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.
Resources
ORDER HERE
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
*Note:
Throughout this program, your fellow students are referred to as colleagues.
The Affordable Care Act (ACA) was enacted in 2010 to expand coverage, improve the quality and the cost of healthcare. It was aimed to improve healthcare value, reduce unnecessary spending, increase access to care, and enforce strategic investments in public health. A critical provision within the ACA that changed the United States (U.S.) healthcare system is by extending Medicaid coverage for low-income and uninsured patients. In addition to ACA Medicaid expansions, insurance purchasing subsidies have been offered to patients with incomes under 400% Federal Poverty Line. Medicaid enrollment in 2015 grew by 5.6 million or by 50% and ACA has decreased the budget deficit by $143 billion between 2010 and 2019 (Walker, V. et.al.,2022).
The Affordable Care Act’s main objective is to increase coverage, make healthcare insurance affordable with a goal of improving health among Americans.
Politicians on the other hand, are politicians. In 2017, President Trump had tried to repeal the ACA with his American Healthcare Act of 2017 but unsuccessful and never went into law. Obamacare or ACA still exist and still the law for healthcare coverage. Though, with the introduction of AHCA, some minor changes had been made including the elimination of the penalty among individuals who refused to get a healthcare coverage.
In early 2022, approximately 35 million Americans enrolled in ACA supported healthcare. This record numbers are part of the substantial impact ACA has on the American healthcare. On the other side, this law has a lot of flaws especially those whose income bracket passed the federal poverty line.
One example, my friend got diagnosed with staged 4 uterine cancer. As a nurse, her income is above federal definition of low-income families. For six months, she did not work, her health insurance coverage is under our employer. She has to come back to work after six months to make sure her health insurance coverage remained active to continue her medical treatment. She and her family are not qualified to get a subsidize healthcare because of her income, having a house and a car. Not until she passed away that her family got qualified for the Obama care and the sad thing, everything had to change because Obama care don’t cover the medications that her daughter is taking and cannot see her previous primary care physician because it is not contracted under Obama care insurance. On the opposite side, we have patients who are uninsured or even undocumented and can have medical access until everything has been exhausted. Their only problem is the follow up after discharge. I found out that county clinics are always full and will take months before an md or a nurse practitioner can see these patients.
Our healthcare system is overwhelmed, needs hauling and changes to better serve the American people and not repeal the ACA for political reasons but improve it to serve and benefit the majority.
With Affordable Care Act, substantial impact has been achieved on health insurance coverage, improve health care utilizations for minority patients, improve equity and reduce disparities through affordability (Ma, A., et al 2022).
References:
Walker, V., Ruley, M., Nelson, L., Layton, W., & Coustasse, A. (2022). The effect of the Affordable Care Act on Medicaid payments in long-term care facilities.
International Journal of Healthcare Management
,
15
(1), 62–69.
https://doi.org/10.1080/20479700.2020.1843886
Ma, A., Sanchez, A., & Ma, M. (2022). Racial disparities in health care utilization, the affordable care act and racial concordance preference.
International Journal of Health Economics and Management
,
22
(1), 91–110.
https://doi.org/10.1007/s10754-021-09311-8
Entress, R. M., & Anderson, K. M. (2020). The Politics of Health Care: Health Disparities, the Affordable Care Act, and Solutions for Success.
Social Work in Public Health
,
35
(4), 152–162.
https://doi.org/10.1080/19371918.2020.1767750
Davalon (2022).https://www.ehealthinsurance.com/resources/affordable-care-act/trumpcare-vs-obamacare
My colleague Sara,
I liked your post on The Affordable Care Act. Yes, many low-income families would have died or struggled to pay medical bills without health care coverage. Thanks to President Barack Obama’s plan. The Affordable Care Act was signed into law on March 23, 2010. The Affordable Care Act created great peace for many American families, dealing with several underlying medical conditions. This comprehensive health plan has implemented a change in how Americans receive health care. Insurance companies now can no longer deny low incomes families, the elderly, and people living with debilitating conditions such as HIV and AIDs insurance coverage. I agreed with you Sara 100%, for example, children born to low incomes mothers should not be denied health care coverage due to the lifestyles of their parents. The elderly population should not be denied prescription drug coverage for any chronic conditions that he or they have been dealing with for decades. The Affordable Care Act will ensure a sense of security, and stability for low-income Americans.
