POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

The Patient Protection and Affordable Care Act of 2010 (ACA) is a revolutionary policy. This Act wanted to address social injustices in the American healthcare system. However, this policy has met stiff opposition from Republican legislators who openly opposed it. When Donald Trump came to power, repealing ACA was one of his number one priorities. They, however, did not get the requisite number to repeal ACA since other legislators felt like many Americans would be affected. Many Republican lawmakers started seeing that they may not get reelected if they continued to support the repeal of ACA.

In May 2017, the House of Representatives passed the American Health Care Act (Jost, 2017). This was the first attempt at repealing ACA. The Trump administration wanted to use this act to repeal ACA.  However, this Act would make millions of Americans lose health insurance coverage. AHCA proposed that tax credit be based on age, which would increase healthcare costs. This Act also created the Patient and State Stability Fund, which would reduce premiums by 25% after 2026 (Jost, 2017). This would increase healthcare costs for Americans with preexisting comorbid conditions.

A cost-benefit analysis by Republican lawmakers revealed that they would not get reelected because of the negative effects of repealing. Repealing ACA would lead to millions of Americans losing insurance coverage (Straw & Aron-Dine, 2020). This was the main reason for implementing ACA. ACA aimed to increase insurance coverage to millions of Americans and reduce healthcare costs (Sommers, 2020). Due to reelection purposes, the Senate Majority Leader McConnell found it hard to garner support for AHCA. To protect their political interest, the US senators came up with another proposal known as the Better Care Reconciliation Act of 2017 (Smith & Gibbs, 2017).

Members of Congress and Senators are elected leaders who must be voted for by the public. Due to this, their positions on policies such as Obamacare are influenced by how their electorates feel. Because of this, their interest is reelection and not ACA.

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References

Jost, T. S. (2017). House passes AHCA; HHS acts on regulations. Health Affairs, 36(6), 982-983.

Smith, K., & Gibbs, T. E. (2017). The APHA PHACT campaign in action in Delaware. Delaware Journal of Public Health, 3(4), 6-11.

Sommers, B. D. (2020). Health insurance coverage: What comes after the ACA? Health Affairs, 39(3), 502-508.

Straw, T., & Aron-Dine, A. (2020). Commentary: ACA Repeal Even More Dangerous During Pandemic and Economic Crisis. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/commentary-aca-repeal-even-more-dangerous-during-pandemic-and-economic-crisis

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Your post well describes the outcome of cost-benefit analysis and recognizes how it was represented regarding attempts to repeal/replace the ACA during the Trump administration. It is clear that that is no longer a threat during the Biden administration.

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10 months ago

TRINA COLEMAN 

RE: Discussion – Week 3

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Sasha,

The last statement of  “….their interest is re-election and not ACA.” This statement highlights the level of politics within politics. Interest groups spend resources on trying to remove legislators who do not share in their intentions. Americans would be better served by policy-motivated committees that dissect and evaluate the benefit of a bill before allowing it to be considered (Lorenz, 2020). Everything boils down to the dollar. I understand health care and politics are as much of a business as anything else. However, it is unfortunate the system is overly saturated with misguided interests, and how does this benefit me. Personal experiences weigh heavily on attitudes toward the government and health care policies within contemporary societies (Larson, 2020). Lobbyists aid in providing and identifying agendas; these “agenda setters” would be more likely to perform in the public’s best interest if a policy-motivated committee was the influence behind new bills (Lorenz, 2020).

Larsen, G. (2020. Personal politics? Healthcare policies, personal experiences and government attitudes. Journal of European Social                       Policy.

https://doi.10.1177/0958928720904319

Lorenz, G. (2020). Prioritized interests: Diverse lobbying coalitions and congressional committee agenda setting. University of Chicago Press Journals.

        https://www.journals.uchicago.edu/doi/abs/10.1086/705744

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10 months ago

Andrea Ferrin 

RE: Discussion – Week 3

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Hi Sasha, I think your discussion post was a great summary of how beneficial the ACA was and the detriment to the entire population we would have seen if the AHCA had been passed. The elderly population would have suffered the most as far as coverage due to costs, and the younger population would have had a harder time finding accessible care because of constituents based on age. Also, I like that you mentioned that health care costs would increase for Americans with comorbidities, as this has been a growing concern over the years.

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10 months ago

Colton Phelps 

RE: Discussion – Week 3

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Hello Sasha,

Thank you for your response to the discussion. The way you ended your post really stands out and is a little unsettling. It is unfortunate that there are politicians who’s main goal is to keep their position or maintain their image for re-election.  I would hope that the majority of politicians stand by their ethics and vote based off their true feelings and advocate for the populations they represent. I would like to see improvements continue to be made in relation to health care without driving the costs of care up. It is obvious that politicians want to make changes, for example, the Better Care Reconciliation Act was created in order to make changes but not to be as controversial (Smith & Gibbs, 2017).

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References:

Smith, K., & Gibbs, T. E. (2017). The APHA PHACT campaign in action in Delaware. Delaware  Journal of Public Health, 3(4), 6-11.

