NURS 6050 Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act

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

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.

This topic is closed for comments.

CK

Chhinderpal Kaur

Sep 12, 2024 9:31am | Last reply Sep 15, 2024 11:37am

Reply from Chhinderpal Kaur

Legislators Re-election and the Affordable Care Act

The Affordable Care Act (ACA) was a great move in America whereby more citizens could be insured and access healthcare services. The retired President Barrack Obama was the one who signed the ACA into law making it possible for many Americans to get health insurance coverage. He aimed to have an insurance scheme that would benefit the citizens. There were efforts to repeal the ACA in 2027 which was met with backlash from those concerned of losing their health coverage, which got Republican legislators thinking of how repealing the act could influence their political career (Cohn, 2020). With increasing public support for the act, especially because it provided coverage even with pre-existing conditions and an expanded Medicaid cover, legislators had to think about how their careers would be affected if they chose otherwise (Nadash et al., 2020). The understanding that repealing ACA without replacing it with another suitable cover put legislators in a political quagmire. Also, some legislators were supposed to go with the flow of the party, as loyalty to the party could guarantee wins. Considering all the political expectations, constituency differences, and re-election risks, most legislators saw that their reelection could not happen if they chose to fully repeal the act without a proper solution, as healthcare is key in the US agendas (McMorrow, 2021).

Voter’s Views and its Effects on Legislators Decisions

Voters are an important part of the community. Legislators are representatives chosen by the voters to represent their community. Legislators often consider what the voters have to say to keep their chances of reelection high. When choosing which policies to support, legislators rely on public opinion, especially from their electoral strongholds. They are likely to support the policies supported by their voters and repeal those repealed by them (Gould, 2021). Legislators can also arrange for frequent town hall meetings to get feedback from voters directly on the issues of concern. This can give them a clue on what policies to initiate and recommend as they will have voter support. Additionally, legislators can consider voter demographics, whereby the largest voter population can guide on which policies to put across (Gould, 2021). For example, a population with many middle-aged people might want to consider issues including housing and better work environment policies.

References

Cohn, J. (2020). The ACA, repeal, and the politics of backlash. Health Affairs Forefront.q https://www.healthaffairs.org/content/forefront/aca-repeal-and-politics-backlash

Gould, J. S. (2021). The law of legislative representation. Virginia Law Review, 107(4), 765-843. https://www.jstor.org/stable/27135587

McMorrow, S. (2021). Stabilizing and strengthening the affordable care act: opportunities for a new administration. Journal of Health Politics, Policy and Law, 46(4), 549-562.https://read.dukeupress.edu/jhppl/article-abstract/46/4/549/167867

Nadash, P., Miller, E. A., Jones, D. K., Gusmano, M. K., & Rosenbaum, S. (2020). A series of unfortunate events: Implications of Republican efforts to repeal and replace the Affordable Care Act For older adults. In Aging Policy and Politics in the Trump Era (pp. 67-89). Routledge. https://www.taylorfrancis.com/chapters/edit/10.4324/9780429021435-5/series-unfortunate-events-implications-republican-efforts-repeal-replace-affordable-care-act-older-adults-pamela-nadash-edward-alan-miller-david-jones-michael-gusmano-sara-rosenbaum

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PA

Precious Funanya Akaeze

Sep 11, 2024 10:25pm | Last reply Sep 14, 2024 7:38pm

Reply from Precious Funanya Akaeze

Affordable Care Act

Precious Funanya Akaeze

Walden University

NURS-6050N: Policy & Advocacy for Pop Hlth-Fall

Crissy Dodson

September 11th, 2024

The cost-benefit analysis in terms of legislators being reelected played a crucial role in shaping efforts to repeal or replace the Affordable Care Act (ACA) (Blumberg et al). Legislators in competitive states weighed several factors related to their chances of reelection when considering such significant legislative actions. The cost-benefit analysis for legislators considering efforts to repeal or replace the ACA was influenced by a combination of public opinion, healthcare industry influence, and the ideological positioning of their political party (Blumberg et al).

Cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA.

Public opinion about the Affordable Care Act improved over time. Over the years, more Americans supported the ACA than opposed it. In this case, legislators who voted for repeal risked being associated with reducing access to healthcare, such as, protections for preexisting conditions (Fowler et al, 2017). There was political benefit for legislators who proclaimed that the ACA was financially unsustainable (Fowler et al, 2017). Their constituents, particularly those in higher-income brackets and small business owners, saw repeal as a way to reduce regulatory burdens and costs.

The healthcare industry, including hospitals, insurers, and pharmaceutical companies, benefited from the expanded insurance coverage under the ACA. In this case, repealing the law without a clear replacement leads to economic instability in these sectors, which could in turn harm legislators’ reelection chances in states with significant healthcare industry employment (Fowler et al, 2017). Legislators who supported free-market healthcare improvement may see a repeal as a beneficial step toward reducing government regulation, winning them support from industry stakeholders who are interested in independent healthcare solutions (Fowler et al, 2017). Some legislators sometimes feel a moral obligation to preserve healthcare access, risking that repeal could result in millions losing coverage. In other words, losing the support from voters who are concerned with health equity and fairness (Fowler et al, 2017). Repealing the ACA fits with a long-term ideological commitment as upholding this commitment, even at the cost of short-term electoral backlash, may be seen as a long-term investment in policy principles.

Analyses of the voters views may affect decisions by legislative leaders in recommending or positioning national policies

Voter views have a significant influence on legislative leaders when they make recommendations on national policies, such as those impacting Medicare and Medicaid. Legislative leaders always adjust their positions based on how voters perceive the costs and benefits of national policies. For example, when a conversation changes to Medicare or Medicaid, leaders often highlight the positive aspects; such as, cost savings and improved care or downplay controversial elements to align with voter preference (Hacker & Pierson, 2018). Legislators are elected to represent their constituents, so they make it a mandate to monitor public opinion on key issues like healthcare (Hacker & Pierson, 2018). If a majority of voters support policies that expand Medicare or Medicaid, lawmakers will endorse or defend these programs to avoid losing political support. Contrarily, if there is strong opposition to government spending on these programs, legislators may advocate for reforms (Hacker & Pierson, 2018). Policies like Medicare and Medicaid directly affect millions of people, especially the elderly, disabled voters and low-income individuals (Hacker & Pierson, 2018). Legislators risk political backlash if they support changes that reduce access to these benefits, risking potential voter dissatisfaction and challenges in future elections. Healthcare policies provide insight into public preferences, guiding legislatives on what policy directions are electorally advantageous. For example, if polling indicates a rise in public health crises, like the COVID-19 pandemic. In this case, the leaders may propose policies that expand Medicare or Medicaid to respond to voters’ evolving needs (Hacker & Pierson, 2018). In other words, analyzing voter views is significant for legislative leaders when positioning themselves on national policies such as Medicare and Medicaid. Understanding voter views enables legislators to balance public support with economic realities, navigate the political landscape, and ensure policies reflect the preferences of their voter. Failure to align with voter preferences can result in electoral consequences, while aligning to voters’ expectations can enhance political capital and lead to sustained legislative success (Hacker & Pierson, 2018).

