the people affected by this restriction are people of color who identify as Black or Latino. It is likely that congressional action will be necessary to secure universal health coverage for the poorest Americans, including Medicaid expansion (Kishore et al., 2023). 

References

 Actions – H.R.3590 – 111th congress (2009-2010): Patient Protection and … H.R.3590 – Patient Protection and Affordable Care Act. (n.d.). https://www.congress.gov/bill/111th-congress/house-bill/3590/all-actions?overview=closed&KWICView=false

The Affordable Care Act is also known as Obama Care; since its enactment on March 23, 2010, it has led to a historical advancement of health equity in the United States (Assistant Secretary for Public Affairs, 2023). Since promulgating the ACA, it has allowed more Americans to gain health coverage without limits and put protections in place for people with preexisting conditions. President Obama’s goal was to provide affordable healthcare to Americans and allow the right for everyone to sustain health insurance without feeling like it’s a privilege since the wealthy could only afford it. Medicare & Medicaid have also been healthcare politics’ “3rd rail” (Milstead, 2019).

Milstead (2019) emphasized that “if expenses of Medicare and Medicaid are higher than projected, the government cannot choose not to provide payment for the overage in services. If the government fails to meet its obligation, beneficiaries are entitled to sue” (p.181). The U.S. government should start finding better ways to meet the demand for health care for the senior population because they’re reaching retirement, living longer with many different chronic illnesses/diseases, and becoming more critically ill. According to Milstead (2019), funding for Medicare comes primarily from general revenues (40%) and payroll taxes (38%), followed by premiums paid by beneficiaries (12%).

Repeal & Replace the ACA

In 2017, the U.S. House of Representatives introduced a proposed bill called the American Healthcare Act of 2017, or AHCA. This bill, also known as Trumpcare, would amend and partially repeal part of the Affordable Care Act (eHealth, n.d.). Trump Administration and 18 state attorneys general petitioned the Supreme Court to strike down the Affordable Care Act. The repeal of the ACA was unsuccessful because the House couldn’t meet its goals and expectations, and Trump needed more votes to repeal the ACA. Across the country, 29.8 million people would lose their health insurance if the Affordable Care Act were repealed, more than doubling the number of people without health insurance. Also, 1.2 million jobs would be lost in health care and across the board in America (Economic Policy Institute, n.d.). In General, liberal thinkers wish to maintain the ACA with possible improvements (Milstead, 2019, p176).

Voters Views

The years of many attempts to repeal/replace the ACA have been unsuccessful. Voter views can impact legislators because their opinions count. Over the years, the voter’s views shifted from being against the ACA to actually in favor of continuing the ACA because of the tremendous overall benefits. If the ACA were repealed, millions of Americans would lose health insurance, which is why many legislative leaders recognized and reconsidered their national policies to repeal the ACA. For re-election and remaining to stay in popular demand, legislative leaders need to gain support and the possibility of re-election by promoting more reassurance to their voters’ ideas and concerns. The voter analysis provides a framework for popular opinion and demand decisions. Legislative leaders usually apply statistics to their campaigns to push for decisions they believe will gain and achieve the highest popularity in elections.   

                                                                                                  References:

Assistant Secretary for Public Affairs (ASPA). (2023, January 23). Fact sheet: Celebrating the affordable care act. HHS.gov. https://www.hhs.gov/about/news/2022/03/18/fact-sheet-celebrating-affordable-care-act.html#:~:text=Protected%20more%20than%20133%20million,mental%20health%20and%20prescription%20drugs

