NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and 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  Although the Republicans repealed parts of the ACA, including the budgetary and fiscal provisions, they did not replace it.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.

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act 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 Medicine, 377(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

Discussion: Politics and the Patient Protection and Affordable Care Act

The five social determinants of health include: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context (U.S. Department of Health and Human Services, 2021).

Out of the 5 social determinants of health, healthcare quality and access to health care appears to be one of the domains the nation struggles with the most. The social determinates of health have such a major impact on individuals’ lives that Healthy People 2030 created one of their goals specifically based on these concepts.

Their goal related to SDOH is as follows: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all (U.S. Department of Health and Human Services, 2021).”

In regard to repealing and replacing the ACA with the AHCA, this would be counterproductive in overcoming the social determinants of health. These determinates are linked to a lack of resources and a lack of opportunity (CDC, 2019). If the AHCA was passed, millions of people would have lost their insurance and lost access to quality healthcare.

This is a prime example of a lack of resources and a lack of opportunity.  These determinates are all linked to each other. For example, if someone with no insurance has a medical emergency and must pay for medical services out of pocket, that now affects the determinate of economic stability (U.S. Department of Health and Human Services, 2021).”

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act References:

• U.S. Department of Health and Human Services. (2021). Social determinants of health. Social Determinants of Health – Healthy People 2030. Retrieved September 16, 2021, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health.
• Center for Disease Control and Prevention. (2019). NCHHSTP Social Determinants of Health. Center for  Disease Control and Prevention. Retrieved September 16, 2021, from Social Determinants of Health | NCHHSTP | CDC.

I couldn’t agree with you more, and I appreciate Dr. A.E.’s intentions in prompting this question and

mentioning social determinants of health. Healthcare quality and access to health care is a major obstacle in healthcare reform. The ACA and AHCA not only strategize to increase access to health care by providing Americans affordable insurance options, but also include interventions to force the improvement of healthcare quality, which becomes a major source of contentions for economic healthcare stakeholders.

An example of this can be explored by discussing the AHCA element of transitioning care from a fee-for-service reimbursement model to a value based reimbursement model. This AHCA enforced change resulted in a major shift for many health care organizations. Fee-for-service reimbursement rewarded providers for the volume of services they provide, while the value-based approach payments are rendered based off of meeting agreed-upon quality and performance measures directly tied to patient outcomes.

According to McHugh, M. D., et al, (2013), the AHCA’s Hospital Readmissions Reduction Program (HRRP) highly invests and highlights the value of quality measures and services offered by health care professionals outside of the provider, specifically nurses. HHRP penalizes hospitals with excessive readmission rates of Medicare beneficiaries; the primary objective of the HRRP is to reduce the rate of readmissions in accordance with the hospitals’ financial incentives with payers’ and patients’ quality goals (McHugh, M. D., et al, 2013).

According to McHugh, M.D., et al, (2013), hospitals with higher nursing staff had 25 percent lower odds of being penalized compared to other similar hospitals with lower staffing. One can see why penalties like these would create resistance and motivation for repeal of the AHCA in primary healthcare economic stakeholders and highly influence their political affiliation despite social determinants of health.

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act References

• McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals With Higher Nurse Staffing Had Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing. Health Affairs, 32(10), 1740–1747. https://doi-org.ezp.waldenulibrary.org/10.1377/hlthaff.2013.0613

Murphy, L. S., & Warshawsky, N. E. (2015). Nursing Education A Solution to Healthcare’s Gordian Knot?JONA: The Journal of Nursing Administration, 45(6), 302–304. https://doiorg.ezp.waldenulibrary.org/10.1097/NNA.0000000000000203

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 votes 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.

Legislators who assume elective positions are always determined to support initiatives that will influence voters to re-elect them. However, due to competing interests of the government, some legislators might get concerned with the potential impacts that some bills, when signed into law, might affect their possibilities of getting re-elected (The Commonwealth Fund, 2017). Borrowing from the events that surround the efforts to repeal/replace the Affordable Care Act (ACA), conducting a cost-and-benefits analysis, in terms of both dollars and votes, can help legislators to decide whether they should support or oppose government initiatives.