Reference

Blumberg, L. J., Holahan, J., & Buettgens, M. (2017). Implications of partial repeal of the ACA through reconciliation. Urban Institute . https://www.urban.org/research/publication/implications-partial-repeal-aca-through-reconciliation

Fowler, E. F., Baum, L. M., Barry, C. L., Niederdeppe, J., & Gollust, S. E. (2017). Media messages and perceptions of the Affordable Care Act during the 2012 presidential election. Journal of Health Politics, Policy and Law, 42 (2), 247–286. https://doi.org/10.1215/03616878-3766713

Hacker, J. S., & Pierson, P. (2018). The dog that almost barked: What the ACA repeal fight says about the resilience of the American welfare state. Journal of Health Politics, Policy and Law, 43 (4), 551-577. https://doi.org/10.1215/03616878-6608642

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MM

Miriane Meigueu

Sep 11, 2024 9:20pm | Last reply Sep 14, 2024 9:12pm

Reply from Miriane Meigueu

Policy development is an intricate process that involves multiple stakeholders. In the US, health policy development is a multi-stakeholder process involving multiple stages. Among the most crucial stakeholders involved in the policy development are legislators at both the Congress and the Senate level (“The legislative process,” n.d.). Elected on a public docket, legislators act in the best interests of representing the public when it comes to policy development in the health sector. Unfortunately, since they are elected on political grounds, legislators tend to align more towards party politics even when handling matters of public concern, such as health policy formulation. Political divisions are generally not new in the country on the grounds of Democrat and Republican stands on crucial issues, such as health care and other social issues. Republicans and Democrats elected on respective party tickets tend to align towards Republican and Democrat party political stands (Cohn, 2020). In some cases, however, some legislators may tend to misalliance lightly with hardline party politics, therefore ending up switching loyalties, especially on controversial issues of divisiveness. One such issue that has attracted a lot of public and political debate is the handling and resolution of the stalemate involving the Affordable Care Act.

The calls to repeal and replace the Affordable Care Act came about during the 2016 general election campaigns, where the then-candidate Donald Trump expressed discontent with various aspects of the ACA and thus pledged to replace it in totality once elected. Since the pledge to repeal the act formed part of his campaign agenda as the presidential candidate, it was widely adopted by the Republican Party as part of party policies (Simmons-Duffin, 2019). This came at a time when the House of Representatives had severally tried to repeal the Affordable Care Act (Rigby et al., 2013, p. 58). The results of the 2017 general elections at the presidential, Senate, and Congress levels were, therefore, partly inspired by the presidential campaign that was mounted by both sides of the political divide. Since the Republicans won the statehouse through President Trump while the Senate fell to the Republicans, the Republicans had an opportunity to effect their political stand of repealing the ACA. However, their hope of repealing the law fell short due to the divisions within the party as some Republican colleagues expressed concerns on the cost of repealing the ACA. At the Congress level, which was controlled by Democrats, the repeal initiative fell short of the much-needed support (Eilperin et al., 2017).

The decision to support or oppose policies presented by the presidency or the ruling party is largely based on the best interest of the public and the cost of enacting the policy. A strategic assessment of the cost of repealing the ACA shows that up to 24 million persons will be uninsured, and an additional 14.5 million people will have no access to Medicaid or CHIP (Buettgens, 2016). In addition, analysis shows that an additional 8.8 million people will have no access to private nongroup coverage, while an additional 700,000 people will lack insurance based on their jobs. On the same note, analysis of the public interest or opinion regarding the question of repealing the Affordable Care Act shows interesting trends. According to a KFF Tracking Poll between 2011 and 2020 on public views regarding the ACA under the 2010 Health Reform Law, the number of persons in favor and in opposition of the law has consistently varied between 40% and 50%. As late as 2020, 55% of polled citizens regard the ACA as favorable, while 34% regard the law as unfavorable, with the remaining portion being undecided or neutral (Buettgens, 2016).

The substantial divisions exhibited in this regard are replicated when it comes to legal redress of various controversial issues regarding the ACA. For example, the KFF Health Tracking Poll held in 2020 showed that 16% of polled Americans want the Supreme Court to overturn the ACA’s protections for persons with pre-existing conditions compared to 79% who are in a position of the overturning of the law. When it comes to public opinion on the repealing of the entire Affordable Care Act, 36% want the law overturned compared to 58%. When it comes to legislators’ party politics, 26% of Republicans want certain aspects of the law repealed compared to 14% Independents and 8% Democrats (Hamel, 2020). On the other hand, 76% of Republicans want the entire Affordable Care Act repealed compared to 29% Independents and 9% Democrats. In general, public opinion and legislators’ opinion on the law are an indication that there are certain legislative provisions of the law that are unfavorable and which warrant redress (Hamel, 2020). This is given the fact that the Democrat-sponsored law is opposed by up to 9% of Democrats, who expressed discontent on various aspects, including protection on pre-existing conditions as well as the individual mandate (Simmons-Duffin, 2019).

It is in the best interest of legislators to serve the interests of the public. Since all legislators work towards seeking re-election, they have to accurately represent the interests of their constituents and the public in general. Legislators have to come to an agreement and compromise on the controversial issues of the Affordable Care Act. This includes engaging members of their constituents and educating them on issues that need to be addressed on the Affordable Care Act. President Trump, for example, was particularly popular for having advocated for repealing the individual mandate provision of the law (Fiedler, 2020). In my own opinion, I think it is high time we consider the costs versus benefits of repealing the entire ACA. Based on analysis of such costs and public interest, we should rather work towards addressing the controversial issues as well as the gaps existing within the ACA to ensure that public insurance is optimally maintained.

References

Buettgens, M. (2016). The Cost of ACA Repeal . Urban Institute Social and Economic Policy Research. https://www.urban.org/sites/default/files/publication/81296/2000806-The-Cost-of-the-ACA-Repeal.pdf. Links to an external site.

Cohn, J. (2020). The ACA, repeal, and the politics of backlash . Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20200305.771008/full/. Links to an external site.

Eilperin, J., O’KeefeJuly, E., & Sullivan, S. (2017, July 18). Senate Republicans’ effort to ‘repeal and replace’ Obamacare all but collapses . The Washington Post. https://www.washingtonpost.com/powerpost/trump-suggests-republicans-will-let-aca-market-collapse-then-rewrite-health-law/2017/07/18/5e79a3ec-6bac-11e7-b9e2-2056e768a7e5_story.html Links to an external site. .

Fiedler, M. (2020). The ACA’s individual mandate in retrospect: What did it do, and where do we go from here? Health Affairs , 39 (3), 429-435. https://doi.org/10.1377/hlthaff.2019.01433 Links to an external site. .

Hamel, L. (2020, September 22). 5 charts about public opinion on the Affordable Care Act and the Supreme Court . KFF. https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/ Links to an external site. .

The legislative process . (n.d.). house.gov. https://www.house.gov/the-house-explained/the-legislative-process Links to an external site. .

Rigby, E., Clark, J. H., & Pelika, S. (2013). Party politics and enactment of “ObamaCare”: A policy-centered analysis of minority party involvement. Journal of Health Politics, Policy and Law , 39 (1), 57-95. https://doi.org/10.1215/03616878-2395181 Links to an external site. .

Simmons-Duffin, S. (2019, October 14). Trump is trying hard to thwart ObamaCare. How’s that going? NPR.org. https://www.npr.org/sections/health-shots/2019/10/14/768731628/trump-is-trying-hard-to-thwart-obamacare-hows-that-going Links to an external site. .