First Response

Hi Kiana

           Great points. I do agree that The Affordable Care Act has gone through intense political bickering between the Democratic party and the Republican party over the years. While any form of debate in a democratic country like the US is warranted for any bill to be scrutinized closely before being passed into law, efforts to repeal and replace the Affordable Care Act (Obamacare) were triggered mainly by politics regardless of the benefits to the American public, especially those with preexisting conditions and the uninsured that could not have otherwise afford the cost of insurance premiums. From its conception, Republicans vowed to do everything they could to block the bill from being heard on the floor of the Congress or Senate.                                                                                                                                                                                                          Some Republican members even try every effort to filibuster the bill by engaging in long, unnecessary, and unmeaningful discussions on the House or Senate floor to hold and delay the bill from being voted upon.  Once the bill became law, Republicans tried everything in their power to cripple this law by having funding for the implementation of this law from their respective states. This puts many Republicans under enormous pressure from their voters, but they find ways to highlight the bill’s weaknesses in their view. They weather the storm by gauging public opinions and the sentiment of their voters about this new law to know what to do next. Almost all Republican efforts to repeal the ACA were stalled in Congress or the Senate. However, the Supreme Court moratorium 2012 gave States back the power to decide about the Medicaid expansion in their state individually, which was a significant win for the Republicans. While Republicans persistently tried to repeal ACA, Democrats voted on multiple occasions to prevent Republican efforts to repeal and replace the ACA from happening and were able to keep the law’s essential protections for Americans with pre-existing conditions and low-income American without insurance (clyburn.house.gov, 2021).                                                                                                                                                                                                                                                   The Affordable Care Act benefits millions of Americans without Medical insurance or underinsured. However, one of the necessary provisions to expand Medicaid was short-lived in many Republican states after the supreme court Moratorium in 2012, which struck down mandatory expansion for Medicaid and instead left the decision to each state to decide. While this was a done deal for many states due to the benefits that come with Medicaid expansion, there are still 11 Republican-leaning states that continue to refuse Medicaid expansion due to politics. Some states mandated that parents only qualify if household incomes are less than 18% of the federal poverty level. This creates enormous disparity since most people affected by this restriction are people of color who identify as Black or Latino. Congressional action will be necessary to secure universal health coverage for the poorest Americans, including Medicaid expansion in those states (Kishore et al., 2023).

                                                                                                            Reference

Health care. Congressman James E. Clyburn. (2021, February 3). https://clyburn.house.gov/affordable-care-act

Hello Kiana,

I agree with the points that you made in your posts. The Affordable Care Act (ACA) has been more beneficial than most Republicans wish to accept. The reason why many attempts have been made to repeal it and have all been unsuccessful is because of the success of the reform. Moreover, those who seek to repeal it are met with barrier because they are yet to come up with a suitable option that is better than the ACA. When President trump introduced Trump care, critics were quick to point out that Trump Care, also known as the American Healthcare Act (AHCA) to be more damaging to the American people.  The AHCA would have caused more than 24 million more Americans to lose their health care insurance, higher potential cost to patient with preexisting conditions, higher premiums for older people, reduce Medicaid and even allow States to waive essential benefits, a provision that is included in the ACA (Worstell, 2021). It is not a surprise that the many lawmakers rejected it and it failed to pass. Legislators were concerned that repealing the ACA without a valid replacement could cost them the vote of their constituents and eventually get them replaced in office. I also agree with your idea that the US government should re-evaluate Medicare spending because people are living longer related to the advancement of medical technology, which means that Medicare spending will increase drastically over the coming years to accommodate the need.  According to the Peter G. Peterson Foundation, Medicare expenditure is estimated to rise from about 3% of the GDP in 2022 to about 5.5% of GDP by 2053 (2023). Thus, there is a need for Law makers to reform Medicare, since a large number of the US population depend on it for healthcare. Great Post.

References

Peter G. Peterson Foundation (2023). Budget Basics: Medicare. Retrieved from https://www.pgpf.org/budget-basics/medicare#:~:text=In%20fact%2C%20Medicare%20spending%20is%20projected%20to%20rise,costs%20that%20are%20growing%20faster%20than%20the%20economy

Affordable Care Act

Obamacare is the colloquial name given to the Affordable Care Act (ACA) signed into law by President Obama in the USA, which ultimately aims to provide universal access to healthcare services for US citizens (Carrasco-Aguilar & Carrasco, 2022). The ACA expanded the number of individuals who received healthcare coverage and increased the quality of healthcare given to American citizens (Willison & Singer, 2017).

Repeal/Replace ACA

The ACA increased access for uninsured and underinsured US residents, estimated to be more than 50 million (Milstead & Short, 2019). The Congressional Republicans attempted to replace the ACA with the American Health Care Act (ACHA). The Trump administration’s attempt to repeal and replace the ACA was unsuccessful, as the ACHA passed as a bill but needed more votes to become a law. However, if the ACHA had been successful, the number of insured Americans would have decreased because the administration’s bill would increase premiums, thus making it difficult for the underserved and underprivileged to afford the premium.

