Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050

Historically, Medicare and Medicaid aside, many Americans had access to employer-sponsored health insurance programs prior to the Affordable Care Act (ACA) (Collins, 2018). In 2010, President Barack Obama signed into law a bill to address insurance gaps and provide an affordable option to health insurance (Collins, 2018). The main objectives of the ACA were to improve access for patients, improve quality of care, and reduce healthcare expenses for Americans (Collins, 2018). The ACA allowed for expanded coverage for minors under a parent’s plan until the age of 26 and gave Americans the ability to compare difference insurance plans (Collins, 2018). In 2013, the Health Insurance Marketplace offered open enrollment to allow an option for all Americans to access health insurance. Quality care is rewarded under the ACA with optimal reimbursement to incentivize meeting care and patient goals (Collins, 2018).

When the Affordable Care Act was being drafted, America was in a recession with many citizens losing both health insurance coverage and work (Silberman, 2020). In 2010, more than 46 million Americans were without health insurance while others were afraid of losing the coverage they had (Silberman, 2020). The ACA required states to expand Medicaid coverage and mandated large employers to offer affordable coverage options to their employees, which was later brought to the Supreme Court to challenge its constitutionality (Silberman, 2020). A replacement bill was proposed by Congress that repealed Medicaid expansion along with the coverage mandates, but Obama had vetoed the legislation (Levitt, 2017). When President Trump entered office, his platform was partially built on the repeal of “Obamacare” or the ACA. Trump’s 2018 budget proposal included Medicaid cuts, reduced public funding for the Food and Drug Administration, the National Institute of Health, and the Centers for Disease Control and Prevention, and overturn the requirement of insurances to cover some preventive services such as contraceptive birth control for women (Jost, 2017). During the Trump administration, nongroup market premiums increased, but increased coverage for services including maternity, mental health, and substance use treatment (Jost, 2017).

Glied (2021) writes that many fundamental problems behind the high cost of employment-based coverage, premiums, and cost sharing are too high due to the high cost of health care. Despite the United States spending more per capita on health care than Canada, the United Kingdom, France and Japan, life expectancy is less than these counties (Milstead & Short, 2019). Glied (2020) argues that government intervention through direct regulation is a means to cap prices. While the intention of the ACA was to improve access and coverage for many preventive services, procedure cost-sharing rates for colonoscopy and mammography remain virtually unchanged (Elwood, 2015). New models in healthcare are shifting from fee-for-service to value-based care, as patients seek better quality care, increased involvement in care decisions, and improved customer service for their increased cost responsibility (Elwood, 2015).

Both Democrats and Republicans have declared drastically differing opinions on the ACA while arguing the motives of the other party. When it comes to reelection, time and climate play large roles in political success (Milstead & Short, 2019). Republicans saw opportunity to repeal or replace Obamacare in the early days of the Trump administration but from the debates on how to make these changes, many politicians realized there may be implications that would affect their re-election (Milstead & Short, 2019). The implementation of any changes would be during the 2018 election cycle and possibly impact the Republican party’s ability to maintain majority in Congress. Milstead and Short (2019) argue that policymakers do not care about the people affected by the ACA, but rather how changes will impact their ability to be re-elected.

The American Care Act is challenged in that it does not provide coverage for everyone. There are states that do not uphold the Medicaid expansions and many Americans unable to afford the Marketplace options (Silberman, 2020). Silberman (2020) argues that the COVID-19 pandemic brought to light how little the country has invested in public health to protect the population, and that improving health involves investing in prevention and addressing social determinants of health. COVID has also shown that the current employer-based system supplemented by federal programs has worked, as the rate of insured dropped only about 1.5% through September of 2020 (Glied, 2021). The removal of the ACA would leave millions uninsured and the process of changing how Americans obtain insurance would take years to implement (Milstead & Short, 2019). When considering voter views, the American opinion remains divided when it comes to how the American Care Act should be replaced, repealed, or maintained (Milstead & Short, 2019). The ACA offers many benefits and shortcomings for providing healthcare coverage, but ultimately the direction that legislation takes is dependent on legislators’ agenda, along with timing and constituent views.

Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050 References

Collins, B. L. (2018). The affordable care act: 8 years later. Nursing Management, 49(8), 42–48. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NUMA.0000538917.37912.d4.

Elwood, T. W. (2015). Elected officials travel in parallel universes regarding the affordable care act. International Quarterly of Community Health Education, 36(1), 19–34. https://doi-org.ezp.waldenulibrary.org/10.1177/0272684X15613906.

Glied, S. (2021). Continue moving forward on the affordable care act path. American Journal of Public Health, 111(4), 612–613. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2021.306175.