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Amy Simmons

Sep 11, 2024 8:54pm | Last reply Sep 14, 2024 12:44pm

Reply from Amy Simmons

Main Post

Cost for Legislators Repealing the ACA and Decisions in National Policies

The Affordable Care Act, also known as Obamacare, was signed into law in 2010 and was created so millions of Americans can have health insurance. The start of the ACA was a major shift in the United States healthcare policy and remains a significant part of the healthcare system despite ongoing political debate and attempts to repeal or modify it (Campbell & Shore-Sheppard, 2020). In the context of repealing or replacing the ACA, legislators faced a cost-benefit analysis focused mainly on their reelection chances. The issue of healthcare policy is not just obvious, but also emotionally charged, and legislatures consider how a decision is perceived by their constituents. Supporting the repeal or replacement of the ACA might have pleased certain voter bases, particularly those who are critical of government-run healthcare or those who view the ACA as a costly overreach.

The cost-benefit analysis, in this case, revolved around political survival. Would supporting repeal generate enough electoral support, or would it lead to backlash from voters who feared losing health care coverage for many legislators, especially those in swing districts or states? The risk of losing support from voters reliant on the ACA outweighed the benefit of repealing it to satisfy a party platform. Losing the ACA would cause tens of millions of Americans to lose critical protections against high medical bills and free preventative care and would be at risk of getting lower-quality care (The White House, 2023).

President Trump’s health policy agenda aimed to dismantle the Patient Protection and ACA, which he described as a ‘disaster.’ His efforts to undermine the ACA included attempting to repeal it through legislation, undermining it with various executive orders, and seeking judicial rulings to deem it unconstitutional. Despite these persistent efforts to challenge the ACA, it continues to be in place as the U.S. approaches the new election (Gusman et al., 2021).

References

Andrea Louise Campbell, & Lara Shore-Sheppard. (2020). The social, political, and economic effects of the Affordable Care Act: Introduction to the issue. RSF: The Russell Sage Foundation Journal of the Social Sciences , 6 (2), 1-40 https://doi.org/10.7758/RSF.2020.6.2.01

Gusmano, M. K., Sparer, M. S., & Brown, L. D. (2021). Trump v. The ACA. Health Economics, Policy and Law, 16 (3), 251-255.https://doi.org/10.1017/S1744133120000389

The White House. (2023, February 28). Fact sheet: The congressional Republican agenda: Repealing the Affordable Care Act and slashing Medicaid . The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/28/fact-sheet-the-congressional-republican-agenda-repealing-the-affordable-care-act-and-slashing-medicaid/

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DT

Deco Tanjong

Sep 11, 2024 8:18pm | Last reply Sep 13, 2024 12:46pm

Reply from Deco Tanjong

A legislator is a person who is involved in making or passing laws. The legislative branch is made up of the House and Senate, known collectively as the legislative branch, which makes all laws, declares war, regulates interstate and foreign commerce, and controls taxing and spending policies(House.gov). Legislators are voted for a four-year term of office, while some are voted for a year term of office depending on the state. Milstead , & Short(2019).

Affordable Care Act (ACA), also known as Obamacare, is a law that was passed in 2010 to reform the health insurance market and increase coverage for the uninsured(Healthcare.gov). ACA includes the provision of patient protection, Young adults on family plans, Small business Health options programs, Tax provisions, and Income limits. With the coming of President Trump’s power, one of his top agendas was to “repeal, replace, repair or starve” healthcare finance in the United States of America Milstead & Short (2019). Liberal thinkers wish to maintain ACA with possible improvement, while other conservatives were open to repairing what they see as flaws in the law as opposed to changing the manner in which all Americans receive health insurance since any enacted legislation will take years to be implemented.

Several Republicans voted to repeal and replace the ACA, except for the late Senator John McCain, who voted no and was condemned by most republican party members, which explained why most legislators focused on reelected as opposed to how it would affect the people he is representing. According to Milstead & Short (2019), ACA increased access to health insurance for United States residents by up to an estimated 55 million people. It will take years to implement a new law to protect these populations.

Legislative decisions or actions affect the voters or general population indirectly because how voters look at a legislator may or may not affect his re-election. Some people look at voting with only two options: either they are voting for a Republican or a Democrat, despite their role during legislation voting. According to the American Nurse Association(2011), 66 million Americans have limited access to primary care, thus putting the population at much risk. In 2022, 92.1 percent of 304 million people had health insurance at some point during the year, according to Census.gov. This shows a great difference, and for a legislator to vote to repeal and replace ACA without presenting the option to replace the law shows that the legislators focus more on reelection as opposed to the population.

Reference:

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

Chapter 5, “Policy Enactment: Legislation and Politics” (pp. 97–117)

Chapter 10, “Financing Health Care” (pp. 239–249)

Congress.govLinks to an external site. Links to an external site. . (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/ Links to an external site.

United States Senate. (n.d.). Senate organization chart for the 117th Congress Links to an external site. Links to an external site. .

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QF

Qiana Felder

Sep 11, 2024 7:46pm | Last reply Sep 14, 2024 8:15pm

Reply from Qiana Felder

The Affordable Care Act (ACA) bill, passed in 2010 under the Obama administration, aimed to expand health coverage, providing more uninsured Americans access to affordable quality healthcare (HHS, 2022). Legislators, whose primary goal is re-election, must be cautious when altering policies. When considering repealing or replacing the ACA, they evaluate the potential risks to their electoral prediction. If they foresee that proposed changes will be widely unpopular with their voters, they may choose to contest the changes or advocate for adjustments that reduce any adverse effects for electoral gain (McIntyre, 2019). The Biden administration focused on repealing policies restricting Americans from accessing health insurance, such as barriers to enrollment, affordability issues, and preexisting conditions (Kenton, 2022). In contrast, the Trump administration cut resources and terminated funding for cost-sharing reductions needed for low-income enrollees (McIntyre, 2019). These different approaches were greatly influenced by partisan considerations, providing a clear contrast for policy analysts, legislators, and individuals interested in healthcare policy.

Voter’s views have a significant impact on decisions made by legislative leaders. They use their feedback to guide policy recommendations (Kulachai, 2023). Positive experiences that meet or exceed expectations are influential in increasing support for the current system or incumbent, while negative experiences may lead to dissatisfaction and drive voters to seek change, making them more likely to oppose the existing political structure (Kulachai, 2023). For example, during the Trump administration 2017, the penalty for individuals not having insurance was removed. Many people complained about this when the bill was passed and advocated for change.

References

HHS. (2022). About the Affordable Care Act . U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/about-the-aca/index.html

Kenton, W. (2022, September 23). Affordable Care Act (ACA) . Investopedia. https://www.investopedia.com/terms/a/affordable-care-act.asp

Kulachai, W., Lerdtomornsakul, U., & Homyamyen, P. (2023). Factors Influencing Voting Decision: A Comprehensive Literature Review. Social Sciences , 12 (9), 1–16. https://doi.org/10.3390/socsci12090469

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS Medicine , 16 (2), 1–3. https://doi.org/10.1371/journal.pmed.1002752

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John Dulko (He/Him)

Sep 11, 2024 7:25pm | Last reply Sep 14, 2024 7:26pm

Reply from John Dulko

Introduction

Legislators are “Individuals elected by voters in a geographic region to represent the constituents at the state legislature or U.S. Congress. Legislators draft, debate, and vote on bills and resolutions” (Short, 2022, p. 97). The prompt stated that the number one job of legislators is to be reelected. This is because it will allow them to continue to advocate for their constituents’ agendas, as “Policy change is a long game full of moves and countermoves to gain ground” (Short, 2022, p. 116). The Affordable Care Act (ACA) is a controversial law that legislators have been campaigning about in recent years, with some favoring it and wanting to protect it, while others disagree with its effects, wanting to repeal or replace it. They must conduct a cost-benefit analysis of their public perspectives on current issues, such as the ACA, to accomplish their number one job of reelection.