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10 months ago

Amber McCarter 

RE: Discussion – Week 3

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Sasha,

I love that you kept the explanation of the health care acts and attempted repeal short and simple but explained it all perfectly. It is a shame that in recent times, politician’s true colors have shown. They are making it more transparent that some, unfortunately most, do not always have the American people’s best interest in mind. With legislators being driven with the primary goal of being re-elected and not solely for the benefit for its constituents (Milstead & Short, 2019), I am grateful we live in a country that allows us to be a part of a democracy in order to have some control in how our amazing country is ran. According to Dr. Nwogu, “democracy is a system of government with four key elements: a system for choosing and replacing the government through free and fair elections, active participation of the people, as citizens in politics and civic life, protection of the human rights of all citizens and a rule of law in which the laws and procedures apply equally to all citizens” (2015). I genuinely believe, if we allowed these elements to guide our country, the government wouldn’t be viewed as corrupt, and we wouldn’t have to analyze how politicians balance cost vs benefit for their gain instead of the American people like it was originally intended way back when.

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 References

Milstead, J. A., & Short, N. M. (2019. Informing public policy: An important role for registered nurses. In Health Policy and Polictics: A nurse’s guide (6^th ed., p. 40). Jones and Bartlett Learning.

Nwogu, G. A. I. (2015). Democracy: Its Meaning and Dissenting Opinions of the Political Class in Nigeria: A Philosophical Approach . Journal of Education and Practice, 6(4). Retrieved 2021, from https://files.eric.ed.gov/fulltext/EJ1083739.pdf.

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.

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050 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

The Affordable Care Act (ACA), also known as “Obamacare,” is a comprehensive healthcare reform law approved in the United States in 2010 under President Barack Obama’s administration. Its primary goal is to increase the quality and affordability of health insurance, expand access to healthcare, and reduce the overall cost of healthcare in the country.

According to the Centers for Medicare & Medicaid Services (2021), there was a new report released that showed 31 million Americans have health coverage through the Affordable Care Act – this was a new record. The report also showed that there had been reductions in uninsurance rates in every state in the country since the law’s coverage expansions took effect (para 1). The ACA has been able to expand access to healthcare coverage by creating state-based health insurance marketplaces, known as “exchanges,” where individuals, families, and small businesses can compare and purchase insurance plans. It has also expanded Medicaid eligibility in many states, providing coverage for millions of low-income Americans who were previously uninsured. It has also introduced regulations that prohibit insurance companies from denying coverage or charging higher premiums based on pre-existing conditions. It also requires coverage of essential health benefits and bans lifetime and annual limits so that insurers cannot cap how much they pay for medical care each year or over a person’s lifetime. (Rapfogel et al., 2020, para 3).

Repeal and Replace the ACA

A tracking poll conducted in March 2022 by the Kaiser Family Foundation found slightly more than half of the American public (55%) held a favorable opinion of the ACA, while about 42% held a negative opinion of the ACA (Kirzinger et al., 2022, para 1). One in five Americans stated that the ACA had hurt them due to increased health care or health insurance costs. Some have said it’s made it more difficult to access care or has caused their family to lose coverage (Kirzinger et al., 2022, para 5). As a result of regulations and requirements, certain insurance plans and providers have exited the market, reducing options for consumers. Additionally, some have experienced difficulty finding healthcare providers within their network or accessing specialized care.

The American Health Care Act (AHCA) was a healthcare reform bill proposed in the United States in 2017. It was put forth by House Republicans as an alternative to the Affordable Care Act (ACA) to repeal and replace certain ACA provisions.

The AHCA aimed to maintain the health insurance markets under the ACA, but proposed providing age-based tax credits instead of income-based subsidies, which would potentially allow insurers to charge higher premiums to individuals who are older and/or have lower incomes (Cox et al., 2017, para 26). Without subsidies or the individual mandate, many healthy people would also exit the market and choose to go uninsured, which will cause insurers to raise premiums further to account for the now sicker, on average, enrollment, which in turn will cause more and more healthy people to rescind their coverage, and premiums to rise further (Rivlin et al., 2016, para 14).

The AHCA also allowed states to seek waivers to modify essential health benefits, potentially leading to variation in coverage across states and resulting in reduced coverage for essential services, such as mental health treatment, maternity care, and prescription drugs. According to Rapfogel et al (2020), individual market plans were not required to cover prescription drugs before ACA. Under the ACA’s essential health benefits requirements, 1.3 million Americans gained prescription drug coverage (para 21). Without ACA, insurers could exclude all drugs or entire classes of drugs, leaving some patients with high out-of-pocket- costs and others unable to afford the treatments they need.

Voter’s Views

Legislators’ primary objective during campaigns is to get re-elected or elected to a higher office. They are very mindful of public opinion and the potential impact of their voting decisions on their electoral prospects. During campaigns, legislators often interact with their voters, listen to their concerns, and gather feedback on various important issues. This direct interaction can help legislators determine what is important to their voters and how they can align their campaign messages with their voters and gain their trust and loyalty for electoral success. Many Republicans realized that if they pushed for repealing and replacing the ACA, they would lose votes and not be re-elected, so they did not vote to repeal and replace it.  

Conclusion

Healthcare reform is a very complex and controversial issue. In order to replace the ACA, a new healthcare plan would need to be developed and introduced that would address key aspects of healthcare such as insurance coverage, cost control, Medicaid expansion, and protections for pre-existing conditions. A new plan would need to be supported by the general public for legislators to notice and act. Legislators are aware of the visibility and public attention their campaigns receive, and voters often expect consistency between a candidate’s campaign promises and their subsequent voting behavior. This new plan would require support from the Senate, House of Representatives, and political parties and would go through many years of debate and negotiation prior to passing it into law.