The Cost-benefit analysis helps lawmakers determine the effects of The Affordable Care Act. According to (CDC, 2020) The Centers for Disease Control and Prevention supports the affordable care act. More healthcare centers are open, and patients can now receive the healthcare needed to live longer. This gives more access to patient wellness such as early health screenings for certain cancers, HIV/AIDS, and STD screening without coming out of pocket. In my hospital, Kaiser Permanente, California I have seen an increasing number of patients coming in for healthcare screening such as wellness exams, blood pressure, and diabetes screening.
The Department of Human Health uses The Affordable Care Act to expand and strengthen cultural competency training for all healthcare workers to provide more equality that will reduce healthcare disparities.
52% of registered voters supported the affordable care act. In August 2022 President Joe Biden signed into law The Inflation Reduction Act to extend plans to support the affordable care act.
References:
Centers for Disease Control and Prevention. (2010. March 23). The Affordable Care Act
Care act. policy and laws.
HTTPS://
www.cdc.gov.policies.aca
Links to an external site.
Census. Bureau. (gov). 2022
https://
www.healthline.com
Links to an external site.
health
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Rafael Carlos Martinez
Dec 15, 2022 7:22pm
|
Last reply Dec 18, 2022 3:44pm
Reply from Rafael Carlos Martinez
The Republican party has largely opposed the passing of the Affordable Care Act (ACA) from the time of its inception to present times. “From January to December of 2011, the (Republican controlled 112
th
Congress) House voted on ACA changes or repeals 24 times (Williams & Anderson, 2020),” even going so far as “declining to fund the federal government unless the implementation of the ACA was delayed (Williams & Anderson, 2020)” in 2013. Because there has been such staunch opposition to the ACA from Republican politicians, repealing or replacing the ACA has now become part of the Republican party’s platform and a core political position for many Republican politicians who seek re-election, although repealing or even simply replacing aspects of the ACA would have a significant impact on the availability of affordable healthcare for many of their constituents and would cost the federal government millions. Even simply removing the Medicaid expansion package from the ACA or decreasing federal funding for Medicaid would have a significant impact on healthcare coverage and access to healthcare for people of color (Williams & Anderson, 2020), and a full repeal of the ACA would cost the federal government an estimated $350 billion through 2027 (Committee for Responsible Federal Budget, 2017).
Because fully repealing the ACA will have a significant impact on healthcare coverage and access to healthcare for millions of potential voters, many Republican lawmakers have openly opposed only certain aspects of the ACA, while advocating for either ACA reform or replacement rather than full repeal to not damage their chances of re-election while still staying within their party’s political platform guidelines.
Committee for Responsible Federal Budget (2017).
The cost of full repeal of the affordable care act
. Retrieved December 14, 2022 from https://www.crfb.org/papers/cost-full-repeal-affordable-care-act
McDonough, J. E. (2017).
Health and taxes and the values at stake in the aca debate
. Milbank Quarterly,
95
(2), 237–240. https://doi.org/10.1111/1468-0009.12251
Williams, N. D., & Anderson, E. A. (2020).
A critique of repealing the affordable care act: implications for queer people of color
. Analyses of Social Issues & Public Policy,
20
(1), 195–210.
https://doi.org/10.1111/asap.12197
Links to an external site.
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Jestanon Ratunil
Dec 15, 2022 12:27pm
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Last reply Dec 15, 2022 12:59pm
Reply from Jestanon Ratunil
The Affordable Care Act.docx
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Kayla Holt
Dec 15, 2022 12:44am
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Last reply Dec 17, 2022 6:58pm
Reply from Kayla Holt
Health insurance in the United States is a misnomer: What we are actually purchasing is sickness insurance (Milstead & Short, 2019). Like other forms of insurance, health insurance is a form of collectivism in which people pool their risks – in this case, the risk of incurring medical expenses (Milstead & Short, 2019). The health insurance mandate in the Affordable Care Act (ACA) provided for the enlargement and balance of the risk pool (Milstead & Short, 2019). Without the option to refuse to cover preexisting conditions the insurance market would collapse: in 2017, many insurers pulled out of the Health Insurance Exchanges because of uncertainty about the continuation of the mandate (Milstead & Short, 2019). Congress and the Trump administration were engaging in a debate over how to “repeal, replace, repair, or starve” healthcare finance in the United States (Milstead & Short, 2019). The American public is strongly divided about how to finance health care in the country (Milstead & Short, 2019).
The realization (for better or worse) that 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 own re-election chances (Milstead & Short, 2019). For example, political interference in sexual and reproductive health research and health professional education threatens the health of women and men (Taylor et al., 2017). While some may find this focus disturbing, it demonstrates not just that elections results do matter but also that even the threat of an upcoming election cycle affects what policymakers are willing or able to do (Milstead & Short, 2019). Timing is everything (Milstead & Short, 2019).