Cost-Benefit Analysis

“The Affordable Care Act is a comprehensive reform law, enacted in 2010, that increases health insurance coverage for the uninsured and implements reform to the health insurance market … Under the Affordable Care Act, patients who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state” (American Medical Association, 2019). One of the costs of any campaign is money. “Candidates must fundraise to run for office, and the price of an election can range from hundreds of thousands of dollars for a local or state position to millions for a congressional seat” (Short, 2022, p. 108). The benefit of promoting the repeal or replacement of the ACA would be votes from people who also support the same. However, “Following Republican efforts to repeal the ACA in the summer of 2017, KFF Health Tracking Polls show an uptick in overall favorability towards the law, and since then, a larger share has held a favorable than an unfavorable view … The May 2024 Health Tracking Poll shows that about six in ten U.S. adults (62%) hold a favorable opinion of the ACA while about four in ten (37%) hold a negative opinion of the law” (Kirzinger et al., 2024). With the majority favoring the ACA and without a strategic replacement proposal, it would be wise for legislators to publicly support the ACA to be reelected. This way, chances of reelection are increased and there is an opportunity to implement a replacement to the ACA once a better strategy is developed. With reelection, they can support the ACA but be able to advocate for their constituents on other issues and implement a replacement once another strategy is developed.

Voters’ Views Effects

As alluded to above, voters’ views have a strong effect on what legislators will support. When discussing why the Republican party struggled to repeal the ACA once gaining control of the government in 2017, Scott and Kliff (2017) stated “Too many Republican legislators actually like certain parts of the health care law — and their constituents like them too. No legislative strategy can skirt around the fact that millions now rely on the health care law for coverage, and do not want to lose their benefits.” That is the job of the legislator: to speak for the people they represent—the voters. And therefore, the voters’ views are the legislators’ views that they will advocate for if the legislator is doing their job right.

Conclusion

Republicans tried to repeal or replace the ACA for seven years. It was a highly debated topic in the 2012 and 2016 presidential elections. Ultimately, the ACA was not repealed; and this is because the legislators that represented the voters saw how it was benefiting many people. Both political parties, however, recognize the need for improvement. Until strategies for improvement are proposed, the ACA is accepted by some as progress, but there is still a long way to go to enhance healthcare access and affordability for Americans.

References

American Medical Association. (2019, December 3). Understanding the Affordable Care Act. American Medical Association . https://www.ama-assn.org/health-care-advocacy/access-care/understanding-affordable-care-act

Kirzinger, A., Valdes, I., Montero, A., Hamel, L., & Brodie, M. (2024, September 11). 5 Charts about public opinion on the Affordable Care Act | KFF . KFF. https://www.kff.org/affordable-care-act/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act/

Scott, D., & Kliff, S. (2017, July 31). Why Obamacare repeal failed. Vox . https://www.vox.com/policy-and-politics/2017/7/31/16055960/why-obamacare-repeal-failed

Short, N. M. (2022). Milstead’s Health Policy & Politics . (7th ed.). Jones & Bartlett Learning.

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CP

Christelle Njieukeng Piemba

Sep 11, 2024 7:23pm | Last reply Sep 13, 2024 12:27pm

Reply from Christelle Njieukeng Piemba

The Affordable Care Act was signed into law by President Obama in 2010, which allowed those with low income and no insurance to obtain Medicaid managed care plans. Obama’s administration’s approach complemented the existing health policies that were put into place by Bush’s administration. The approach brought about policies that were favorable and recognized the need to make healthcare resources available to all Americans.

The Role of Cost-Benefit Analysis in Legislators’ Decision-Making on Healthcare Policies

The cost-benefit analysis in terms of legislators being re-elected in efforts to repeal/replace the Patient Protection and Affordable Care Act (ACA) can cost Americans millions of dollars in addition to possibly taking years to happen. The cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. The Affordable Care Act also known as Obamacare had three main goals; to make affordable health insurance available to more people, to expand Medicaid to cover all adults with income below 138% of the federal poverty level, and to support medical delivery geared to lower cost (“ACA,” n.d, para. 1). Family Care lower income families could afford health insurance with the subsidies that were provided and if you were in college you could remain on your parents insurance until age 26. With more citizens in the community having access to healthcare like Medicaid or an affordable option, this leads to a healthier community. There are some that would like to maintain the ACA just the way it is with some possible improvements and there are others that would like to repeal or replace it, or repair it (Milstead & Short, 2019). If the ACA was repealed and not replaced, the amount of those insured would greatly drop, and out-of-pocket costs would increase. Society would be negatively affected without insurance, especially the underserved, those living in rural and remote areas. Those without health insurance coverage would not get treatment, which could lead to a decrease in quality of life and an increase in mortality rate.

The primary goal of legislators is to be re-elected and to increase their chances for political support. The decisions by legislative leaders in recommending or positioning national policies are most likely affected by their political party’s agenda. Politicians encourage laws and regulations that impose politics and ideology on evidence-based care and restrict ethical standards of care (Taylor, et al., 2017). In most cases the legislative leaders are obligated to do what is best for their party and not necessarily what is best for our society. References Adler, M. (2002). The positive political theory of cost-benefit analysis. However, the legislator’s cost-benefit calculations are not the cost benefits to society of enacting legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur because of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support legislation (Feldstein, P., p.27).

References

Taylor, D., Olshanskym E., Fugate-Woods, N., Johnson-Mallard, V., Safiret, B.J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual andreproductive health research and health professional education. Nursing Outlook. 65(2), 346-350. doi:10.1016/j.outlook.2017.05.003

Adler, M. (2002). The positive political theory of cost-benefit analysis. Retrieved from https://scholarship.law.upenn.edu/cgi/viewcontent.cgi? article=3273&context=penn_law_review.

Milstead, J.A., & Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning. Smartsheet, (2019). An expert guide to costs benefit analysis. Retrieved from https://www.smartsheet.com/expert-guide-cost-benefit-analysis Links to an external site.

Affordable Care Act (ACA). (n.d). Retrieved from https://www.healthcare.gov/glossary/affordable-care-act/ Links to an external site.

Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Health Administration Press, 27

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2 Replies

BG

Brandon Grundy

Sep 11, 2024 6:41pm | Last reply Sep 13, 2024 1:24pm

Reply from Brandon Grundy

Re-election is always a top priority for law makers, so consequently voter sentiment becomes a key factor in the decision-making process on any major policy. To understand the repeal or replacement efforts surrounding the Affordable Care Act (ACA), it’s essential for legislators’ to consider not only the financial costs to the public but also the political consequences, especially regarding their voting base.

Historically, legislators from conservative districts have found themselves under intense pressure to follow through on campaign promises to repeal the ACA, which many saw as a form of government overreach. However, they also had to think about the backlash from constituents who benefited from the ACA, like those who gained Medicaid coverage or were protected due to pre-existing conditions (Jacobs & Mettler, 2018). So, the decision-making process became about more than just the financial impacts—it was also about navigating voter perception and the possible fallout. Public opinion has also played a significant role in forming decisions around programs like Medicare and Medicaid. Voters tend to have complex views, often supporting individual components of healthcare reform while aligning with a different political perspective all-together (Oberlander, 2017).

Beyond immediate election results, legislators also consider how these decisions affect their long-term political careers. For instance, older voters, who generally vote in higher numbers and depend heavily on Medicare, tend to resist changes that might threaten their healthcare access. This makes any attempts to alter programs like Medicare risky for politicians (Sparer, 2019). As a result, many leaders move carefully when positioning national healthcare policies, aligning with their voter base while avoiding actions that could harm their re-election prospects.