Repealing/replacing the ACA is associated with benefits and costs measured in dollars and votes. According to the Committee for a Responsible Federal Budget. (2017), the cost of repealing or replacing the ACA through 2027 is estimated to be 350 billion United States dollars. However, the United States government will save approximately 1.55 trillion through 2027 when only the coverage provisions of the ACA are replaced. It is further anticipated that although repealing Medicare cuts would cost about 1.10 trillion United States dollars, it is likely to cause a slight improvement in economic growth, which would translate into additional net savings of about 200 billion United States dollars (Committee for a Responsible Federal Budget, 2017). As for Americans, their concern is whether they will still benefit from increased health coverage, enabling them to continue receiving affordable prescription drugs and accessing other healthcare services (The Commonwealth Fund, 2017; Willison & Singer, 2017). In this respect, legislators will likely benefit from their political maneuvers and get re-elected only when repealing/replacing ACA increases health coverage for Americans and economic growth. In this respect, legislative leaders must analyze the voters’ views before positioning or recommending national policies.

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.

The Affordable Care Act, called Obamacare, was a significant healthcare reform passed in 2010. Its replacement became a severe issue, with various lawmakers advocating for multiple approaches based on their ideological beliefs and perceived societal benefits.

            The cost-benefit analysis regarding legislators reelected significantly impacted efforts to repeal or replace the Affordable Care Act (ACA). The ACA’s new exchanges were successful, depending on where one looks, as states implemented and undercut the ACA during the Obama administration. Different states in the US that tried to create their exchanges failed, while others that appeared hostile on the surface worked with the Obama administration behind the scenes. Repealing will undermine efforts to reduce the budget deficit, primarily rooted in the cost of health care in the United States. The Congressional Budget Office (CBO) addressed that the ACA will reduce the deficit by $100 billion over the first decade and by more than $1 trillion between 2020 and 2030. ACA would not diminish the rising healthcare costs. The bill incorporates many current ideas about reducing healthcare costs, which is not insufficient. Introducing cost-saving measures, such as payer rates and a public option, has become necessary. The Democrats continue to control the Senate, and President Obama will veto any bill trying to repeal the ACA. Also, Republicans will be able to dismantle the ACA by refusing to fund it. They evaluated the healthcare system’s impact on insurance markets, healthcare providers, and the economy. The negative consequences of supporting a full repeal or replacement outweighed the benefits. They were concerned about adverse reactions and relied on the ACA for healthcare access, affordability, and protection. The lawmakers are mindful that the reelection was compromised if they supported a policy that resulted in constituents losing coverage or facing higher costs.

voters views

                                 The ACA needed to meet the political goal of most voters about the affordability of their coverage. The law’s supporters among the public did not say making affordable care was a reason. Analyses of voter views on healthcare, such as public opinion polls, and surveys, provided insights for legislative leaders. They allowed lawmakers to understand the concerns and priorities of constituents regarding healthcare, including Medicare and Medicaid policies.(Nahouraii et al., 2021) Legislative leaders understand that their success hinges on voter approval. Aligning their recommendations with the current voter views increases voter support and ultimately being reelected. Voter views on healthcare policies will help legislative leaders to craft effective messaging strategies.

                   A legislator’s job is to reelect; this does not imply that electoral considerations solely drive their decisions. Lawmakers also consider policy goals, constitutional obligations, and the long-term implications of their choices. However, voter views are critical in shaping legislative leaders’ recommendations on national policies, mainly on essential issues like healthcare that directly impact their constituents’ lives.

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

Submission and Grading Information

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

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act

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

Learning Resources

Required Readings

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

• Chapter 3, “Government Response: Legislation” (pp. 37–56)
• Chapter 10, “Overview: The Economics and Finance of Health Care” (pp.
  180–183 only)
• Congress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T.
(2017). Corrigendum to position statement: Political interference in sexual and reproductive
health research and health professional education. Nursing Outlook, 65(2), 346–350.
doi:10.1016/j.outlook.2017.05.003.

• United States House of Representatives. (n.d.). Retrieved September 20, 2018, from
  https://www.house.gov/
• United States Senate. (n.d.). Retrieved September 20, 2018, from https://www.senate.gov/
• United States Senate. (n.d.). Senate organization chart for the 115th Congress. Retrieved
  September 20, 2018, from https://www.senate.gov/reference/org_chart.htm

Document: Legislation Grid Template (Word document)

Required Media

• Laureate Education (Producer). (2018). Working with Legislators [Video file]. Baltimore, MD:
  Author.
• Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel
  Teitelbaum [Video file]. Baltimore, MD: Author.
  Credit: Provided courtesy of the Laureate International Network of Universities.
• Laureate Education (Producer). (2018). Contemporary Issues in Public Health Policy with Joel
  Teitelbaum [Video file]. Baltimore, MD: Author.
• Laureate Education (Producer). (2018). Peter Beilenson: Population Health [Video file].
  Baltimore, MD: Author.

