Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act

Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act

Initial Post 

Legislators weighing the pros and cons of replacing or repealing the Affordable Care Act must consider the possible effects on their constituents and the political ramifications of their decisions. Things to consider include how the public feels about them, how much support they have from their party, and the pros and cons of their healthcare policy position. The two major parties adopted opposing positions regarding the Affordable Care Act’s implementation during their presidency.

Democratic stance on ACA

President Biden, the vice president under Obama, supports the Affordable Care Act. He took a stance to expand on the healthcare agenda by advocating for expanding resources for Medicare and federal funding for public health (Nuzum et al., 2020). The advancement of the ACA could close the gap between racial differences. Keith (2023) states that the Navigator Grant Fund received nearly $100 million in 2023 from the Biden administration. This money was intended to promote marketing and aid with coverage enrollment. Minorities whose primary language is not English will be better able to access healthcare and have a higher level of health literacy due to these changes.

Republican stance on ACA

According to Milstead and Short (2019), Trump could not fulfill his campaign promise to fully repeal the ACA because doing so would have been highly costly and time-consuming, and it would have put him in a vulnerable position leading up to the next election. In the end, Republicans opted not to do away with the program altogether. An estimated $350 billion will be required to repeal the Affordable Care Act in its entirety between 2017 and 2027, according to the Committee on Responsible Federal Budget (2017). Reversing Obama’s policies would be too expensive, so the Trump administration imposed regulations to make specific changes. His reforms led to higher premiums and lower availability. Even more ominously, Trump was said to have intended to establish the Association Health Plan, his insurance marketplace.

Analyses of voter sentiment significantly impact legislative leaders’ decisions, especially when putting forth or establishing national policies. Political campaigns collect quantitative and qualitative data on issues and candidate preferences through public opinion polls, focus groups, and door-to-door canvassing. Other ways to gather voter feedback include town hall meetings and campaign events (Mathur & Moschis, 2022). In order to avoid issues, leaders should listen to their constituents and change their plans accordingly. Depending on the policy, different groups may benefit from its creation and execution. A good policy should solve the most critical problems facing society at the moment, which should benefit everyone.

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The Affordable Care Act expands the coverage of insurance in two ways. First, it increases the access of coverage through Medicaid and subsidies to buy private insurance on health care exchanges. Second, enhance the quality and dimensions of coverage by improving benefits, including the Essential Health benefits (EHBs). Essential health benefits contain 10 categories of care which provides access to health care services for individuals and small groups to improve the health and wellbeing of Americans.

     Cost and benefit analysis plays a significant role in policy making such as this if legislator would want to repeal the ACA. It helps them identify the consequences, evaluate if policy maximizes financial resources, and measures the total welfare of the population. The benefits of repealing the ACA coverage would save $1.5 trillion 2027 and increase economic growth. The house of representatives introduced 50 bills to repeal ACA in whole or in part. The vote was defeated in the effort of repealing it in the summer of 2017.  Repealing the Affordable Care Act would cause disadvantages to the Americans. The government would reduce their expend budget on healthcare insurance for non-elderly which is the aim of those who advocate for it. The following below are the effects if ACA will be repealed:

  • There will be an increase of 81% of uninsured Americans.
  • There will be 14.5 million people who will get less Medicaid coverage.
  • There will be no assistance support for those who have received tax credits for private health coverage.
  • State expend will increase by $68.5 billion between 2017 and 2026 since Medicaid spending is reduced by uncompensated care.
  • Various states reported that there will be shortage of budget if Medicaid is expanded and repeal the ACA.
  • Health care services will be limited to modest-and-low-income families.

Legislators are dealing with intricacy and the risks that could come if ACA is completely repealed and many states are against repeal the efforts.

     Voters’ view is significant in making policies as it has an influence on legislators in making decisions. Legislators represent the community, and they seek and receive information from sources. The need to replace the ACA was mainly taken by the Republicans leaders view as for them it deeply hurts the Americans while the Democratic leaders wants to maintain the law as it helps the American citizens. However, the debate on repealing it most people’s view is based on their belief and values about the responsibility of the federal government to provide insurance for those who are uninsured. Majority of the public opinions believed that the government should be involved in improving the health care system, 87% from the Democrats and only 28% of Republicans. They preferred lawmakers to make changes so the more people would get the benefit of health insurance whereas Republicans chose to reduce the government spending. This is what makes the legislators had a difficulty in approving the single-repeal-replace plan.