In short, the push to repeal or replace the ACA highlights how much voter sentiment and re-election concerns influence legislators’ actions on healthcare policy. Whether it’s Medicare, Medicaid, or other national issues, public opinion plays a huge role in shaping how policies are recommended and enacted, forcing legislators to balance political survival with effective policymaking.

References

Jacobs, L. R., & Mettler, S. (2018). When and how new policy creates new politics: Examining the feedback effects of the Affordable Care Act on public opinion . *Perspectives on Politics, 16*(2), 345-362. https://doi.org/10.1017/S1537592718000044

Oberlander, J. (2017). The art of repeal—Republicans, Democrats, and the fate of the Affordable Care Ac t. *New England Journal of Medicine, 376*(25), 2405-2408. https://doi.org/10.1056/NEJMp1706362

Sparer, M. S. (2019). Medicaid at 50: Remarkable growth fueled by unexpected politics . *Health Affairs, 38*(6), 996-1001. https://doi.org/10.1377/hlthaff.2019.00088

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HW

Hiedi Wurster

Sep 11, 2024 5:36pm | Last reply Sep 14, 2024 1:09am

Reply from Hiedi Wurster

Healthcare as Legislative Decisions

Healthcare is unique in that everyone needs it, but not everyone has it. It is also a hot button political issue. In March, 2010, The Patient Protection and Affordable Care Act, more commonly known as the Affordable Care Act (ACA) was passed. It had three main goals; make health insurance available to more people by lowering the cost, expand Medicaid, and lower the cost of healthcare by utilizing new methods of delivery (Services, n.d.) Healthcare is also a bargaining chip in political campaigns.

Attitudes toward ACA appear to be divided along political lines. One poll showed that 87% of Democrats and 65% of Independents approve of the ACA, whereas 66% of Republicans do not approve (Kirzinger, 2024). Unfortunately, our healthcare system is complex. There (Facts, n.d.) are thousands of insurance companies, each with their own procedures and sets of regulations. Medicare and Medicaid complicate the situation. Medicare is a federal program, whereas Medicaid is a state / federal program. The federal government regulates it, but it is administered by each state (services, n.d.). Thanks to the ACA, as of 2023, at least 40 million Americans are now insured, and over 19,000 lives have been saved due to them having insurance (Affordable care act Statistics and Facts).

Cost of Repealing the ACA

The cost of repealing the act comes in several forms. The monetary cost to repeal it is estimated to be $350 billion (Budget, 2017). But there is no way to calculate the cost in lives for people who would lose their coverage. In addition, there is the political cost for our representatives. In the state of Washington, “much of what they actually decide depends on the views, interests, and preferences of the citizens who elect them” (Legislature, n.d.). So it is fair to say that if the legislators in my home state want to get reelected, then they will most likely vote based on the will of their public.

References

Budget, C. F. (2017, January 4). The full cost of repeal of the affordable care act . Retrieved from https://www.crfb.org/papers/cost-full-repeal-affordable-care-act#:~:text=Previously%2C%20CRFB%20estimated%20full%20repeal,%24600%20billion%20from%202018%2D2027.

Facts, A. C.-S. (n.d.). Affordable care act – statistics and facts . Retrieved from Statista: https://www.statista.com/topics/3272/obamacare/#topicOverview

Kirzinger, A. V. (2024, February 22). 5 charts about public opinion on the affordable care act . Retrieved from KFF: https://www.kff.org/affordable-care-act/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act/

Legislature, W. S. (n.d.). A citizen’s guide to effective legislative participation . Retrieved from https://leg.wa.gov/legislature/Pages/EffectiveParticipation.aspx#:~:text=Yet%2C%20much%20of%20what%20they,the%20citizens%20whom%20they%20represent.

Services, D. o. (n.d.). About the affordable care act . Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html

services, D. o. (n.d.). What’s the difference between medicare and medicaid . Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html

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Eric M Arutyunyan

Sep 11, 2024 3:05pm | Last reply Sep 12, 2024 1:31pm

Reply from Eric M Arutyunyan

Politics and the Patient Protection and Affordable Care Act

During legislation, legislators often get concerned about the competing interests of the government in the bill and the impact on the issues that affect them. This implies that legislators focus more on their interests and concerns, particularly on getting reelected; thus, they make use of any chance that can help them maintain their political relevance and influence to the people for them to be voted (Hall, 2021). For legislators to achieve this objective, they make calculations on cost-benefit analysis when there are legislation demands from the government. The cost-benefit calculations by the legislators are mostly not for the common interest of the people, but it is a means to get more political supporters by supporting the legislation. In most cases, legislators and politicians focus on things that will help them have political influence and win elections (Delaney, 2021). When contentious matters that can compromise their re-election come up, legislators tend to weigh the pros and cons of the matter carefully to understand how it will affect their re-election.

One of the bills that has been most contentious in the US is the Affordable Care Act (ACA). When this bill was introduced by President Barack Obama, a heavily contested debate happened in Congress, whereby, the Republicans were strongly opposed to it, while Democrats supported the bill wholly. The ACA passed narrowly after Democrats did intensive lobbying. After President Donald Trump took power in the US, he made a promise to repeal the ACA, with reasons that it was costly to the US healthcare amounted to over $200 billion, and high-cost premiums (Saltzman & Eibner, 2016). However, democrats held that the ACA had revolutionized the healthcare sector and increased the number of people who could afford healthcare insurance. Democrats also indicated that ACA was beneficial to patients with chronic illnesses such as cancer, citing the discrimination such patients went through before ACA (Roland, 2019). These are the considerations that Republican and Democrat legislators considered when they grappled with making decisions on repealing and replacing the ACA or voting against it. For legislators, a determination of how these factors affected the people was important when voting (Saltzman & Eibner, 2016). One of the reasons that led to the failure of repealing and replacing ACA was the strong support that came from public support of the ACA who were mainly constituents of democrats.

The analyses of voters’ views usually affect the decisions made by legislators when making recommendations or giving positions on national policies. Understanding the views of voters is important in shaping the voting decisions of legislators, especially when dealing with complex matters of health (Brown & Raza, 2020). Through analysis of voters’ views, legislators can anticipate how constituents will react to specific decisions or vote. As shown by NCSS (n.d), legislators take a keen interest in the Triangle Test when making voting decisions. They largely consider whether the people they represent care about the issue; thus, legislators whose goal is to get re-elected, listen to the popular views of the voters. About the bills that touch healthcare such as Medicaid and Medicare, legislators have to consider the views of the voters, and what they need and desire on the issue (Dodson et al., 2018). Legislators listen to the views of voters to protect their political prospects; thus, they focus on making popular decisions that cannot compromise their political careers. It is imperative that the vote of the legislators align with the views and wishes of the voters because they are their representatives in Congress.

References

Brown, C. L., & Raza, D. (2020). Voting, health and interventions in healthcare settings: A scoping review. Public Health Reviews , 41 (1). https://doi.org/10.1186/s40985-020-00133-6 Links to an external site.

Delaney, E. (2021, December 14). The role of cost-benefit analysis in public policy decision-making . Berkeley Public Policy Journal. Retrieved September 11, 2024, from https://bppj.studentorg.berkeley.edu/2021/12/14/the-role-of-cost-benefit-analysis-in-public-policy-decision-making/ Links to an external site.