Awareness can be used in developing strategies for appealing to what really matters to policymakers (Milstead & Short, 2019). Deciding which of several policy options will lead to the greatest benefits and the fewest costs, in a world where re-election is a key consideration and media are a relentless presence, means the best solution may not be the path ultimately chosen (Milstead & Short, 2019).
References
Milstead, J. A., & Short, N. M. (2019).
Health policy and politics: A nurse’s guide
(6
th
ed.). Jones & Bartlett Learning.
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
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Sarah E. Tasker
Dec 14, 2022 10:38pm
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Last reply Dec 14, 2022 10:42pm
Reply from Sarah E. Tasker
Politics and the Patient Protection and Affordable Care Act
Based on the shared goals of the legislators recently elected into congress, there have not been efforts to repeal or replace the Affordable Care Act (ACA) but to “protect and build on” the act instead (Unknown, 2020, para 8). Current President, Joe Biden, started his presidency with plans to strengthen the ACA by closing loopholes that allow the rich to avoid taxes on capital gains (Unknown, 2020). Instead, people making over $1 million will pay the top rate on capital gains and double their typical tax rate on possessions such as their assets (Unknown, 2020). Overall, by taxing the rich, President Biden hopes to strengthen the ACA by doing things such as; lowering healthcare premiums and out-of-pocket costs, easing the enrollment of affordable coverage, expanding Medicaid services in remaining states, improving home care for older Americans and Americans with disabilities, introducing new options for people with a mental health crisis, and extending postpartum coverage during the first year after delivery (The United States Government, 2022).
The voter’s view can significantly influence the decisions of legislative leaders. According to Figure 10-3 in the text
Health Policy and Politics
, the views on repealing the ACA were split almost evenly, with 45% saying they should vote to repeal, 51% saying they should not vote to repeal, and 6% undecided or refused to answer (Milstead & Short, 2017). With this being said, the voters who share their views also vote for each legislator’s re-election. To analyze further, each legislator can research the majority’s view regarding Medicare and Medicaid. For example, suppose most voters would feel they would benefit from Medicare or Medicaid changes. In that case, the legislator should feel the need to represent those changes to impress the voters.
References
Unknown. (2020).
Plan to protect and build on Obamacare
. Democratic National Committee. Joe Biden for President: Official Campaign
Website. https://joebiden.com/healthcare/#
The United States Government. (2022).
Fact sheet: Biden Harris Administration proposes rule to fix “Family glitch” and Lower Health Care Costs
.
The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/05/fact-sheet-biden-harris-administration
-proposes-rule-to-fix-family-glitch-and-lower-health-care-costs/
Milstead & Short.
Health Policy and Politics
(6th ed.). Jones & Bartlett Learning. https://mbsdirect.vitalsource.com/books/9781284155235
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Essie Tani Richardson
Dec 14, 2022 10:23pm
Reply from Essie Tani Richardson
Since its introduction, the Affordable Care Act (ACA) 2010 has generated a lot of discussion. It is to thank for the rise in the number of Americans with health insurance and for giving millions of individuals access to high-quality healthcare. The ACA has drawn criticism for its exorbitant expenditures and effects on the economy and healthcare sector. The Republican-controlled Congress made a failed attempt to abolish the ACA in 2017. In 2018, states were permitted to waive parts of the ACA’s requirements as a result of a Trump administration executive order.
For a legislator, evaluating cost-benefits and efforts to repeal/replace any policy when being reelected is of utmost importance because “[d]eciding which of the several policies could lead to low costs and great benefits, the best solution may not be the path ultimately chosen,” according to the Affordable Care Act (ACA) (Milstead & Short, 2019, p. 51). The Affordable Care Act (ACA), sometimes referred to as Obamacare, was drafted and put into effect during the presidency of President Obama. The ACA’s three main objectives are to lower the cost of healthcare by promoting innovative care delivery models, expand Medicaid to cover all individuals with incomes that are 138% or less below the poverty line, and cover more people with health insurance (HealthCare.gov, n.d.). Since the Affordable Care Act (ACA) was a contentious issue both during President Obama’s administration and at the beginning of President Trump’s, it was crucial for lawmakers who wanted to win reelection. It meant upheaval at the risk of the dominant party losing control of both houses of Congress if Obamacare was repealed and replaced.
