As a nursing professional advancing my education, it is essential to comprehend the profound effects legislative decisions can have on the healthcare delivery system. The legislative process, often intricate and protracted, involves the introduction of bills by legislators, subject to debates, amendments, and votes before becoming law (Milstead & Short, 2019). The intricacies of this process play a pivotal role in shaping healthcare policies, highlighting the delicate balance between political considerations and the welfare of the public. A recent, and intensely debated, legislative initiative within the political sphere is the Affordable Care Act (ACA).

According to Auerbach (2019), the ACA was a Democratic initiative with the goal of restructuring the healthcare system, providing coverage to uninsured Americans, and reducing healthcare delivery costs. By 2019, the fiscal impact of Medicaid expansion and ACA subsidies was estimated to exceed $120 billion (McMorrow et al., 2020). Due to the challenges encountered during the passage and complete implementation of the ACA, there was an increased focus on repealing or replacing the legislation during the 2012 presidential re-election.

Legislators, driven by the primary goal of re-election and the necessity of constituent support, align with preferences and prioritize policies benefiting their community (Milstead & Short, 2019). In this dynamic, a delicate balance emerges as legislators weigh the added political support from endorsing legislation against potential losses resulting from their actions (Feldstein, 2006). Ultimately, their decision to support legislation relies on whether the benefits, characterized by positive political support, outweigh the costs represented by negative political support.

Democrats and Republicans engaged in a cost-benefit analysis when considering the repeal of the ACA. Democrats highlight the positive impact of the ACA, emphasizing increased healthcare access and consumer protections, arguing that these benefits outweigh potential drawbacks. Meanwhile, Republicans often focus on concerns about government intervention and rising healthcare premiums, weighing these perceived costs against their policy goals of promoting free-market principles and reducing government involvement in healthcare. Ultimately, the Democrats lost the House majority in the 2010 midterm elections, shortly after the passage of the ACA. This was due to a combination of economic concerns, controversy surrounding ACA and the tea party movement (Karpowitz et al., 2011).

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Analyses of voters’ views play a pivotal role in shaping decisions by legislative leaders, particularly when recommending or positioning national policies. Political campaigns gauge voter views through public opinion polls, focus groups, and door-to-door canvassing, collecting both quantitative and qualitative data on issues and candidate preferences. Other opportunities to gather voter views include town hall meetings and campaign events (Mathur & Moschis, 2022). By understanding what the constituents like or don’t like, leaders can adjust their plans to match public opinion and avoid problems.

In summary, for advanced practice nurses, active engagement with healthcare policy is crucial. The dynamic nature of the political landscape, shaped by elected officials and constituent needs, underscores the professional responsibility to contribute to healthcare policy and engage in political activism. Regardless of your political views, the decisions made by an elected official will significantly impact your daily life. The actions of the legislators play a critical role in shaping policies that will affect the lives of their constituents. The ACA serves as an illustrative example, emphasizing the importance for healthcare professionals to not merely adhere to regulatory changes but to actively participate in shaping them.



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.


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.

The Affordable Care Act (ACA) was made into law in 2010 by President Obama. “Under the Affordable Care Act, patients who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state” (American, 2019). This law also helped cover those who fell below the federal poverty line to have access to the Medicaid program. (ASPA, 2022). One of the reasons legislators want to repeal or replace the ACA would be to remove the requirement that all Americans have to have insurance. Also, they have an issue with government involvement in healthcare (Dalen, 2015). Another issue is also the partisan divide in 2010 the law was passed by a Democratic President and was supported mainly by the Democrats, “Eighty-three percent of Republicans opposed the ACA, and 56% said it should be repealed. In contrast, only 19% of Democrats were opposed, and only 4% wanted it to be repealed” (Dalen, 2015).   

When it comes to re-election, voters are looking for someone with the same mindset as them, especially regarding healthcare. If a voter is someone who was uninsured before ACA and has health issues, they are going to be looking to support someone who plans on keeping people like them in mind when replacing ACA. Then you have the other side of voters that may have no health conditions or private insurance, and the ACA can go away and remain unaffected. They might view laws like the ACA as costing them more taxes.   

When campaigning, the legislative leaders have to look at the population where they are; if the majority of their voters in that region have ACA and support it, then it is unlikely they will get support to replace it. In today’s world, TV and social media are used extensively to advertise and campaign. “Americans state that what they know about the ACA comes from watching television” (Dalen, 2015). Those who are looking to get re-elected will use TV/social media to get their point across, and they will try to get voters that way.  


American Medical Association & American Medical Association. (2019, December 3). Understanding the Affordable Care Act. American Medical Associationhttps://www.ama-assn.org/delivering-care/patient-support-advocacy/understanding-affordable-care-act#:~:text=Membership%20Moves%20Medicine%E2%84%A2&text=The%20Affordable%20Care%20Act%20(ACA,to%20the%20health%20insurance%20market

Links to an external site..  

Assistant Secretary for Public Affairs (ASPA). (2022, March 16). About the Affordable Care Act. HHS.gov. https://www.hhs.gov/healthcare/about-the-aca/index.html

Links to an external site.  