Analysis of Voter Views Affecting Legislative Decisions

Voter’s views can heavily affect decisions by legislative leaders in recommending national policies. The attempt to repeal and replace the ACA was a prime example. If many people lost insurance, it would affect election votes. A primary goal of the legislative leader is to get re-elected. Therefore, legislative leaders gravitate toward the people’s issues and attempt to develop policies to support the subject of the voter’s interests and sometimes create new acts in their interest.  

References

Carrasco-Aguilar, A., Galán, J. J., & Carrasco, R. A. (2022). Obamacare: A bibliometric perspective. Frontiers in Public Health, 10, 979064. https://doi.org/10.3389/fpubh.2022.979064

Reply#1

Hello Tiffany,

You did well with your analyses. I like to look at this base on the advantages the population has enjoyed benefitting from the  Affordable Care Act ( ACA ). Repealing this will have adverse reactions on the American household income. Also, higher premiums and deductibles will make it more difficult for citizens to afford health insurance. It will also damage the advancement toward universal healthcare. Under the ACA, preventative care is affordable to its citizens if this bill happens to be repealed, people will be less likely to go for basic screening and check-ups, which can likely increase the mortality rate. The ACA was just one part of an effort to reform the healthcare industry. The objective is to provide higher-quality care in a more cost-efficient way through better proficiency while reducing waste.

References

How would repealing the Affordable Care Act affect health care and jobs in your state? (n.d.). Economic Policy Institute. https://www.epi.org/aca-obamacare-repeal-impact

What Are the Implications of Repealing the Affordable Care Act for Medicare Spending and Beneficiaries? https://files.kff.org/attachment/Issue-Brief-What-Are-the-Implications-of-Repealing-the-Affordable-Care-Act-for-Medicare-Spending-and-Beneficiaries

Response 1

Hi Tiffany,

Great post! Change is difficult to obtain in politics. It takes time and money. The Trump Administration took actions to lower the prices of prescription drugs, increase access to affordable health insurance, provided price and cost transparency for healthcare services, helped US citizens gain access to doctors, ensured those with pre-existing conditions would be protected, and helped to end surprises when citizens received their bill from the hospital (The White House, n.d.). The Affordable Care Act has provided millions of Americans with health coverage with no lifetime limits, preventative care, rehabilitation care, wellness visits, mental health treatment, and substance abuse treatment (U.S. Department of Health and Human Services, 2022). 

References

The White House. (n.d.) Healthcare. The White House. https://trumpwhitehouse.archives.gov/issues/healthcare/

                          POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT  

           Health care in the United States is provided through a combined network of government agencies, private health insurance, public health coverage, clinical care delivery systems, community-based organizations, educational institutions, and other organizations that work together to support the health and well-being of Americans. The US health system mixes public and private, for-profit and nonprofit insurers and health care providers (2020_IntlOverview_USA.Pdf, n.d.). The populace health care for all is the first discussion concern depending on the political party, not only in the United States but also around the globe. Unlike other developed countries, the US health care system does not provide health care to all people, and a combination of private insurance and various federal and state programs covers most citizens.   

          The federal government plays a significant role in America’s public health care system by examining the population’s health status and needs, determining policies and standards, approving laws and regulations, helping finance, and sometimes providing personal health services. The federal government provides funding for the national Medicare program for adults 65 and older and some people with disabilities, as well as for various programs for veterans and low-income people, including Medicaid and the Children’s Health Insurance Program (2020_IntlOverview_USA.Pdf, n.d.). The legislators or lawmakers elected by the state need to make cost-benefit health care policies to cover all American citizens. Cost-benefit analysis is a way to compare the costs and benefits of an intervention, where both are expressed in monetary units. Costs include those of implementing an intervention and Benefits resulting from an intervention, such as medical costs averted, productivity gains, and the monetized value of health improvements (Cost-Benefit Analysis | POLARIS | Policy, Performance, and Evaluation | CDC, 2021).   

          Elections are one of the fundamental engines that drive legislative policy; they determine who serves in office and what kinds of incentives state legislators will have when thinking about reelection campaigns (State Elections, Policy Choices, and Accountability | Stanford Institute for Economic Policy Research (SIEPR), n.d.). When legislators plan to get re-elected, they must investigate the citizens’ concerns and how to serve them to pursue more moderate policies. Voters influence government policies by compelling politicians to adopt “middle ground” platforms. Competition for votes can force even the most partisan Republicans and Democrats to moderate their policy choices. In the extreme case, competition may be so intense that it leads to “full policy convergence”: opposing parties are forced to adopt identical policies (Lee et al., 2004, pp. 807-859).  

