POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT NURS 6050

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

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

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

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

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

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

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

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

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

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

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

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

https://doi.10.1177/0958928720904319

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

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

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10 months ago

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

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10 months ago

Colton Phelps 

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

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

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

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I love that you kept the explanation of the health care acts and attempted repeal short and simple but explained it all perfectly. It is a shame that in recent times, politician’s true colors have shown. They are making it more transparent that some, unfortunately most, do not always have the American people’s best interest in mind. With legislators being driven with the primary goal of being re-elected and not solely for the benefit for its constituents (Milstead & Short, 2019), I am grateful we live in a country that allows us to be a part of a democracy in order to have some control in how our amazing country is ran.

According to Dr. Nwogu, “democracy is a system of government with four key elements: a system for choosing and replacing the government through free and fair elections, active participation of the people, as citizens in politics and civic life, protection of the human rights of all citizens and a rule of law in which the laws and procedures apply equally to all citizens” (2015). I genuinely believe, if we allowed these elements to guide our country, the government wouldn’t be viewed as corrupt, and we wouldn’t have to analyze how politicians balance cost vs benefit for their gain instead of the American people like it was originally intended way back when.

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

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

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

Healthcare and the Election of Legislators

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

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

Surveying and polling the constituency is one way to represent and extrapolate voter views. However according to Pew Research Center in 2014 regardless of party, roughly half of voters said their house member was “in touch with the district” (Pew Research Center, 2014). Meaning even if there was a Republican elected, half of the republicans in that representative’s constituency would still say their representative was out of touch.

Later Pew Research in 2022 found that the majority of people did believe that it was important that their preferred party held majority in the congress (Pew Research Center, 2022). This lends evidence that voters in general tend more look at the beliefs and policies the party as a whole has rather than the individual representative of their region, when making voting decisions. This definitely simplifies any vote choice but also at the downside of less specificity when it comes to more detailed issues and talking points.

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

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

Healthcare Impact on Re-election 

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.

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

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/

Walden University, LLC. (Producer). (2018). Introduction to Health Policy and Law with Joel

Teitelbaum [Video file]. Baltimore, MD: Author.

The ACA was a very democratic lead legislation, being passed with no republican votes (Walden University LLC, 2018b).

RE: Day 3 Discussion – Week 3 Affordable Care Act

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Frequent attempts have been made by Congress to repeal the Patient Protection and Affordable Care Act (ACA) in the six years since its enactment. In January 2016, a repeal bill passed both houses of Congress for the first time and was vetoed by the president. The bill did not define any replacement for the ACA because there was no general agreement among congressional Republicans on what should replace it. Some, but not all, Republican candidates have proposed health policies that they would like to put in place after repeal, but there is no broad agreement on a replacement for the ACA. The US Department of Health and Human Services released an estimate that 20 million people have thus far gained health coverage because of the ACA. Given the magnitude of this gain in coverage and the congressional interest (and possible presidential candidate interest) in repeal without necessity of replacement, the consequences of repealing the ACA deserve scrutiny.

The role of public policy issues in elections is of particular interest to the voters. The transformation of the voters’ will is characterized by many complex variables including the factors of influence upon voting decisions. Elections are widely justified as providing a means for citizens to influence governmental decisions by choosing among contenders for office. The assumption often is that the electorate will shape government policy by selecting candidates on the basis of their policy stands. Indeed, we frequently hear complaints that the candidates in a legislators’ election are failing to clearly address the real issues. The term issue sometimes is used more generally to refer to anything that is a source of conflict or contention, but in this discussion, I am referring to public policy issues, meaning questions of what the government should or should not do. Policy issues involve conflict over the direction of government policy.

Some policy issues in an election may be quite specific, such as the conditions under which abortion should be legal or whether social security should be partially privatized by allowing individuals to have personal investment accounts. Often the policy issues are more general, dealing with broad approaches to problems, such as whether the federal government should enact stricter environmental regulations or whether the federal government should attempt to ensure that nearly everyone has health care insurance.

For a policy issue to affect the vote decision, voters must have opinions on the issue and must perceive differences between the candidates on the issue. Even on important issues, many voters will fail to meet these conditions. Some will have opinions that are too weak and unstable to provide a basis for evaluating the candidates, while others will not see any significant differences between the candidates on the issue (Campbell et al. 1960, 168-187; Lewis-Beck et al. 2008, 161-185). But some voters will have definite opinions and clear perceptions of candidate differences, particularly when the candidates clearly articulate their differences (Nie, Verba, and Petrocik 1976, 164-173). Moreover, candidates often target specific groups and issues in an attempt to win the votes of partisans from the other party who disagree with their party’s candidate on an issue of concern to them (Hillygus and Shields 2008).

In light of the cost-benefit analysis to overturn ACA, it would have a devastating impact on ordinary Americans’ health and economic security while providing an enormous financial windfall to the very wealthy. An ACA repeal would have salient effects on the economic security and well-being of American households, as this would likely strike down the regulations that ensure vibrant health insurance marketplaces with large numbers of participants, while terminating subsidies and limiting affordable public insurance through Medicaid. This will hurt low and moderate-income Americans while showering large tax cuts on the highest-income Americans.

For many Americans, the debate over repealing and replacing the Affordable Care Act (ACA) isn’t about political maneuvering or vote counting. For families its about whether they will still have health coverage after the dust settles and whether they will still be able to afford their prescription medications. Foe health providers, it is about being able to serve all the patients in their community by the cost of uncompensated care.

By disavowing cost benefit analysis in order to repeal ACA , legislators might not  be able to accomplish their goal of being reelected yet simply restoring the previous status quo would mean to continue having the voters’ approval in future elections. All these underlines the critical importance of the voters’ impact on this issue of repeal/replace ACA, that has long been a political litmus test, depending on the administration, ACA has been targeted for substantial expansion, contraction and transformation.

Frequent attempts have been made by Congress to repeal the Patient Protection and Affordable Care Act (ACA) in the six years since its enactment. In January 2016, a repeal bill passed both houses of Congress for the first time and was vetoed by the president. The bill did not define any replacement for the ACA because there was no general agreement among congressional Republicans on what should replace it. Some, but not all, Republican candidates have proposed health policies that they would like to put in place after repeal, but there is no broad agreement on a replacement for the ACA. The US Department of Health and Human Services released an estimate that 20 million people have thus far gained health coverage because of the ACA. Given the magnitude of this gain in coverage and the congressional interest (and possible presidential candidate interest) in repeal without necessity of replacement, the consequences of repealing the ACA deserve scrutiny.

The role of public policy issues in elections is of particular interest to the voters. The transformatio