Reference

Berkeley Public Policy Journal. (2021, December 14). The Role of Cost-Benefit Analysis in Public Policy Decision-Making – Berkeley Public Policy Journal. Berkeley Public Policy Journal. https://bppj.berkeley.edu/2021/12/14/the-role-of-cost-benefit-analysis-in-public-policy-decision-making/

Links to an external site.

Blendon, R. J., & Benson, J. M. (2017). Public Opinion about the Future of the Affordable Care Act. New England Journal of Medicine377(9), e12. https://doi.org/10.1056/nejmsr1710032

Links to an external site.

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine16(2), 1–3. https://doi.org/10.1371/journal.pmed.1002752

Links to an external site.

The Cost of ACA Repeal. (2016). https://www.urban.org/sites/default/files/publication/81296/2000806-The-Cost-of-the-ACA-Repeal.pdf

Links to an external site.

The Cost of Full Repeal of the Affordable Care Act. (n.d.). Committee for a Responsible Federal Budget. https://www.crfb.org/papers/cost-full-repeal-affordable-care-act#:~:text=Repealing%20the%20ACA%E2%80%99s%20coverage%20provisions%20would%20save%20%241.55

Links to an external site.

‌ 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

Links to an external site.

Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act

Week 3 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.

Week 3 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 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

RE: Main Question Post (edited, please use for grading)

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     The Affordable Care Act (ACA) was set in motion to help improve the health equity of persons in the United States. It is argued that the Trump administration has no set goal of improving health equity (Grogan, 2017). Grogan (2017) reports that the ACA proposed replacement will decrease the availability of healthcare coverage; low-income Americans will pay higher insurance premiums and remove the taxation on wealthy Americans, therefore, reducing the number of tax dollars for healthcare expenditures. Changes being proposed by the Trump administration could completely dissolve the efforts made by the ACA.  Grogan (2017) predicts if the repeal goes through, our country will be on the road to more significant health inequities and an increased amount of health disparities.

Politicians have to rely on others for financial support. Campaigns can cost millions of dollars. This money comes mostly from wealthy individuals, large organizations, or specialty groups that support the agenda or that will pay for the politician to promote their agenda. In the 2016 election cycle, I found it interesting that the healthcare sector contributed over 236,000,000 dollars, most of that to Republican parties (Milstead & Short, 2019).

Although necessary to need financial contributions, I find that it is appalling that politicians would choose to support an agenda that risks the health of the American people, just for their monetary gain. Haselswerdt (2017) reports that poor health drains resources, time, and money. Americans spent 3.6 Trillion dollars in healthcare in 2018 (“Historical,” n.d.). It would seem that politicians would want to decrease the amount spent on healthcare and move to more preventative health, which would include persons being able to be insured.

Grogan, C. M. (2017). How the ACA Addressed Health Equity and What Repeal Would Mean. Journal of Health Politics, Policy, and Law, 42(5), 985-993. https://doi-eor.ezp.waldenulibrary.org/10.1215/03616878-3940508

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

Historical. (n.d.). Retrieved March 10, 2020, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical

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

Week 3 Discussion

Politics and the Patient Protection and Affordable Care Act

Source: Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Chicago, IL: Health Administration Press.

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.

The suppliers of legislative benefits are legislators, and their primary goal is to be re-elected. Thus, legislators need to maximize their chances for re-election, which requires political support. Legislators are assumed to be rational and to make cost-benefit calculations when faced with demands for legislation. However, the legislator’s cost-benefit calculations are not the cost-benefits to society of enacting particular legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur as a result of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support legislation. (page 27)

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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 aim of this law was to improve the health care system of the U.S. by widening health coverage to more Americans, and by protecting existing health insurance policy holders.

There were several parts of the bill that had important implications for many Americans.

These relate especially to coverage for pre-existing conditions, including pregnancy, children on parental plans, and help for small businesses to have their employees insured.

Coverage for pre-existing conditions

Beginning in 2014, insurance companies could not raise premiums for infants or children because of a pre-existing condition or disability.

Adults who previously could not get coverage because of a pre-existing condition, and who had had no insurance for 6 months or more would now get insurance.

The Pre-Existing Condition Insurance Plan (PCIP) was aimed at adults who could not get coverage because of a pre-existing condition, such as diabetes or cancer. From 2014, the Act made access available to them.