          The Affordable Care Act, known as the Patient Protection and Affordable Care Act or Obamacare, was signed into federal law by President Barack Obama on March 23, 2010. The Affordable Care Act has led to an historic advancement of health equity in the United States. This landmark law improved the health of all Americans, including women and families, kids, older adults, people with disabilities, LGBTQI+, and communities of color (Affairs (ASPA), 2022). The law was designed to ensure affordable health insurance, with increased coverage reducing premiums to cover a specific list of diseases regardless of gender with pre-existing conditions at the same insurers’ rates. This law states that insurers and employers must cover many insurance services without charging more than the insurance providers. Although the ACA was controversial due to two mandates, including the individual and the employer mandates, it means anyone who does not have insurance or any employers who do not provide health insurance for their employees must pay a fine to encourage Americans to maintain health insurance coverage. However, many voters did not want the ACA repealed. The mandate drew widespread criticism from those who believed having a health insurance plan should be a personal choice (What Is the Affordable Care Act (Obamacare) Individual Mandate? n.d.).  

         This bill aimed to increase the quality and affordability of health insurance, reduce the rate of non-insurance through the development of insurance coverage, and reduce health care costs. The plan of repeal and replacement of the Obamacare plan was passed and got approved a plan by Republican lawmakers to repeal and replace parts of the Obama health care program in the US House of Representatives, despite repealing the ACA would have been costly. The former president Trump tried to repeal Obamacare and replace it with another law, but he failed. The debate in the US Senate regarding the approval of the alternative healthcare program finally failed to reach a final agreement on the healthcare law to replace Obamacare. In fact, former President Trump’s administration’s bill was expected to reduce the federal budget deficit. However, it did increase the number of uninsured citizens. As many as 133 million Americans — roughly half the population under the age of 65 — have pre-existing medical conditions that could disqualify them from buying a health insurance policy or cause them to pay significantly higher premiums if the health law were overturned (Abelson & Goodnough, 2021). Repealing Obamacare during the Coronavirus pandemic, with millions of people losing their health coverage, would hurt many American families. It is necessary to mention that about 20 million Americans were covered by health insurance under the Obamacare program then. The Affordable Care Act touches most Americans’ lives, and its abolition could significantly affect millions more people than those who get their health coverage through it (Abelson & Goodnough, 2021).   

References:  

2020_IntlOverview_USA.pdf. (n.d.). Retrieved June 13, 2023, from https://www.commonwealthfund.org/sites/default/files/2020-12/2020_IntlOverview_USA.pdf

Hi Fariba,

Good post. Right, the government is the insurance for about half of Americans including those with Medicare (55 million), Medicaid (66 million) and the military, VA, Indian Health Service, and prisons (CDC, 2022). The question becomes, is having healthcare insurance connected to employment the best solution for the remaining Americans?

Dr. Robin

Centers for Disease Control and Prevention. (2022, September 6). Life expectancy.  http://www.cdc.gov/nchs/fastats/life-expectancy.htm

Legislation and Efforts to Repeal/Replace the Affordable Care Act

           The Affordable Care Act (ACA), also known as Obamacare, was implemented in 2010 to increase health coverage for those uninsured; it helps provide coverage to patients with preexisting conditions and those with limited finances (AMA, n.d.). Between 2010 and 2016, the Republicans made many efforts to repeal and replace the ACA; house republicans passed repeal bills more than 50 times (Cohn, 2020). When voting to revoke such an extensive health care reform, legislators should weigh the cost-benefit analysis in their decision. The cost-benefit analysis evaluates a determination by considering an intervention’s potential benefits and costs (CDC, 2023). For legislators voting to repeal the ACA, it means electing to “strike down” affordable health care for tens of millions of Americans, negatively impacting mainly low- and moderate-income Americans while providing high-income Americans with tax cuts (Hanlon et al., 2020, para. 6). 

Voters Views 

           Analyzing a voter’s views and perspectives on a topic, mainly over time, affects how a legislator recommends or positions a national policy. For example, Obamacare was immediately declared first on the Republican party’s list to be repealed and replaced. However, when the revelation emerged that the plan was to repeal this reform within the first year of Trump’s inauguration, moderate Republicans expressed concerns (Milsted & Short, 2019). The reason for this was that implementing this repeal of the ACA and changes to Medicaid programs would “run up against the next election cycle in 2018,” and the “inevitable implementation problems” might not “bode well” will voters, decreasing the majority party’s ability to maintain their current dominance over the Houses of Congress (Milsted & Short, 2019, p. 40). 