Module 2 Discussion: Politics and the Patient Protection and Affordable Care Act

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. 

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act References

• 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

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The concept of cost benefit analysis plays a major role in helping leaders and policymakers, especially in Congress, to make better decisions on distribution of resources at the federal level. The technique is effective at evaluating if a program, like the Patient Protection and Affordable Care Act (PPACA), is cost-effective in attaining its expected goals (Bussing et al., 2020). The use of the concept depends on the legislators running for office and their personal views as well as political position on healthcare system in general. For instance, if a legislator or candidate believes that resources used for the ACA could be utilized or allocated somewhere else for better use, then this could have an effect on their idea to repeal and replace the Affordable Care Act (ACA).

The case of ACA and efforts to repeal and replace demonstrate how legislators and Congress can apply the cost-benefit approach to save a program that has a fundamental effect on the health of millions of Americans. The ACA was enacted to reduce the cost of care, increase access to care, and improve quality of care for millions of Americans, especially those from low-income households. The Trump administration was determined to repeal and replace the ACA; implying that over 25 million Americans could have lost their health and medical insurance. These include the aged and individuals with preexisting conditions who benefit from expanded Medicare and Medicaid programs (Nadash et al., 2018). Therefore, after conducting a comprehensive cost-benefit analysis, many legislators, especially leaning towards Trump and the Republican Party, withdrew their support and realized the proposal to repeal and replace ACA would hurt the American voters. Therefore, this would cost them by hindering their re-election to Congress.

The cost-benefit analysis allowed the legislators to determine if actions or opinions would impact their re-election to office in a negative or positive way. Therefore, many who supported the need to repeal and replace ACA lost their re-election while others withdrew their support for the same to enhance their re-election based on public opinions as many Americans hailed Obamacare, especially those with preexisting conditions (Milstead & Short, 2019). The legislators’ views and support to repeal and replace the ACA impacted voters’ decisions concerning their re-election and this means that a cost-benefit approach is essential in healthcare reforms.

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act References

Bussing, A., Patton, W., Roberts, J. M., & Treul, S. A. (2020). The electoral consequences of roll

            call voting: Health care and the 2018 election. Political Behavior, 1-

21. https://link.springer.com/article/10.1007/s11109-020-09615-4

Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics: A Nurse’s Guide (6 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 policy, 30(3-4), 259-

281. DOI: 10.1080/08959420.2018.1462683.

RE: Discussion – Week 3

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Top of Form

            When starting the discussion assignment for this week I found myself feeling extraordinarily overwhelmed.  I was unfamiliar with cost-benefit analysis, and I had no idea the main job for a legislator is to be re-elected!  Therefore, I had to take a very systematic approach to this week’s discussion.  First, it was important to understand cost-benefit analysis.  After much research it appears this is an umbrella term that is applied to any situation where one weighs the advantages versus the price or cost of a decision.  Price or cost is relative.  What ideals or issues a legislator chooses to support impacts if groups of people will vote for them in the future.  For example, in one of the articles for this week the authors discuss limiting political interference in sexual and reproductive health education and research (Taylor et. al., 2017).  The American Academy of Nursing is the group behind these driving principles and likely supports a legislator or legislators that advocate for these beliefs.  As nurses in the current political climate we are in a unique position of influence.  “Participation by nurses will help the public see the breadth of expertise nurses bring to the table” (Milstead & Short, 2019, p.39). 

            As it pertains to our discussion this week, the cost for a legislator to support repealing or replacing the Affordable Care Act (ACA) could be an actual monetary value or a vote.  There are supporters on both sides of the proverbial fence when it comes to the ACA.  In the current divided political atmosphere, there is a clear delineation of support split into democrat and republican.  A legislator typically takes a stance on the issue and thereby attains support which equals votes.  The legislator then must decide how to vote, or which acts or reforms to support or refute.  If a legislator who gained their position by supporting democratic issues, then supports republican views they would likely stand to lose the support of their democratic voters.  When considering this they must ask themselves which views their supporters’ advocate.  There is another consideration; the legislator’s financial supporters, which often have conflicting interests, must also be taken into consideration.  Deciding one way or the other could cost votes or financial support.  Considering the above mentioned, it stands to reason the agendas of those who vote for or financially support the legislator are influential in legislation. 