Dodson, E. A., Geary, N. A., & Brownson, R. C. (2018). State legislators’ sources and use of information: Bridging the gap between research and policy. Health Education Research , cyv044. https://doi.org/10.1093/her/cyv044 Links to an external site.

Hall, A. (2021, November). State elections, policy choices, and accountability . Stanford Institute for Economic Policy Research (SIEPR). Retrieved September 11, 2024, from https://siepr.stanford.edu/publications/policy-brief/state-elections-policy-choices-and-accountability Links to an external site.

NCSS. (n.d.). How legislators make decisions . National Council for the Social Studies (NCSS). Retrieved September 11, 2024, from https://www.socialstudies.org/advocacy/how-legislators-make-decisions Links to an external site.

Roland, J. (2019, August 17). The pros and cons of Obamacare . Healthline. Retrieved September 11, 2024, from https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare#:~:text Links to an external site.

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1 Reply

Mihret Ghebreamlak

Sep 11, 2024 7:43am | Last reply Sep 13, 2024 10:53am

Reply from Mihret Ghebreamlak

The Role of Electoral Considerations in Healthcare Policy

The Patient Protection and Affordable Care Act has become the focus of political and healthcare debates. This post examines how legislators’ desire for re-election affects their behavior regarding the ACA and how the electorate’s preferences determine legislative choices on national programs such as Medicare and Medicaid.

Reelection Concerns and ACA Repeal Efforts

Reelection self-interest is a factor that affects legislators’ positions on the ACA. Challengers to repeal also had to consider how their decisions would shape their political existence. Expectations of political backlash for those from districts that supported the ACA for voting for repeal were high (Willison & Singer, 2019). In contrast, those from districts that opposed the ACA were pressured to show that they supported its repeal. This electoral calculus frequently outweighed longer-term policy impact at the expense of political gain in the next electoral term.

Cost-Benefit Analysis of Legislators’ Decisions

It operates under the cost-benefit analysis, where legislators consider the effects of the policy on their constituents and compare them to the effects on their political careers. Endorsing ACA’s repeal may help gain votes from selected constituencies and financial support for the campaigns (Campbell & Shore-Sheppard, 2020). Arguing against repeal could attract a different set of voters and keep a legislator from being typecast as the one defending the accessibility to healthcare (Courtemanche et al., 2020). This dynamic (states are both the legislative actors and the beneficiaries of legislation) makes the legislative process a multi-layered process fraught with conflict.

Voter Influence on Policy Positioning

Voter opinion is, therefore, an essential tool in influencing the decisions made by legislative leaders. For instance, Medicare and Medicaid legislation also affects seniors, one of the most prominent voting groups in the United States (Willison & Singer, 2019). Politicians adapt to these polls to determine the new direction to take in policymaking to follow the sentiments of most citizens or the active groups in society (Campbell & Shore-Sheppard, 2020). Awareness of these voter tendencies assists the legislators in creating policies that can help them secure their seats in Parliament while satisfying the electorate.

Impact of Voter Analysis on Healthcare Policy

Understanding voters’ characteristics assists the legislators in gauging the electoral consequences of their policy choices. This analysis does not restrict itself to basic approval ratings; it factors in demography, constituency demands, and newer healthcare concerns (Courtemanche et al., 2020). Politicians with the skills to understand these mechanisms can take more effective positions in the broad context of healthcare policy, supporting or opposing a bill that would be more favorable to the constituents.

Conclusion

Political ambition affects legislators’ conduct, especially regarding healthcare decisions. The ACA is the duality of representing the public interest and getting re-elected. It is imperative to comprehend this dynamic to assess the efficiency and future trajectory of strategies concerning healthcare policy in the United States. Lawmakers must weigh these factors well because they must govern for the common good and, at the same time, stay in power.

References:

Campbell, A. L., & Shore-Sheppard, L. (2020). The Affordable Care Act’s social, political, and economic effects: Introduction to the issue. RSF: The Russell Sage Foundation Journal of the Social Sciences , 6 (2), 1–40. https://doi.org/10.7758/rsf.2020.6.2.01 Links to an external site.

Courtemanche, C., Marton, J., & Yelowitz, A. (2020). The Full Impact of the Affordable Care Act on Political Participation. RSF: The Russell Sage Foundation Journal of the Social Sciences , 6 (2), 179–204. https://muse.jhu.edu/pub/207/article/761095 Links to an external site.

Willison, C. E., & Singer, P. M. (2019). Repealing the Affordable Care Act Essential Health Benefits: Threats and Obstacles. American Journal of Public Health , 107 (8), 1225–1226. https://doi.org/10.2105/ajph.2017.303888 Links to an external site.

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Kayla Rena Davis

Sep 11, 2024 5:53am | Last reply Sep 11, 2024 12:04pm

Reply from Kayla Rena Davis

The Affordable Care Act (ACA) aimed to expand and improve health insurance coverage by increasing the number of individuals with insurance coverage, increasing access to coverage, and upgrading the quality and scope of coverage. Passed in 2010, public opinion has faced broadly divided public opinion. The ACA offers guaranteed access to insurance, prohibiting surcharges for preexisting conditions. The pre-existing conditions portion of the ACA has gained support on a bipartisan level. According to the analysis at KFF, pre-existing conditions affect 27% of adults ages 18-64 (Kirzinger & Valdes, 2024). While ACA has improved healthcare access for some, it has flaws; one in four people says it has made it more difficult or increased the cost of healthcare (Kirzinger & Valdes, 2024). Legislators must weigh the cost and benefits of the actions regarding reelection, evaluating what is best for their voter groups and who will benefit from any provisions to the ACA.

One of the bipartisan issues by The Affordable Care Act (ACA) mandated that U.S. citizens obtain health insurance but did not provide explicit guidelines regarding coverage levels. States were given the authority to select benchmark plans, resulting in varying coverage across different states (Willison & Singer, 2017). Small group insurance plans offered through health exchanges were intended to increase consumer options when selecting health coverage. However, these plans encountered challenges, leading many to withdraw from the marketplace, ultimately reducing the choices available to consumers (Willison & Singer, 2017). Proposals for interstate exchanges aimed at expanding consumer choice and reducing premium costs have been met with concern, as they could further threaten smaller insurance companies (Willison & Singer, 2017). Despite ongoing discussions, states have been reluctant to repeal the ACA and its components due to the lack of a viable replacement framework.

Legislators’ decisions on healthcare reform are intrinsically tied to their reelection prospects and influence their relationship with voters. These elected officials must navigate the complex balance between addressing their constituents’ preferences and aligning with their campaign contributors’ interests. During election periods, healthcare often emerges as a pivotal issue, utilized strategically by candidates to appeal to their bases. Additionally, partisanship remains a key predictor of voting patterns, significantly shaping legislative outcomes (Shor, 2018). Given healthcare’s significance to voters, the policies legislators support play a critical role in their political survival and future electoral success.

Reference:

Kirzinger, A., & Valdes, I. (2024, May 15). 5 charts about public opinion on the Affordable Care Act . KFF. https://www.kff.org/affordable-care-act/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act/

Shor, B. (2018). Ideology, party, and opinion: Explaining individual legislator ACA implementation votes in the States. State Politics & Policy Quarterly , 18 (4), 371–394. https://doi.org/10.1177/1532440018786734

Willison, C. E., & Singer, P. M. (2017, August). Repealing the affordable care act essential health benefits: Threats and obstacles . American journal of public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508159/

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Tamika Cheatham

Sep 11, 2024 1:50am | Last reply Sep 11, 2024 12:05pm

Reply from Tamika Cheatham

Success in America Care Act (ACA) repeal and substitution effort depends on several political, economic, and social factors. The core of the debate centers on cost-benefit analysis by legislators themselves, particularly relative to their reelection prospects. Legislators often balance the expected benefits from supporting or opposing policy changes against the political costs related to their decisions (Elinson & Gould, 2022). In the case of the ACA, this calculation has formed many of the approaches lawmakers took.