Jost, T. S. (2017). ACA replacement battle moves to senate. Health Affairs (Project Hope), 36(7), 1173–1174. https://doi-org.ezp.waldenulibrary.org/10.1377/hlthaff.2017.0688.

Levitt, L. (2017). What might an ACA replacement plan look like? JAMA, 317(8), 795–796. https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2017.0661.

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

Silberman, P. (2020). The affordable care act : Against the odds, it’s working. North Carolina Medical Journal, 81(6), 364–369. https://doi-org.ezp.waldenulibrary.org/10.18043/ncm.81.6.364

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.

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 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.

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!

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days by expanding on their explanation and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

In 2010 President Obama passed the Affordable Care Act (ACA). The primary objective of the ACA was to decelerate the increasing cost of health care and promote a more cost efficient and high value health care program in the United States (Bowling et al, 2018). The advantage of ACA was to help more American who did not have health care benefits attain them.  During President Trumps campaign he voiced his plan to repeal and replace the ACA, but the Trump administration was unsuccessful twice with their replacement plan; the American Health Care Act.  For the incumbent president advancing their agenda relies heavily on having the appropriate staff at the department and agency level (Weinstock, 2017), as well as having the support of the American voters.  Healthcare agenda is always a hot topic of debate in the political sector and in the homes of Americans.  When we as Americans are listening to politician’s campaign speeches what goes through our minds is a quick cost-benefit analysis of how this leader’s agenda will affect our family, community, income, and future.  If the political leader’s agenda aligns well with your personal agenda he or she will win your vote.  Unfortunately, policymaker’s agendas have not always focus on how Obamacare, Medicare or Medicaid will actually have an effect on the American population. Rather their agenda focuses more on how it will affect their own re-election (Milstead & Short, 2019). The two sides of the of the ACA cost-benefit analysis for the American people was that it would require insures to cover preventative care without deductible, copayment or other out of pocket expenses, coverage for children with preexisting conditions, cover college age student to age 26 under their parents plan, premiums to go to the individuals benefit verses the administrator cost, and provide explanation for rate increases (Mandel, 2021).  All of these were benefits to the American people, but the money needs to come from somewhere to fund this.  On the cost side of the ACA new tax fees were instituted, health insurance premium increased up to 40%, individuals who earned more that $200,000/year and couples who filed joint earing $250, 000/year were tax to help pay for Medicare, fees were applied to medical device and brand name prescription companies, and finally medical tax deduction increased from 7.5% to 10% (Auerbach, 2019).  Regrettable there is no perfect plan in place that benefits every American equally and is a cost-effective plan for the individuals and the economy. Political leaders have their own agenda and sometimes it benefits the American population and other times it is only to their reelection benefit.

Auerbach, M.P, (2019). Patient Protection and Affordable Care Act: Overview. Salem Press Encyclopedia.

Bowling, B., Newman, D., White, C., Wood, A., & Coustasse, A. (2018). Provider Reimbursement Following the Affordable Care Act. Health Care Manager, 37(2), 129–135.

Mandel, I. (2021). Access to Health Care in the U.S. Research Starters: Sociology. https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=9&sid=c0e7ff24-32e0-4832-aa16f292b0a05f5d%40sessionmgr4006&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=89185280&db=ers

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

Weinstock, M. (2017). Trumps first 100 days marred by failed ACA repeal effort. Modern Healthcare, 47 (18), 7. https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=1&sid=c0e7ff24-32e0-4832-aa16-f292b0a05f5d%40sessionmgr4006&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=30476392&db=mnh

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:

Week 3 Discussion

The cost-benefit analysis made quite the impact on legislatures and their reelection. This has been a political debate for years, and it’s now being used selfishly to win votes. The law and healthcare tie into each other and can significantly impact votes for representatives. For many years republicans used the ACA repeal for votes and attention. The ACA was part of their success, and it was the star of their campaigns at times. People voted specifically on the promise of the ACA being repealed. This didn’t just affect republicans either; this affected all legislation. According to Johnathan Cohn (2020), “Democrats lost 64 seats in the House of Representatives, relinquishing a majority they had won just four years before. And although the results reflected a variety of factors, they had a lot to do with anger over the Affordable Care Act (ACA)”.

For years republicans struck the ACA and tried tearing it apart piece by piece. A lot of people thought that it would ruin the entirety of the healthcare system and make insurance pricier. A cost-benefit analysis by the legislators, Republicans included, soon showed them that they risked not getting re-elected because of the far-reaching negative aspects of ‘repeal and replace. The new policy would deprive many Americans of access to affordable healthcare (Daniel, 2017). Everyone quickly realized that The AHCA would be a financial disaster for millions.