The Affordable Care Act was heavily covered in the media around the time President Trump started his campaign for president, and Republicans, the majority party, naturally seized the chance to act on the timing of a problem (healthcare) and a policy (Affordable Care Act) during the season of politics within an election (Kingdon, 2001, para. 4). In fact, the discussion over whether to repeal and replace was in full swing before a large portion of the Republican party took government. Obamacare must be repealed immediately, replaced later, or a replacement strategy must be established first and an appeal made afterwards (Milstead & Short, 2019, p. 39). Milstead & Short (2019) assert that there were technicalities in eliminating and altering the Medicare and Medicaid systems, raising concerns that doing so would coincide with the 2018 election cycle (p. 40). Voters’ opinions were not always a major consideration in the ACA law’s decision-making for Medicare and Medicaid when a technicality resulted in changes to insurance and their implementation. The implementation issues would be ominous for the legislation and would have an impact on insurance firms, people, and both big and small businesses. The majority party’s 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 own reelection chances” when faced with the reality of inevitable problems with implementation of repealing and replacing (Milstead & Short, 2019, p. 40).
References
Healthcare.gov (2010). Affordable Care Act. Retrieved March 17, 2021 from https://www.healthcare.gov/glossary/affordable-care-act/
Kingdon, J.W. (2001). A model of agenda-setting with applications. Detroit College of Law at Michigan State University Law Review, 2001, 2(331). https://advance lexiscom.ezp.waldenulibrary.org/api/document?collection=analytical materials&id=urn:contentItem:44N6-2010-00CV-V1SC-00000-00&context=1516831.
Milstead, J.A., & Short, N.M. (2019). Health Policy and politics: A nurse’s guide (6th ed.). (pp. 37-56). Burlington, MA: Jones & Bartlett Learning.
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Bonita Leone
(She/Her)
Dec 14, 2022 9:33pm
|
Last reply Dec 18, 2022 1:28pm
Reply from Bonita Leone
Affordable Care Act Winners and Losers
The question of who benefits the most when the policy is developed is a great question related to the Affordable Care Act (ACA). Legislatures lose focus on how their constituents will benefit from change and instead focus on their prospects for reelection (Milstead & Short, 2019). I see no true winners. As a legislature’s primary goal is to win reelection, one strategy many follow to achieve reelection is to follow the money. Sometimes that is in the form of campaign contributions from big pharmaceutical companies, often referred to as “big pharma.” One prominent opponent of the ACA is a Republican Senator of South Carolina whose goal is to repeal and replace Obamacare. From June to December 2021, this Senator was the top earner of big pharma campaign contributions in Congress, receiving $99,000. Political expert Joel Teitelbaum fears that a major reform for universal healthcare for the 20-25 million still left uninsured after the passage of the ACA will fall to the wayside as politicians often fear the backlash. Ultimately, the cost of universal coverage for all may end up a victim of the political aspirations of legislatures wanting to stay in the game.
One way voters band together to influence legislative outcomes to support their views is by forming political action committees (PACs). The American Nurses Association has a PAC. State legislatures also have access to studies within a bipartisan organization called the National Conference of State Legislatures. This group can provide bipartisan information for the state legislatures, giving them insight into the views of their constituents.
References
Here’s the republican senator that big pharma is betting on
. (2022, April 1). Tampa Bay Times.
Links to an external site.
https://www.tampabay.com/news/health/2022/04/01/heres-the-republican-senator-that-big-pharma-is-betting-on/
Links to an external site.
Legislators and legislative staff
. (n.d.).
Links to an external site.
https://www.ncsl.org/legislators-staff.aspx
Links to an external site.
Milstead, J. A., & Short, N. (2019).
Health policies and politics a nurse’s guide
(6th ed.). Jones & Barlette.
Links to an external site.
. (n.d.).
Links to an external site.
Walden University, LLC. (Producer). (2018). Contemporary Issues in Public Health Policy with Joel Teitelbaum [Video file]. Baltimore, MD: Author.
Links to an external site.
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Holly Anne Mayes
Dec 14, 2022 9:20pm
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Last reply Dec 17, 2022 7:54pm
Reply from Holly Anne Mayes
The Affordable Care Act is a comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”).
The law has three primary goals:
Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the
federal poverty level
Links to an external site.
(FPL).
If your income is above 400% FPL, you may still qualify for the premium tax credit in 2022.
If your income is at or below 150% FPL, you may qualify to enroll in or change Marketplace coverage through a
Special Enrollment Period
Links to an external site.
.
Expand the Medicaid program
Links to an external site.
to cover all adults with income below 138% of the FPL. (Not all states have expanded their Medicaid programs.)
Support innovative medical care delivery methods designed to lower health care costs generally (HHS, 2022).