The voter’s views and an analysis thereof would reasonably influence the decisions being made.  After all it is the job of the legislator to “make decisions regarding bills and resolutions pending before the legislative body to which they have been elected” (Milstead & Short, 2019, p 38).  Legislators also must be aware of their political health.  In an effort to retain their position “legislators must be aware of not only the political climate but also be aware of how certain votes will affect their ability to stay in office” (National Council for the Social Studies., n.d.).     

NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act References

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

National Council for the Social Studies. (n.d.). https://www.socialstudies.org/advocacy/how-legislators-make-decisions

Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook, 65(2), 346–350. doi:10.1016/j.outlook.2017.05.003.

Thank you for your post. It is very detailed, but I want to add that it is indeed very accurate that people usually develop concerns when evaluating perceived competing interests of government and their influence on topics of interest to them regardless of their political associations. The same case also appears to have been present in the health care domain courtesy of the controversial Patient Protection and Affordable Care Act, which on March 2010 became law but received formal protest seven years later when leaders from The Republican Party introduced a bill to repeal the Affordable Care Act (Wilensky, 2019). When legislatures develop policies and implement them, we expect the primary beneficiaries of such policies to be the electorate. Although it is said that the act was done for citizens with little or no insurance to be provided with affordable healthcare coverage, critics have argued that the bill was indeed forced through the legislative process by the Democratic party, which boasted of a majority. After facing numerous attacks in the form of legislative efforts to repeal it about its validity, given the conflict between Republicans and Democrats, the demand to repeal the Affordable Care Act progressed thanks to a Republican nominee in the 2016 elections (Campbell & Shore-Sheppard, 2020). The House of Representatives, in fulfillment of their campaign promise, passed the American Healthcare Act bill in May the following year. This new bill would reform how healthcare is financed for individuals without insurance and phase out the decree that required all Americans to have insurance.

In its frequent attempts, last January of 2016, for the first time, congress passed a bill repealing the Affordable Care Act (ACA) to reduce federal government spending on health care by $927 billion between 2017 and 2026. During Trump’s administration, republican candidates planned to propose health policies to put in place after repeal; although, they made no broad agreement. Former President Trump wanted to revoke ACA provisions such as individual mandates, health insurance reforms, affordable insurance exchanges, employer requirements, and premium credits to eligible individuals and families (Nadesh et al., 2018). However, this impacts coverage and welfare for most uninsured individuals with preexisting health conditions and disabilities. It was predicted that if this reform succeeds and continues, by 2021, the number of uninsured individuals will rise by 24 million, 81% will lose coverage in working families, and 14.5 million fewer people with Medicaid coverage in 2021. Moreover, approximately 9.4 million people who received tax credits for private coverage will no longer receive assistance, and State spending will increase by $68.5 billion between 2017 and 2026. As reductions in Medicaid spending would be more than offset by increases in uncompensated care, and less health care treatment would be provided to modest-and low-income families (Buettgens et al., 2016).

Republicans campaigned attacking “Obamacare” during the 2010 midterm elections dishonoring and disapproving his U.S. health care system plans. Eight years later, republicans lost dozens of house seats, which was believed to have something to do with the repeal effort. In contrast, the democrats focused on health care, which involves the preservation of the revenue streams for health institutions, e.g., medical hospitals, insurance coverage, and drug industries. Between 2010-2016 House Republicans passed repeal bills more than 50 times. Elements of this campaign were arguably actions by GOP state officials who refused to expand Medicaid programs as several republican governors embraced its expansion, with the federal government picking up nearly all cost. However, GOP officials held out in states like Georgia, Florida, and Texas, and millions of low-income people remained uninsured. Trump’s 2016 victory made the repeal inevitable, yet the former president and his allies could not keep their vows. As he promised that in his term, there would be health insurance for everyone, but health care coverage is so expensive, and the government spent much money in the form of subsidies. As a result, this does not favor the public. The lack of success in repealing legislation did not end well with the Republican Party’s ultimate plan of eliminating the Affordable Care Act program. The Trump administration canceled funding for outreach, and an essential set of subsidies for insurers was already unfunded, eventually changing the policies on how states could design their Medicaid program. In 2017, congress passed a tax bill zeroing the ACA’s penalty for people who did not carry insurance, and Trump agreed to sign the provision (Cohn, 2020). In the middle of the Pandemic during Trump’s administration, with the death of Justice Ruth Bader Ginsburg days before the Supreme Court will hear oral arguments regarding the health care repeal lawsuit, the chance of the Affordable Care Act (ACA) remaining active is entirely uncertain. Totally revoking the ACA would have been disastrous to millions of Americans and wreaked havoc on the insurance markets and the U.S economy in general. As the pandemic continued, Medicaid expansion as an alternative was vital to the nation, especially for curative and preventive care during the outbreak. Finally, economic research highlighted that Medicaid expansion had enhanced public safety, especially for low-income adults, saving communities tens of billions of dollars (Rapfogel et al., 2020).