The cost-benefit analysis put all the tiny puzzle pieces together, showing everyone the bigger picture that would change millions of lives. Repealing the ACA would cost roughly $350 billion through 2027 under conventional scoring and $150 billion using dynamic scoring. Repealing ACA would increase the number of uninsured people by 23 million (Daniel, 2017). Figuring out the numbers changed the legislature’s minds and forced them to change how they would win the public votes. The CBA showed the nitty gritty details that people weren’t considering. It showed the actual cost, the time it would take, and the advantages and the disadvantages.

A video from Walden University (2018) featuring Joel Teitelbaum shares, “It is clear that politics is playing a vital role in the design at the outset and now the implementation of the ACA.” I think the cost-benefit analysis greatly impacted whether specific people would earn votes. The most recent KFF Tracking Poll conducted in March 2022 found slightly more than half of the public (55%) hold a favorable opinion of the ACA, while about four in ten (42%) hold a negative view of the law (Montero,2022). The ACA has brought division to the political parties and in several communities.

Legislators’ goals are to remain in office, so at this point, they would do anything for support to be re-elected. As their agendas changed, so did their views. Now they had to change the message to attract different people. The public view changed, and legislatures soon realized they must be careful about what policies they allow to represent them and what procedures they chose to support. Many opinions on government involvement in the health care system impact voters’ choice of the presidential candidate. Blendon and Benson (2014) state, “Polling results have highlighted that voters do not see health care as a single issue. In one poll, 73% of respondents said health care was an important issue in their voting decision. When asked from a list what they meant by this statement, the ACA or Obamacare was the dominant health care issue (48%). Medicare was mentioned by 25%, and Medicaid by 14%”.

As Americans, we want to keep moving forward, working towards coverage that suits everyone. The debates over healthcare and the ACA, in general, will not cease, as we will continually have to work to come to the same solution. Though the answer seems far away, hopefully, one day, we can find a middle ground that suits everyone, even if it looks a little different through political representation. The representation of the specific legislators and what they support/represent will always be what sways votes. Taking each aspect into consideration and looking at the targeted population is what will keep legislators in office.

Interesting post. The U.S. government is based on democratic principles, where its citizens have the opportunity to participate in decision-making through voting and engaging with elected officials. The government is supposed to ensure that diverse voices are heard, promote civic participation, and allow for peaceful transitions of power. Democrats and Republicans also try to work together to implement social welfare programs and safety nets to support vulnerable populations, alleviate poverty, and provide assistance like the Affordable Care Act (ACA). Their integrity, values, and commitment to their voters affect their vote in Congress.

The ACA was created to ensure that all Americans have access to quality, affordable healthcare. According to President Biden, during the months of open enrollment (between November 2022 to January 2023), four out of five consumers shopping through the ACA were able to find healthcare coverage for as little as $10 a month or less, saving families $800.00 per person per year on their premiums (The White House, para 2, 2023). The ACA provides financial assistance in the form of premium tax credits and cost-sharing reductions to help individuals and families with lower incomes afford health insurance (Kaiser Family Foundation, 2022, para 3). These subsidies are based on income and help reduce the out-of-pocket costs of insurance premiums and healthcare services.

A major healthcare reform proponent in 2017 was the American Health Care Act (AHCA). It was created by House Republicans and proposed providing age-based tax credits instead of income-based subsidies, meaning that the amount of financial assistance from the government would depend on an individual’s age rather than income (Cox et al., 2017, para 26). This would then cause higher premiums for older individuals. Fortunately, the AHCA did not pass.

Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050 Rubric Detail

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Name: NURS_6050_Module02_Week03_Discussion_Rubric

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		Excellent	Good	Fair	Poor
Main Posting		45 (45%) – 50 (50%)Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%)Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%)Responds to some of the discussion question(s).One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 34 (34%)Does not respond to the discussion question(s) adequately.Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness		10 (10%) – 10 (10%)Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)Does not post by day 3.
First Response		17 (17%) – 18 (18%)Response exhibits synthesis, critical thinking, and application to practice settings.Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%)Response exhibits critical thinking and application to practice settings.Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%)Response is on topic and may have some depth.Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%)Response may not be on topic and lacks depth.Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response		16 (16%) – 17 (17%)Response exhibits synthesis, critical thinking, and application to practice settings.Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%)Response exhibits critical thinking and application to practice settings.Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	12 (12%) – 13 (13%)Response is on topic and may have some depth.Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%)Response may not be on topic and lacks depth.Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation		5 (5%) – 5 (5%)Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

Name: NURS_6050_Module02_Week03_Discussion_Rubric