As of 2018, health insurers cannot deny or cancel coverage for someone with a pre-existing condition. The insurance must also cover that condition, and insurers cannot charge someone more for having that condition. Pregnancy is still considered to be a pre-existing condition, so insurance now covers all prenatal care and the birth from day one of coverage.

However, President Trump’s administration recently said that he would no longer support this provision in the PPACA.

According to the Kaiser Family Foundation, this may head to the Supreme Court for a final ruling in 2019.

Children remain on parental plans

The Act means that young adults can stay on their parents’ health plans until they are 26 years old.

This includes:

  • those who do not live with their parents
  • those who are out of school
  • those are not financially dependent on their parents
  • those who are married

A child who has health insurance under their parents’ plan will lose coverage on their 26th birthday.

This is considered to be a special enrollment period. It means that they can sign up for a new plan without having to wait for open enrollment at the end of the year.

It is important to recognize that, under this plan, insurance does not cover spouses and offspring of adult children.

Committee chairs (appointed by the political party in the majority) are extremely influential, particularly with respe ct to the subject areas that are the focus of the committee’s work. Chairs determine which bills will be heard and when, and they estab lish the procedural framework under which the committee operates. The chair’s position on an issue can determine the fate of a bill from the outse t. Because of the extent of their power and influence, committee chairs are able to raise large sums of money from special-interest groups to support their re-election- and re-election is always an important consideration for lawmakers. The House and Senate leaders (elected by their colleagues) determine who will be named committee chairs. Certain committees are seen as more prestigious than others, so being named the chair of one of those committees is very important to an ambitious legislator. “Ranking members” are the appointed committee leaders for the political party in the minority.

Not surprisingly, political considerations play a role in this entire process. Being aware of the dynamics that are the foundation of the overall committee process helps ensure more effective representation by those who want to influence the outcome of the committee’s work.

Floor Action

If a bill is able to garner committee approval, it goes to the full chamber for a vo te. The timing for scheduling a vote, as well as various attempts to amend the bill or delay the vote, are integral parts of the lawmaking process. Much maneuvering occurs backstage, and the ability to influence these less public interactions is as

Congressional Structure
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100 members, 2 from each stat e.

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important as the words or concepts being debated. Again, people’s relationships and polit ics determine the ultimate results. To be effective in one’s efforts to in­ fluence outcomes, one must be aware of these relationships and take them into account. Once a bill is approved in either the House or Senate, legislators begin the process again in the other chamber.

Conference Committee

Seldom does a bill complete the journey through the second chamber without change, which means the originating chamber must agree to the new version of the bill. Without agreement, a bill will be referred to a conference committee made up of representatives from the House and Senate; they reconcile the differences in the two bills and ask their respective chambers to support the conference committee report. If agreement cannot be reached, the bill dies.

Chief Executive Signature

If the House and Senate reach agreement , the bill goes to the chief executive (president or governor), who must sign the bill before it can become law. If the chief executive vetoes the bill, it goes back to the legislature for a potential veto override, which requires a two-thirds majority of both chambers.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

  • Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
  • Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
  • One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
  • I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

  • Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
  • In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
  • Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
  • Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

  • Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
  • Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
  • I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

  • I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
  • As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
  • It is best to paraphrase content and cite your source.

LopesWrite Policy

  • For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
  • Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
  • Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
  • Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

  • The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
  • Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
  • If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
  • I do not accept assignments that are two or more weeks late unless we have worked out an extension.
  • As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

  • Communication is so very important. There are multiple ways to communicate with me: 
    • Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
    • Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

1 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)

2 https://www.congress.gov/

3 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

Note: You will access this article from the Walden Library databases.

4 https://www.house.gov/

5 https://www.senate.gov/

6 https://www.senate.gov/reference/org_chart.htm

Discussion: 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 voters 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.

Imagine this, a world where the primary motivation for the decisions of a government body was solely for the good of its citizens, and the issue of reelection was not even considered. Unfortunately, legislators who focus on the people, instead of how to stay in their position of power, are few and far between; if they even exist at all in the United States today. When it comes to the cost, or votes, versus the benefit, potential legislation to aid the constituents, representatives are more likely to lean towards options that will bring in more votes because getting reelected is a major focus for them (Milstead & Short, 2019). Legislators’ concentration on winning more votes for reelection has greatly impacted healthcare reform in this country.