When it comes to reelection, many campaigns’ cost-benefit analyses depend on the success of either replacing or repealing Obama care. Many Republicans, for instance, look to pull back the affordable care act as they believe it is an overreach of power from the government (Hollingsworth et al., 2019). On the flip side, the democrats, when supporting Obama care, felt that there was a lack of coverage for Americans seeking treatment that could not afford it. To completely pull back healthcare coverage that the ACA has provided to many Americans would not be a popular position; I do not see that happening in future administrations, considering it would affect many.
Voter decisions and views directly impact legislation; to move legislation forward, one has to have the support of their constituents. Depending on the demographic and needs of the voter, those running have to ensure they can meet their needs. Those on Medicare and Medicaid will rely heavily on the government for their care. Legislators have to consider those individuals’ needs to secure their votes.
Hollingsworth, A., Soni, A., Carroll, A. E., Cawley, J., & Simon, K. (2019). Gains in health insurance coverage explain variation in Democratic vote share in the 2008-2016 presidential elections.
PloS one
,
14
(4), e0214206.
U.S. Department of health and human services. (2022, March 17).
About the affordable care act
. HHS.gov. Retrieved December 13, 2022, from www.hhs.gov
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Madeline Reighard
Dec 14, 2022 8:30pm
Reply from Madeline Reighard
When discussing cost-benefit analysis in regard to legislators, the cost of supporting or opposing policies can either aid a legislator in gaining votes or losing votes which in turn will hinder their likelihood of being re-elected. America is politically divided by two main parties, Republicans and Democrats, that being said in the last two decades opposition between the parties is more widespread than it has ever been (Pew Research Center, 2014). Since the political parties are increasingly polarized and hostile in their conflicting views this makes it even more difficult for politicians to please the public. Legislators must weigh what their constituents want when taking their own political stance, but also must interpret how it will likely affect their political standing.
The Affordable Care Act (ACA)
otherwise known as Obamacare is a perfect example of division among the American people. The ACA was signed into law on March 23, 2010 and has three main goals. First, to provide affordable health care to more Americans by providing individuals with subsidies that decrease health insurance premiums especially for those in the middle- and lower-income classes (HealthCare.gov, n.d.). Second, the ACA aims to grow Medicaid so that adults with an income 138% below the federal poverty line would be covered and lastly the law encourages change in the way medical decisions are made by lowering healthcare costs in general (HealthCare.gov, n.d.).
Through the ACA, uninsured rates fell from 18% to 13.4% in roughly one year (Dalen et al., 2015). Obamacare has faced public scrutiny and multiple attempts have been made to repeal and replace the act. Ultimately, the public was divided according to a survey coordinated by the Pew Research Center (2012), that found “48% of the general public disapprove of the 2010 Affordable Care Act, while 43% approve” (para. 2). The public is almost evenly split on their views of the ACA which makes the decision for legislators difficult in whether or not they should support the act in its entirety or repeal and replace. Most notable in trying to reconcile the ACA is the American Health Care Act of 2017 (AHCA), proposed by the House Republicans and fully endorsed by Trump which would dismantle the ACA’s premiums and penalties and instead of generalized healthcare for all the AHCA would put more control into the states which would end up in Americans having to expend more money for chronic or pre-existing conditions (Ballotpedia, n.d.). Many Americans would argue that the power given to the states is justified and since it would cut taxes on the middle and upper class this would be a discernible win; however, the AHCA cuts to just Medicaid would end up in 14 million Americans losing health insurance (Nadash et al., 2018). This would greatly affect poverty stricken older adults and those that are no longer able to work because of health-related issues or other reasons, thus this a large portion of the country that would be against and/or wary of repealing or replacing the ACA.
Overall, the role of a legislator is not an easy undertaking, and there will constantly be voters for and against their decisions. Voters will support who they feel will best represent their morals and views and impact political changes in favor of their opinions. Legislators will support policies that they feel constituents want which in turn will aid them in being re-elected in the long run.
References
Ballotpedia. (n.d.). Obamacare overview. Retrieved December 9, 2022, from https://ballotpedia.org/Obamacare_overview
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
HealthCare.gov (n.d.). Affordable Care Act (ACA). Retrieved December 9, 2022, from https://www.healthcare.gov/glossary/affordable-care-act/
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/10.1080/08959420.2018.1462683
Pew Research Center. (2012). Obama health care law: Where does the public stand? Retrieved December 9, 2022, from https://www.pewresearch.org/politics/2012/06/15/obama-health-care-law-where-does-the-public-stand/
Pew Research Center. (2014). Political polarization in the American public. Retrieved December 14, 2022, from https://www.pewresearch.org/politics/2014/06/12/political-polarization-in-the-american-public