One of the biggest factors in this analysis is the perception of ACA among the voters. To several legislators, especially those from the conservative districts, opposition to ACA serves concomitantly with the preference of their constituents, who may look at the law as an overreach of government authority or economically burdensome. These legislators may calculate that supporting efforts to repeal or replace the ACA would bolster their reelection chances by demonstrating alignment with their voters’ values and priorities (McGee, 2021). Conversely, for the legislators in the more liberal or swing districts who may consider the ACA favorable for expanding care and access to healthcare, the political cost of supporting this repeal can be great politically, perhaps enough to cost the legislator those people’s support and even jeopardize their reelection prospects.

Also, in the cost-benefit analysis came the benefits of the ACA, which became vital to the low- and middle-income citizens who finally got access to healthcare coverage. Therefore, any legislative modifications to the current status would have to be seriously considered– how it will affect their constituents, especially those who directly benefit from such a law (Catuara, 2024). These involve, for example, the loss of coverage for millions of Americans, engendering significant public backlash and thus being politically risky for legislators to support a repeal without a viable replacement that maintains or improves coverage levels. This concern is most acute for legislators in states that took the ACA’s Medicaid expansion, where the loss of federal funding might have severe consequences for state budgets and healthcare access.

The analyses of the voters’ opinions also play a critical part in the decisions of the legislative leaders while implementing national policies in Medicare or Medicaid. They must consider the implications of his course of action regarding changes in these programs within their base and among the larger electorate. For example, cuts to Medicare or Medicaid would always prove politically damaging, particularly among older voters and lower-income populations, who depend greatly on these programs (Martinez, 2020). For this reason, it is in the best interest of legislative leaders to avoid unpopular policy decisions, resulting in blatant voter dissatisfaction, reduced support in subsequent elections, and losing a seat altogether.

In conclusion, the efforts to repeal or replace the ACA and other national policy decisions are deeply enlaced with the legislators’ desire for reelection. The cost-benefit calculus entails the possible economic effects of policy changes, and the political risks associated with voter reaction. Certainly, the recipients of policy-making and the will of the public cannot go unaccounted for, as the success or failure of these policies could have cascading implications upon the lawmakers’ political futures.

References

Catuara, L. G. (2024). The Side-Effects of Imprisonment: Harm to the Family. Criminal Law and Philosophy, 1-21. https://link.springer.com/content/pdf/10.1007/s11572-024-09734-7.pdf Links to an external site.

Elinson, G. A., & Gould, J. S. (2022). The Politics of Deference. Vand. L. Rev., 75, 475. https://scholarship.law.vanderbilt.edu/cgi/viewcontent.cgi?article=4811&context=vlr Links to an external site.

Martinez, M. (2020). The New Deal and Implementing the Welfare State (Doctoral dissertation). https://repositories.lib.utexas.edu/bitstreams/e5c192b0-f88d-4094-a915-9b60591aea2b/download Links to an external site.

McGee, Z. A. (2021). The systematic impact of intraparty factions in the US House of Representatives (Doctoral dissertation). https://repositories.lib.utexas.edu/bitstreams/c80f41c9-caba-475f-8831-1614d3caca62/download Links to an external site.

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1 Reply

LA

Lailat Andu

Sep 11, 2024 12:46am | Last reply Sep 12, 2024 12:36pm

Reply from Lailat Andu

The Cost-Benefit Analysis

The Affordable Care Act is a piece of legislation that aim to expand insurance coverage and regulate the healthcare market. The law has been subject to significant political debate, particularly regarding efforts to repeal or replace it. The cost-benefit implications of these repeal/replace efforts in the context of reelection strategies for policymakers can be very tricky. I believe policymakers must weigh the substantial short-term costs against the potential long-term benefits, including political gains and possible improvements in the healthcare system. The interplay between these factors highlights the critical role of political strategy in shaping healthcare policy outcomes. For legislators who are particularly seeking reelection, fulfilling campaign promises to dismantle the ACA can enhance their electoral appeal among conservative constituents who view the ACA as government overreach (Cohen, 2019). Meanwhile Moffit, (2021) indicates that replacing the ACA with alternative policies might offer the opportunity to redesign the healthcare system to better align with free-market principles, potentially lowering long-term federal spending and improving market efficiencies.

The Cost-Benefit Analysis in Reelection

Most of the Legislators’ primary motivation often revolves around securing reelection, and this ambition shapes their policy decisions. The interplay between cost and benefit in reelection can be complex and deeply intertwined with political strategy. While the immediate costs of repealing the ACA are high, the political capital gained by aligning with voter preferences can be significant. Conversely, failure to address healthcare reform can also lead to electoral consequences, as seen in the midterm elections where healthcare issues were a major factor in voter decisions (Jacobson, 2018). I believe disrupting coverage for millions of Americans could lead to increased public dissatisfaction and potential backlash against incumbents (Sommers et al., 2017). Such policy moves can be politically risky, as they may alienate voters who have benefited from the ACA’s provisions, such as coverage for pre-existing conditions and expanded Medicaid access (Himmelstein et al., 2016).

Voter opinions play a pivotal role in shaping national policies. Legislative leaders closely monitor and analyze these views to align with their policy recommendations with public sentiment, thereby ensuring political support and advancing their legislative agendas. The interplay between voter opinion and legislative decision-making is a crucial dynamic in democratic governance. Leaders consider public sentiment to ensure their policies align with constituents’ preferences, thereby securing electoral support and political capital.

References

Cohen, S. (2019). Political calculus in healthcare reform: Repeal and replace. Journal of Health Politics, Policy, and Law, 44(1), 67-89.

Himmelstein, D. U., Thorne, D., Warren, E., & Woolhandler, S. (2016). Medical bankruptcy in the United States, 2007: Results of a national study. American Journal of Public Health, 96(8), 1256-1261.

Jacobson, G. C. (2018). The politics of healthcare reform. Political Science Quarterly, 133(4), 669-692.

Moffit, R. (2021). The case for healthcare market reforms. Heritage Foundation. https://www.heritage.org/health-care-reform/report/the-case-healthcare-market-reforms

Sommers, B. D., Maylone, B., & Kahn, J. G. (2017). The impact of the Affordable Care Act on health care utilization. New England Journal of Medicine, 376(4), 340-350.

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Julia N Taylor

Sep 11, 2024 12:43am | Last reply Sep 14, 2024 8:47pm

Reply from Julia N Taylor

The Role of Cost-Benefit Analysis in Legislators’ Decision-Making on Healthcare Policies

The cost-benefit analysis related to legislators’ reelection prospects significantly impacted efforts to repeal or replace the Affordable Care Act (ACA). To ensure reelection, legislators must ensure that the choices they make reflect the desires of the public. Some groups opposed the ACA, some claiming that the government was overstepping in the management of their health care needs even though it aided in giving millions of people access to health care services. According to Campbell and Shore-Sheppard (2020), legislators were likely to weigh the political advantages of appealing to anti-ACA voters against the risks of losing support from constituents who benefited from the policy.