The Affordable care act (ACA) enacted in 2010 made major changes in the United States’ healthcare system. This law’s primary purpose was to decrease the number of people with no insurance coverage and make health insurance more affordable for the United States population (Huguet et al., 2021). As a result of this new law, about 20 million people became newly insured, and it is expected that 29 million people will enroll by 2022 (Huguet et al., 2021) et al., 2011). Despite the success recorded by the ACA’s implementation, some people call for it to be repealed, but this has not been successful in all fronts for some reason (Huguet et al., 2021).

One of the primary reasons why all attempts to repeal the ACA failed since 2010 is the legislator’s reelection. Legislators are voted into position by the citizens and will continue to need their vote to remain in that position. Repealing the ACA will lead of 29.8 million people losing their health insurance and 1.2 million jobs would be lost (Eltorai & Eltorai, 2017). The lower class and the poor are people who will be hit hard by this action. These individuals are the people that are meant to vote for the reelection of these legislators. Families that have lost their health insurance and jobs will not vote for their legislatures that supported the repeal of ACA that brought them woes. The primary goal of legislators is to be re-elected and to increase their chances for political support; the legislators will always work towards gaining votes by listening and satisfying the groups of people and communities where their votes for reelection will come from.

This prioritization of reelection has many areas of society in need of new legislation, especially healthcare reform. Both sides have indicated that the Affordable Care Act (ACA) has some issues that need to be fixed, but reform is difficult when neither side is willing to work toward a compromise. Per Franz et al. (2021), “fundamental conflicts – on the role of government in providing and subsidizing health care and on tradeoffs between reducing costs and increasing access – stand in the way” of reform for the ACA. Reforms are even more difficult to accomplish given that drastic change that is viewed to be too far to the left or right hurts a legislator’s chances of reelection, especially if it does not appear to have social or financial protection for the people (Franz et al., 2021). Therefore, to attempt to maintain their position while also performing the responsibilities they were elected to carry out, legislators will only agree to terms on reforms of ACA that meet specific criteria in the minds of their constituents.

Other national healthcare policies of interest include Medicare and Medicaid. Ideally, representatives are elected to be the voice of a region on a national scale and will form their legislative decisions based on what will benefit their constituents the most (Milstead & Short, 2017). However, the citizens they are representing may have conflicting ideas with their chosen politicians, and in these cases, the congresspersons will align their vote with the opinion of most of their people. It is in their best interest to please as many voters as possible to increase their chances of being reelected (Milstead & Short, 2017).

While the purpose of congressional representatives is to pass legislation in the best interest of their constituents, their decisions are guided by their own self interests. Healthcare policy affects all American citizens, but even this topic of great interest does not inspire politicians to primarily consider the well-being of the people over their own (Milstead & Short, 2017). The drive of legislators to get reelected currently has, and will continue to have, a strong effect on healthcare in the United States.

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

Indeed, the recent global experience can be used to summarize the current crisis in access to mental health services and other healthcare issues; “During the past 2 years, exacerbated by the COVID-19 pandemic, there are more individuals suffering from depression, anxiety, substance abuse, social isolation, and interpersonal conflicts. There are more deaths by accidental drug overdose than ever in our history. More and more people every day cannot access the mental health treatment they so desperately want due to long waits for an evaluation, a lack of resources, and an underfunded mental health infrastructure. We need more psychiatrists, more PMHNPs, more psychotherapists, more mental health clinics, more psychiatric hospital beds, more partial hospitalization programs, more resources for the homeless suffering from mental illness, and more reforms to release individuals with serious mental illnesses from incarceration due to minor offenses, often directly related to the consequences of lack of treatment” (Kuntz, 2022).

Looking at what is happening in the healthcare setting, Nurses at all levels need to promote and educate the masses on the Cost-Benefit Analysis of the Affordable Care Act (ACA) and the need to promote the ACA and support the reelection of any legislators that promote ACA. Yes, I believe your statement that “engaging NPs in political efficacy, they can advocate and influence change in the state rules and regulations which would allow them full practice.” According to our study material, “According to the Federal Elections Commission, as of November 28, 2016, the healthcare sector had contributed $236,399,000 to campaigns during the 2016 election cycle, with approximately 60% of that total going to Republican candidates” (Milstead & Short, 2019).

