Healthcare and the Election of Legislators

The reelection cycle of legislators promotes actions taken by legislators to not run counter to their future efforts to be reelected. In regards to the ACA, I believe Milstead & Short illustrate how these two items combined may play out. It is stated that as the Republican party began to take legislative majority, repeal or revision of these ACA programs would interfere with the upcoming 2018 election cycle (Milstead & Short, 2019, p. 39). As such, some of the major changes to the ACA made as talking points by Republican legislators were held back, relative to an aggressive perusal of overhauling the ACA. If such an attempt was made, the breadth of changes needed would be disruptive enough to have voters possibly lose support for the actions of the Republican party, and as such, pose a major risk to reelection/loss of majority. This demonstrates the cost-benefit calculation that legislators must keep in mind when making legislative decisions in our current system of reelection.

Voter views thereby affect the actions of elected legislators. If an overwhelming and vast majority of Legislator A’s constituents want ACA essentially abolished, this legislator will support relatively aggressive policies and positions which lead to that outcome. In Legislator B’s constituency, the vast majority seem mixed or even indifferent about the fate of the ACA. Legislator B will then likely not show strong support for any policies affecting the ACA, one way or another. This would be partially because any policy support either direction would likely not upset legislator B’s chances of reelection. This would also incentivize legislator B to show strong opinions toward other issues that their constituency does care about greatly, shifting attention elsewhere.

Surveying and polling the constituency is one way to represent and extrapolate voter views. However according to Pew Research Center in 2014 regardless of party, roughly half of voters said their house member was “in touch with the district” (Pew Research Center, 2014). Meaning even if there was a Republican elected, half of the republicans in that representative’s constituency would still say their representative was out of touch. Later Pew Research in 2022 found that the majority of people did believe that it was important that their preferred party held majority in the congress (Pew Research Center, 2022). This lends evidence that voters in general tend more look at the beliefs and policies the party as a whole has rather than the individual representative of their region, when making voting decisions. This definitely simplifies any vote choice but also at the downside of less specificity when it comes to more detailed issues and talking points.


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

Pew Research Center. (2014). GOP Has Midterm Engagement Advantage. Pew Research Center.

Pew Research Center. (2022). Midterm election preferences, voter engagement, views of campaign issues. Pew Research Center.

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.

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.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

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

esponse 1 wk 3

Hello Michael, the republican party tends to hold back when it’s beneficial to them, and that’s what makes them a stronger party. They stand together and support each other. In terms of voting, I dont specifically vote for a person, I tend to vote for the party, I am a proud democrat and  I go with the belief as a whole, which can sometimes be a flaw.  The republicans always seem to be aware of the cost benefit calculation as you mentioned. Cost-benefit analysis (CBA) in the federal rulemaking process is the systematic examination, estimation, and comparison of the potential economic costs and benefits resulting from the promulgation of a new rule. (Perkins & Carey, 2017). Senator Ron johnson was one of the voices that emphasized seeing the GOP repeal the Affordable care act if the republican party were to win the white house, house of rep and senate majorities in 2024. He also stated that the republicans were being strategic in obstructing president Bidens and the democrat’s agenda, and that was a goal they set. (Wang, 2022)


Perkins, D. W., & Carey, M. P. (2017, April 12). Cost-benefit analysis and Financial Regulator Rulemaking. Cost-Benefit Analysis and Financial Regulator Rulemaking. Retrieved September 13, 2022, from https://sgp.fas.org/crs/misc/R44813.pdf

Wang, A. B. (2022, March 7). Sen. Ron Johnson says Obamacare should be repealed if GOP wins power back. The Washington Post. Retrieved September 12, 2022, from https://www.washingtonpost.com/politics/2022/03/07/sen-ron-johnson-obamacare-repeal-gop-majority-midterms-2024/


I believe the costs that come alongside the changes needed to repeal the ACA would deter conservative legislators because increasing government spending typically goes against the conservative financial viewpoint of typically reducing government spending. However, repealing the ACA can also be “sold” in a way to actually appeal to conservative financial values, because after the initial spending to make the changes necessary to appeal ACA, there may be a large reduction in government spending in healthcare afterwards. That viewpoint would then appeal to conservative legislators and be in-line with conservative financial beliefs.

RE: Discussion – Week 3

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.



Committee for a Responsible Federal Budget. (2017). The cost of full repeal of the Affordable Care Acthttps://www.crfb.org/papers/cost-full-repeal-affordable-care-act

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

The Commonwealth Fund. (2017). How would repeal and replace of the Affordable Care Act affect your state? https://www.commonwealthfund.org/blog/2017/how-would-repeal-and-replace-affordable-care-act-affect-your-state

Willison, C. E., & Singer, P. M. (2017). Repealing the Affordable Care Act essential health benefits: Threats and obstacles. American Journal of Public Health107(8), 1225–1226. https://doi.org/10.2105/AJPH.2017.303888