Conclusion

Overall, legislators and policymakers are driven by re-election chances even more than focusing on how their policy changes may affect real people (Milsted & Short, 2019). It is eye-opening and essential for healthcare providers to know the roles and priorities of the individuals in our government with the power to affect change within the healthcare policies that can affect their patients. 

References

American Medical Association (AMA). (n.d.). Understanding the affordable care act. https://www.ama-assn.org/delivering-care/patient-support-advocacy/understanding-affordable-care-act

Hi Amanda,

Good post. Some Congresspersons may have not wanted the repeal in any form. Yet, Congressional members do not want to go against their party. This is for two reasons. The main reason is that it could cost votes at re-election time, or it could cost them in committee membership. Being on certain committees is significant and being chair of a committee takes years of service. In the Senate, after a bill is introduced, it goes to the appropriate committee (GovTrack, n.d.). Not all bills make it any further than the committee. Why do so many bills become stuck in committee?

Dr. Robin

GovTrak. (n.d.). How a bill becomes a law. https://www.govtrack.us/how-a-bill-becomes-a-law

Hi Dr. Robin,

Many bills become stuck or held in committee because once a bill arrives at the committee, the members study various viewpoints of the bill that are debated to many extents (US House of Representatives, n.d.). Committee members can offer amendments to the bill and vote to accept or reject changes; this process can take time and effort, especially with differing opinions (US House of Representatives, n.d.).

References

US Department of Health and Human Services (HHS). (n.d.). National opioid crisis: Help and resources. Retrieved June 7, 2023, from https://www.hhs.gov/opioids/index.html

Hi Amanda, 

Good job on your analysis, just to add to the voter’s view is the fact that supporters of the affordable care act held a firm belief that it had expanded access to health care for those with pre-existing conditions and insurance coverage to millions of previously uninsured. It has also reduced the cost to many American citizens who now have access to essential health benefits, including preventive and rehabilitative care, prescription drugs, wellness visits and contraceptives, mental health, and substance use treatment. This health reform meant that Medicaid assistance will be provided to assist those in need of medical help.

References

https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/28/fact-sheet-the-congressional-republican-agenda-repealing-the-affordable-care-act-and-slashing-medicaid/

Affordable Health Care Act

President Obama’s Affordable Care Act (ACA) did not meet its promise. The ACA aimed to improve health care by improving healthcare quality, reducing cost, and expanding coverage. However, there are also more individuals without insurance; premiums and overall healthcare spending increase (The Broken Promises of the Affordable Care Act | Mercatus Center, 2016).

A disparity in age and coverage is now happening related to the ACA. The ACA wanted younger, healthier enrollees by offering subsidies to lower-income individuals and mandating insurance. Nevertheless, healthy young individuals did not sign up, leaving the older and more unhealthy population accessing most health insurance. Consequently, younger, healthier enrollees have high premiums, deductibles, and fewer choices (The Broken Promises of the Affordable Care Act | Mercatus Center 2016). According to the 2019 American Community Survey, “Adults ages 19 to 34 had the highest uninsured rates of all age groups in the United States.” (Conway, 2020) Thus, raising rates for future years.

Repeal and Replace the Affordable Care Act

There have been many attempts to repeal parts of the ACA or replace it altogether. The Congressional Republicans want to repeal the ACA for budget cuts, wherein Medicaid will be affected the most.  Devastating to the older, more unhealthy population by  not insuring or charging them more if they had pre-existing health conditions, exhausting their lifetime benefit caps, and scaling back prescription cover. 

Re-election, as in efforts to repeal and replace the ACA

Therefore, repealing or replacing the ACA would only benefit the wealthy and get the votes. As shown above, the young, poor, older, and unhealthy will not benefit from repealing the ACA. The ones who will benefit are the wealthy. They  are the only ones that will be able to afford health care. According to the White House (2023), congress plans to balance the budget by cutting Medicaid and “adding 3 trillion more to the deficit through tax cuts skewed to the wealthy and large corporations”.  From the voter’s view, they get re-elective by fostering to the rich which gets somehow gets them the elected.