Thus, healthcare providers can influence the legislators and help in campaigning for those legislators that will promote healthcare bills. I remember when Trump’s presidential campaign promised to repeal and replace the ACA but finally made some changes. Indeed, repealing and replacing the ACA will be of negative impact on society. Indeed, if more nurses advance in becoming qualified PMHNPs and functioning at the highest level of their education and scope of practice, in that case, it will go a long way in making healthcare affordable. The quality of care will improve, and legislators will seek opinions from nurses before making any policies that will affect the healthcare sector. Thanks a million for your contribution.

Reference

Kuntz, L. (2022). Psychiatric Care in the US. Psychiatric Times39(4), 1–4.

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

Jones & Bartlett Learning. Chapter 3, “Government Response: Legislation” (pp. 37–56)

Submission and Grading Information

Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act Rubric Detail

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Name: NURS_6050_Module02_Week03_Discussion_Rubric

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Main Posting

45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness

10 (10%) – 10 (10%)

Posts main post by day 3.

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)
Does not post by day 3.
First Response

17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response

16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation

5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)

0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module02_Week03_Discussion_Rubric

RE: Discussion – Week 3

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Initial Post

President Obama passed the Affordable Care Act (ACA) in 2010 with the intent to improve America’s healthcare system by providing Americans with more affordable healthcare options, increasing access to healthcare and improvement in the quality of healthcare received (healthcare.gov, n.d.). The ACA was not well received by the opposing political party. President Trump took the lead in efforts to abolish the ACA with the intent to create a healthcare system that would place control of healthcare back into the hands of Americans through the American Healthcare Act (AHCA) (NCBI.mln.nih.gov, n.d.).  According to Dabbous et al (2019), President Trump promised to repeal and replace the Affordable Care Act (ACA) while ensuring insurance coverage for all with no cuts to social security, Medicare, and Medicaid, and allowing health insurance to be purchased across state lines in a bid to promote competition, and to maintain protection for people with pre-existing conditions.

Cost benefit analysis is one tool regulatory decision makers use in determining how to move forward on a proposed regulation or whether to move forward at all (Foreffective.gov.org, n.d.). Legislators weigh the risks and benefits associated with a policy and how it will affect them in terms of re-election. Legislators typically pass policies that they feel will be supported by their voters. If a legislator proposes policies that opposes the views of their supporters, they risk losing voters and subsequently losing their position of power. President Trump has not been able to abolish the ACA as originally intended; however, he has made adjustments that have been favorable to the American people for example, the removal of the tax penalty for not having healthcare coverage. Because the ACA as so many benefits to Americans, it has proven challenging to replace without negatively impacting our current healthcare system, so it remains intact.

Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act References

Dabbous, M., François, C., Chachoua, L., & Toumi, M. (2019). President Trump’s prescription to reduce drug prices: from the campaign trail to American Patients First. Journal of Market Access & Health Policy7(1), 1–4. https://doi-org.ezp.waldenulibrary.org/10.1080/20016689.2019.1579597

Foreffective.gov.org. (n.d.). Center for Effective Government. Cost-Benefit Analysis. https://www.foreffectivegov.org/node/3470#:~:text=Cost%2Dbenefit%20analysis%20(CBA),to%20society%20as%20a%20whole.&text=Executive%20Order%2012866%2C%20Regulatory%20Planning,any%20%22significant%22%20proposed%20regulation.

Healthcare.gov. (n.d.) Affordable Care Act (ACA). https://www.healthcare.gov/glossary/affordable-care-act/

Discussion: Politics and the Patient Protection and Affordable Care Act

The enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA) remains the most revolutionary approach to ensuring that Americans get health equity and increased accessibility. However, the policy faced political undertones in Congress as Republican lawmakers voiced their open objection to the legislation. Under the Trump Administration, these lawmakers started efforts to “repeal and replace” the policy; a move that would have led to over 25 million Americans losing their medical coverage. The initial attempt to repeal and replace the ACA occurred in 2017 when the House of Representatives passed the American Health Care Act (AHCA) (Stevens, 2018). However, an analytical perspective demonstrated that implementing the AHCA would lead to increased cost of premiums and fail to cover individuals with pre-existing conditions.

Through a cost-benefit approach, the legislators, including the proponents, realized they risked losing their re-election due to the far-reaching negative effects of repealing and replacing the ACA. The new law would have deprived millions of Americans access to affordable healthcare. Because of the re-election reasons, the Majority Leader in the Senate could not get enough votes for the proposed new legislation (Obama, 2017). The Congressional Budget Office (CBO) asserted that AHCA would have far-reaching negative effects on health spending by federal government.