Dalen, J. E., Waterbrook, K., & Alpert, J. S. (2015). Why do so many Americans oppose the Affordable Care Act? The American journal of medicine, 128(8), 807–810. https://doi.org/10.1016/j.amjmed.2015.01.032 Links to an external site.


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

The Affordable Care Act (ACA) is  ”a landmark piece of legislation with the potential to reshape health care in the United States. Its potential to reshape politics is also considerable” (Haselswerdt, 2017). President Obama’s efforts to reform healthcare have been considered the most significant effort made since the creation of Medicaid and Medicare in 1965 (Haselswerdt, 2017). President Obama and his administration made great strides; however, there was much controversy surrounding the ACA. The Bill only passed by a slim margin with the majority of the republican parties against the efforts. Since the election of President Trump, his administration immediately began talking about how to repeal or replace the ACA (Milstead & Short, 2019).  

            Many factors play a part in why policymakers support or oppose specific health policies. One main reason is financial. Politicians must have financial supporters to be able to campaign for election or reelection. Campaigns can cost millions of dollars (Milstead & Short, 2019). With the high cost of running for office, oftentimes, politicians must partner with those who are wealthy or with special interest groups, the other side of that is that the politician must be willing to support the efforts of the said persons (Milstead & Short, 2019). In the 2016 election cycle, the healthcare sector contributed over 236,000,000, with over 60% of that going to support Republican candidates (Milstead & Short, 2019). One of the other top supporters was insurance companies (Milstead & Short, 2019). This information can lead one to believe that the healthcare sector and the insurance companies could gain from supporting Republican efforts.   

            Another factor that can influence choices policymakers make are voters. During the first year of President Trump’s administration, several moderate Republicans voiced concerns about the repeal of the ACA (Milstead & Short, 2019). Their concerns were that the repeal or revision could take time to implement and could run over into the next two years, affecting the 2018 election (Milstead & Short, 2019). A study conducted by Haselwerdt (2017) looked at how the expansion of Medicaid and Medicare could affect voter participation. The results showed that depending on where the voter stands, benefiting from the expansion or feeling that the expansion could negatively affect one, could affect whether they voted or not (Haselswerdt, 2017). Another law associated with the ACA was the enforcement of penalties for individuals that did not obtain insurance coverage and businesses that had 50 or more employees and did not offer insurance coverage (Nadash, 2018). This mandate was unpopular with the public, the republican parties took advantage of this, attempting to increase their votes at the polls by promising to repeal this law (Nadash 2018). 

            In conclusion, money and decisions that influence voter support are at the heart of a policymaker’s agenda. To be elected, they must have financial support. Financial support often influences decisions made while in the office. Policymakers also consider how their choices and timing of decisions will impact their chances for reelection. Milstead and Short (2019) state, “policymakers are not necessarily focused on how real people will be affected by changes to Obamacare or Medicare and Medicaid but rather on how the changes will affect their reelection chances.” Although sad, this is a true statement. 


Haselswerdt, J. (2017). Expanding Medicaid, Expanding the Electorate. The Affordable Care Act’s Short-Term Impact on Political Participation. Journal of Health Politics, Policy & Law, 42(4), 668-695. https://doi-org.ezp.waldenulibrary.org/10.1215/03616878-3856107 

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide(6thed.). 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. https://doi-org.ezp.waldenulibrary.org/10.1080/08959420.2018.1462683 

I agree that the Affordable Care Act (ACA) has faced opposition since its enactment in 2010. Fundamentally, since its inception, legislators have expressed concerns about the individual mandate that requires Americans to have health coverage. It is true that cost-benefit analysis by legislators was instrumental in determining legislators’ decisions to repeal the law and that many Americans support the ACA. However, Pacheco et al. (2020) discovered that since the inception of ACA until 2016, polarization towards the ACA has never fallen below 50% in any state. This trend has been attributed to politics, particularly the differing opinions between Republicans and Democrats. I concur that the debate regarding the expansion of healthcare for Americans will persist for an extended period due to political partisanship. However, it is worth noting that although Democrats and Republicans hold differing opinions about ACA, legislators affiliated with each party tend to be influenced by the perceived benefits of the decisions they make. For instance, some Republican legislators refused to support the bill that sought to repeal the law (Crowley & Bornstein, 2019). Their decision not to support the bill might have been driven by the fact that their actions would jeopardize their chances of reelection since a majority of Americans support ACA. Legislators tend to support laws that voters are in favor of to appeal to them and increase their reelection chances.


Sasha Shaheen  

RE: Discussion – Week 3 

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. 


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 



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                       Policyhttps://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



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. 


