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 People voted specifically on the promise of the ACA being repealed.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.

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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.


Blendon, R. J., & Benson, J. (2014, September 12). Voters and the affordable care act in the 2014 election: Nejm. New England Journal of Medicine. Retrieved September 13, 2022, from https://www.nejm.org/doi/full/10.1056/NEJMsr1412118

Cohn, J. (2020, March 6). The ACA, repeal, and the politics of backlash. Health Affairs Forefront. Retrieved September 13, 2022, from https://www.healthaffairs.org/do/10.1377/forefront.20200305.771008

Daniel, M. (2017). The cost of full repeal of the Affordable Care Act. Committee for a Responsible Federal Budget. Retrieved September 13, 2022, from https://www.crfb.org/papers/cost-full-repeal-affordable-care-act

Montero,A. (2022, April 14). 5 charts about public opinion on the Affordable Care Act. KFF. Retrieved September 13, 2022, from https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/

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 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.

The Affordable Care Act was established in 2010, since then many Americans now have health insurance even with preexisting conditions (ASPA, 2023). The Affordable Care Act increased the quality and decreased the health disparity of many Americans. Also, since 2010 it has been a hot topic with every election with both democrats and republicans arguing back and forth over changing it or replacing it.  

According to The United States Government (2023), for the last decade nearly every republican budget or fiscal plan has involved repeal of the Affordable Care Act and cuts to medicaid. If this were to happen it would increase the cost of healthcare as well as decrease the coverage people currently receive.  

I can see both the positives and negatives of obamacare. When obamacare first started, I had just graduated from high school and could not find a full-time job. Many of my family members and the more influential adults in my life said that this was because many employers did not want to have to pay for health insurance, so because of that when it first came out I was not all for it. After some research and time I realized that it has actually helped.  

A legislator’s main job is to get reelected, because of this voters can impact many things. Voters impact the issues legislators run on as well as how they vote because they want to get reelected (Lee et al, n.d.). If you watch a senator’s time in office, as there is no limit, you may see much flip-flopping on issues. 

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.

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.

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.


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 Medicine377(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

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