The number one priority of legislators is to get re-elected and this means that they must campaign. Due to this fact, their opinions, decisions and positions on policy issues like health care affect their influence on voters. The implication is that they must champion for and advocate issues that affect their electorate to get the opportunity to represent them in Congress (Nadash, et al., 2018). Therefore, the legislators could not risk losing their elective positions because of passing the AHCA by repealing and replacing the ACA. 

Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act References

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.

Obama, B. H. (2017). Repealing the ACA without a replacement—the risks to American health

care. Obstetrical & Gynecological Survey, 72(5), 263-264. doi: 10.1056/NEJMp1616577.

Stevens, C. D. (2018). Repeal and replace? A note of caution for medical school curriculum

reformers. Academic Medicine, 93(10), 1425-1427.

doi: 10.1097

Module 2 Discussion: Politics and the Patient Protection and Affordable Care Act 
          The Affordable Care Act was enacted by former President Obama in 2010. The goal of the ACA was to make health insurance more affordable and available to the people, expand the medicaid programs statewide, as well as support innovative medical care delivery methods which would hopefully decrease health care costs (ACA). Health care and repealing/replacing the ACA is a hot topic among the political world. The ultimate goal of the politician or legislator is to gain votes and be reelected. Whether a legislator truly believes repealing/replacing the ACA with something different will be beneficial to Americans, they are likely to do so anyway to gain the vote from the community. Politicians desire to secure reelection seems to cause legislators to engage in undesirable activities. Money unfortunately plays a critical role in these election and reelection campaigns, as it costs millions of dollars to win an election even at the local level (Milstead & Short, 2019). Cost benefit analysis plays a huge part in terms of legislators being reelected. Legislators will partner with “527 committees” to gain funds for their campaigns (Milstead & Short, 2019). This can skew their actual viewpoint and opinion on a topic, but due to the necessity of big money needed to win an election, they will partner with these wealthy individuals and employ and project their opinion on a political topic to gain money and votes (Milstead & Short, 2019). The republican party is working on, and has been trying hard, to repeal/replace the ACA in order to gain votes of the people who are not in favor Obamacare, which in turn helps them gain votes for reelection. To do this, the republican party  has tried to implement the Better Care Reconciliation Act, which has cut funding in certain areas, and cost the American people more money in ways (Amadeo, 2018).  

                                                                                                   References 

ACA. (n.d.) Affordable Care Act- Healthcare.gov Glossary. Retrieved March 11, 2020, from https://www.healthcare.gov/glossary/affordable- 

             care-act/ 

Amadeo, K. (2018, October 17). What a Congressional Plan to Repeal Obamacare Would Look Like. Retrieved March 11, 2020, from  

https://www.thebalance.com/congressional-plans-to-repeal-and-replace-obamacare-4160599

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

Your post was not only scholarly but informative. I would like to mention that each presidential candidate in the United States have to develop an appropriate health strategy that will seem to improve the quality and safety of the population. In most cases, the citizens always have no choice to elect a good performer but are obliged to elect the person with most fulfilling promises. As such, the politicians have understood the wants and needs of the population and will go ahead to promise them without a clear probability that they will be able to meet or fulfill them. A notable legislation that aided the election of president Obama was the Obama care (Affordable care act, (ACA). The enactment of the affordable care act was meant to make healthcare services be affordable and accessible to all citizens in the United States. The ACA has been identified to change the lives of many individuals who can now get affordable care Services either in the various programs offered by the government in the market places via the private insurance (HealthCare.gov, 2018). The Affordable Care Act, thus provided income based premiums subsidies to those that purchase the health coverages in the market place. The healthcare reform was aimed at enhancing the provision of quality, safe and affordable care to all United States population. To ensure that the votes of the youths were taken, president Obama increased the year of dependency to parents. The ACA increased the number of year a child would depend to their parents making it 26 years which helped between 2-3 million young people (McIntyre & Song, 2019). Despite its positive implications to nurses, hospitals, the patients and the insurers, the ACA had a series of negative impacts. Notably, following its enactment and implementation, there was an increase in medical errors, delayed care, increases patient dissatisfaction, increased deaths and increased rates of infections.

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