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 (6th 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


Amber McCarter  

RE: Discussion – Week 3 

Legislators Influence On Health Care 

            The Affordable Care Act, also known as ACA or “ObamaCare”, was enacted in March 2010 by the Obama Administration. According to HealthCare.gov, the health care reform law has three primary goals; “make affordable health insurance available to more people, expand the Medicaid program to cover all adults with income below 138% of the federal poverty level, and support innovative medical care delivery methods designed to lower the costs of health care generally” (“Affordable Care Act (ACA)”, n.d.). This health care law was enacted in order to move towards the end goal of universal health care and provided as a right vs a privilege (Teitelbaum, 2018). According to Economic Policy Institute, approximately 29.8 million people would lose their health insurance and approximately 1.2 million would lose their jobs (“Repealing the ACA”, n.d.). With the repeal prospectively affecting that many Americans, you would assume this would play a large role in the legislative leader’s position in congress. We as a democracy, can influence those in the position to place laws and policies that impact our day to day lives. With the impact this repeal would have, I think it would be safe to say, the legislative leaders would have to rebuttal in order to save face and protect their position within congress. Once legislators found how many Americans would be affected by the repeal, the Trump Administration proposed the Better Care Reconciliation Act in 2017. This act would provide more help to cover out-of-pocket costs, health savings accounts, allocating additional resources to combat the opioid epidemic, providing more options for Americans to buy lower premium plans, as well as tax and Medicaid revisions (Senate Budget Committee, 2017). By providing these alterations to the Affordable Care Act, I feel that the legislative leaders were able to secure their position in congress and I can only hope their intentions are to continue to implement laws, policies and acts to better American lives across the nation. 


Discussion draft – better care reconciliation act (BCRA). U.S. Senate Committee On The Budget. (n.d.). Retrieved December 13, 2021, from https://www.budget.senate.gov/bettercare

HealthCare.gov. (n.d.). Affordable care act (ACA). Affordable Care Act ACA. Retrieved December 13, 2021, from https://www.healthcare.gov/glossary/affordable-care-act/

How would repealing the Affordable Care Act Affect Health Care and jobs in your state? Economic Policy Institute. (n.d.). Retrieved December 13, 2021, from https://www.epi.org/aca-obamacare-repeal-impact/

Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel Teitelbaum [Video file]. Baltimore, MD: Author 


Tamika Robinson  

RE: Discussion – Week 3 

The cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA (Obama Care) is a very interesting topic in healthcare. The impact can either help or hurt some of us. The goal for the legislator is to be reelected, so the decision must be supported throughout society. From my point of view, making ACA affordable, having access to healthcare, and making sure those without insurance are insured. Repealing the ACA keeps health insurance which make it appealing for some of us, while on the other hand, replacing the ACA can make it unappealing. This far, ACA has been very effective, and affordable, so let’s just keep it. On the other hand, if the ACA was replaced, many Americans would pay millions for prescription drugs, like medications that could save lives. According to the NCBI, the public debate focuses not on such important and difficult questions as how to discount future benefits or how to estimate cancer rates but on whether it is proper (or, as some contend, sinful) to “put a price tag on human life (National Research Council (US) Steering Committee on Valuing Health Risks et al., 1990). 

The decisions by legislative leaders could affect low-income families currently benefiting from Medicaid expansion would be at grave risk of financial catastrophe and more likely to take out debt in the event of a health emergency if they were to lose their coverage (Cusick Director et al., 2021). Legislatives invests nearly $1 trillion over the 2010–2019 time period aimed at making coverage affordable, the Act more than offsets these expenditures through curbs on Medicare and Medicaid spending, new taxes on high-cost plans, and tax shelters used most heavily by affluent families (Rosenbaum, 2011). Replacing the ACA with (the American Health Care Act – AHCA) can cause significant changes like age of the client, cost, and the lack of coverage. The decision is normally made by voters that have the most votes. The end goal is protecting families and their health.        


Cusick Director, J., Cusick, J., Director, Director, S. H. A., Hananel, S., Director, A., Seeberger Director, C., Seeberger, C., Oduyeru Manager, L., Oduyeru, L., Manager, Gordon Director, P., Gordon, P., Shepherd Director, M., Shepherd, M., Director, J. P. D., Parshall, J., Director, D., President, L. R. V., … Simpson, E. (2021, November 7). The chaos of repealing the Affordable Care Act during the coronavirus pandemic. Center for American Progress. Retrieved December 13, 2021, from https://www.americanprogress.org/article/chaos-repealing-affordable-care-act-coronavirus-pandemic/. 

National Research Council (US) Steering Committee on Valuing Health Risks, Costs, & Decisions, and B. for E. (1990, January 1). The politics of benefit-cost analysis. Valuing Health Risks, Costs, and Benefits for Environmental Decision Making: Report of a Conference. Retrieved December 13, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK235528/. 


Hi Tamika Robinson  

Legislators must conduct a cost-benefit analysis on repealing Obamacare. The objective of any legislator is to be reelected. The mandate of electing leaders lies with the general public. I agree with your point of view; repealing ACA may negatively affect healthcare costs and access to healthcare services. Since its inception, ACA has increased the number of Americans insured (Silberman, 2020). The decision by legislators can thus affect low-income families who are Medicaid beneficiaries. Legislators will follow what the electorates say to protect their positions to ensure they get reelected. 


Silberman, P. (2020). The Affordable Care Act: Against the odds, it’s working. North Carolina Medical Journal, 81(6), 364-369. https://doi.org/10.18043/ncm.81.6.364 

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