In my view, cost-benefit is vital for legislators in determining their opinions and actions regarding a specific policy that impacts every voter’s decision whether they will be re-elected or not. It is crucial for the safety of the people and our nation’s economy. The ACA has proved a stumbling block for several Republicans who want to abolish it. Every policy passed or repealed is based on the legislators’ decisions, and the probability of its consequences is inevitable. In this case, the dubious cycle of repealing the Affordable Care Act causes different opinions from democrats and republican parties; however, popularity votes regarding a specific national concern that caters more to the people’s welfare prevails and wins in the end. For example, Republican Sen. Martha McSally was one of the more vocal advocates of repealing the ACA. She publicly acknowledged that this would negatively impact her senate bid, and she indeed lost, and the seat was filled instead by Sen. Jon Kyl. Dr. Daniel Derksen, a professor of public health at the University of Arizona, said, ” The fall election will significantly revolve around people’s belief about what candidates will do for their health coverage.” According to Ashley Kirzinger, associate director of public opinion and survey research for the foundation, since Trump won the election in 2016, a larger share of the public holds’ favorable views of the health law. This was evident in 2017 after the failed repeal in the senate. ACA policies became much more prevalent in some other States, and it is believed that the people bringing up this Act are the Democrats. The foundation’s polling found that in 2014, 55% of voters opposed the ACA law, while only 36% favored it; last 2020, it shifted to 51% favoring it and 38% opposing it. A shift was seen in political groups, with only 74% of Republicans still viewing it unfavorably in the latest poll (Hawyluk, 2020).

The Affordable Care Act 2010 is a landmark legislation aimed at expanding access to quality and cost-effective care for millions of Americans who lacked a medical cover or insurance. With its enactment, over 20 million Americans, especially from low-income and ethnic minority groups got health insurance coverage through insurance exchange markets focusing on their incomes (Campbell et al., 2020). However, political opposition to the policy from Republicans and other stakeholders affects the support of the legislation with attempts by the Trump administration that was keen on repealing and replacing the ACA 2010 when he came into office.

The initial attempt to repeal and replace ACA occurred in 2017 when House of Representatives passed the American Health Care Act (AHCA). However, the Congressional Budget Office (CBO) was categorical that implementing the AHCA would lead to a rise in the cost burden for the federal government while over 24 million individuals would lose their health coverage. The AHCA proposed having tax credits based on age and not income. The AHCA also wanted a patient and state stability fund to be established to reduce premiums from 2026 by 20% percent. The implication is that these measures were going to lead to a rise in the cost of healthcare (Li et al., 2020). Americans with chronic conditions were going to pay higher rates of premiums while states would be at liberty to suspend several components of the ACA.

Re-election Prospects impacted attempts to repeal and replace the ACA based on the cost-benefit analysis by legislators, especially Republicans. Public opinion showed that a majority who were supporting the AHCA would lose their re-elections due to the negative effects of repealing and replacing the ACA. The proposed policy would lead to a rise in the number of uninsured Americans. Many health care professional associations like the American Academy of Family Physicians (2020) were against these proposals. Due to re-election fears and possible losing of their seats, the Republicans led by the then Senate Majority Leader could not vote for the AHCA. Their interests to be re-elected would be impacted negatively had they voted to repeal and replace the ACA. They instead had their proposed approach under the Better Care Reconciliation Act.

Voters’ views impacted the decisions by legislative leaders in positioning national policies as they realized that repealing and replacing the ACA would make millions to lose health insurance. Legislative leaders are elected by voters and any decision they make to affect them can have serious consequences, especially on their re-election (Rapfogel et al., 2020). Consequently, they did not support the repeal and replacement of the ACA based on cost-benefit analysis as they realized that doing that would cost them their seats and chances of getting re-elected by voters.