Opinions of the voters remain very influential in the formulation of policies that enter the national stage, especially in sensitive areas, such as health. Legislative leaders, before recommending or positioning policies, often analyze the preferences of their constituents to avoid alienating key voter demographics. For example, Medicare and Medicaid policies impact substantial and powerful voting segments, including elderly and low-income populations. Rosenzweig (2021) also established that the majority of the legislators wish to associate with policies that protect the interests of such groups to reduce electoral backlash that could result from it.

A legislator’s decision-making process is heavily influenced by their main responsibility, which is to be elected or re-elected into office. Politicians can ensure political support by promoting or defending ideas that are supported by the majority of their voter base. As a result, they would not like to risk their political careers. Since Medicare and Medicaid are quite popular among the citizens, legislators are likely to support policies that will retain these programs and ensure their continuation. Legislators aim to maintain stability and ensure their political longevity by aligning themselves with voter preferences. The Administration continues to build on, strengthen, and protect Medicare, Medicaid, and the Affordable Care Act (ACA)—and now more Americans have health insurance than under any other President (Whitehouse).

References

Campbell, A. L., & Shore-Sheppard, L. (2020). The social, political, and economic effects of the Affordable Care Act: Introduction to the issue. RSF: The Russell Sage Foundation Journal of the Social Sciences , 6 (2), 1-40.

Rosenzweig, S. C. (2021). Dangerous disconnect: Voter backlash, elite misperception, and the costs of violence as an electoral tactic. Political Behavior , 43 (4), 1731-1754.

https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/11/fact-sheet-the-presidents-budget-protects-and-increases-access-to-quality-affordable-healthcare/

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Lorrissa Lingen

Sep 11, 2024 12:08am | Last reply Sep 14, 2024 9:06pm

Reply from Lorrissa Lingen

Health care is an important issue in every election, constantly drawing significant attention. The American people frequently discuss concerns about the cost and availability of medications and services, stressing the need for effective solutions. Voters look to their leaders for guidance and decisive action to address these challenges, highlighting the essential role of health care in shaping electoral outcomes.

The Affordable Care Act was put into place in 2010, it was created to provide and offer the people living in the United States Affordable Health Care coverage regardless of their preexisting conditions (Understanding the Affordable Care Act).

While some policymakers are in support for repealing the Affordable Care Act (ACA) due to its financial burden on the government, this could backfire as many Americans support the ACA and may choose to withhold their votes from those supporting its repeal. The Affordable Care Act (ACA) is intended to provide healthcare coverage primarily for lower-income to middle-class families. If individuals lose their healthcare coverage, it could negatively impact legislators, potentially leading to a loss of voter support. On the other hand, if government spending is directed towards areas that some Americans consider unnecessary, this could also result in a loss of voter support. Balancing these concerns is vital for policymakers (Weller, 2020).

The legislative process starts when a bill is introduced to Congress. Anyone can write a bill, but only Congress members can introduce it. The president can also introduce bills. The bill can change a lot during the process of being made (The Legislative Branch 2021). A legislator’s primary goal is to be reelected, so they aim to align their priorities with those of their citizens. To secure votes and remain in Congress, they often tailor their responses to match what the public wants to hear, such as support for student loan forgiveness.

According to the White House, reducing the Affordable Care Act (ACA) could result in many people losing their insurance, including those with preexisting conditions. (Fact sheet: The congressional republican agenda: Repealing the Affordable Care Act and slashing Medicaid 2023) Most Americans do not support the increase in medical bills and the loss of preventive care. The fear of rising medication costs and reduced services could influence voter support.

References:

The United States Government. (2023, February 28). Fact sheet: The congressional republican agenda: Repealing the Affordable Care Act and slashing Medicaid. The White House.

https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/28/fact-sheet- Links to an external site. the-congressional-republican-agenda-repealing-the-affordable-care-act-and-slashing-medicaid/

The United States Government. (2021, January 15). The Legislative Branch. The White House.

https://www.whitehouse.gov/about-the-white-house/our-government/the-legislative- Links to an external site. branch/

Understanding the Affordable Care Act. American Medical Association. (n.d.). https://www.ama- Links to an external site.

assn.org/health-care-advocacy/access-care/understanding-affordable-care-act#:~:text=The%20Affordable%20Care%20Act%20(ACA,a%20better%20health%20care%20system.

Weller, C. E. (2020, September 29). Repealing the ACA Would Put Millions at Risk While Giving

Big Tax Cuts to the Very Wealthy. Center for American Progress. https://www.americanprogress.org/article/repealing-aca-put-millions-risk-giving-big-tax-cuts-wealthy/

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Selina Villanueva

Sep 10, 2024 10:27pm | Last reply Sep 14, 2024 7:19pm

Reply from Selina Villanueva

Legislators Being Reelected Affected Efforts To Repeal/replace The ACA

Being elected as a legislator is not only a honorary job ,but it also comes with substantial responsibilies. The Affordable care act definition is for Americans to expand Medicare and have cheaper health insurance . You may see the ACA be referred to different names as well known as PPACA or ACA. Depending on who is elected as a legislator they make a significant impact based on whether they want personal gain or truly concerned in changing how real people will be affected by the changes in Medicare. The Biden administration has reinvigorated the ACA by restoring funding for consumer assistance and outreach and by increasing premium subsidies to make coverage more affordable, resulting in record enrollment in ACA marketplace plans and historically low uninsured rates (Levitt ,2024).Voters views have a major influence on leaders when it comes to decision impacting policies due to them wanting to make the people happy to keep there place.Democrats were able to win votes with new policy, but Republicans also win votes by undermining it (Niskanen,2019).American voters are crucial if changes are to be made especially national policies like Medical. November it will be up to California voters whether to lock billions of special tax dollars into Medical the state’s health insurance program for low-income residents leave the decision up to lawmakers who might be tempted to use the money elsewhere (Hwang,2024).

References

Hwang, K. (2024, July 1). Billions for Medi-Cal at stake with health tax in CA 2024 election . CalMatters. Retrieved September 3, 2024, from https://calmatters.org/health/2024/07/medi-cal-mco-tax-initiative/

Levitt, L. (2024, May 28). The Politics of Health Care and the 2024 Election . KFF. Retrieved September 3, 2024, from https://www.kff.org/health-policy-101-the-politics-of-health-care-and-the-2024-election/?entry=table-of-contents-the-affordable-care-act-obamacare

Niskanan center. (2019, May 22). How Medicaid And Obama Care Drive Voting . NiskanenCenter.org. Retrieved September 3, 2024, from https://www.niskanencenter.org/how-medicaid-and-obamacare-drive-voting/

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Tracy M Chaves

Sep 10, 2024 10:03pm | Last reply Sep 12, 2024 3:32pm

Reply from Tracy M Chaves

I like the statement in the text by Nancy Short, “there is no such things as a free lunch” (p. 230). This quote meaning that there is always a trade-off or a cost to a decision or change. If there is money allocated to healthcare, it is also taken from somewhere else. Right now, health care in the U.S. is at an all time high (Short, 2022). The Affordable Care Act or ACA was put in place by President Obama in 2010 in hopes of lowering cost of healthcare for consumers and health care generally, and expanding the medicaid program (HHS, n.d.) It has been success in some areas and needs improvement in others, but making changes isn’t just about the president.

It is not easy to get a bill through legislation, especially when other factors other than who is president affects the outcome. The way our government is set up, the majority in the House and the Senate can determine which way legislation goes (Levitt, 2024). The party that controls the houses affects the President’s ability to follow through on election promises.

Per The White House, Republican budget plans over the last decade have included some type of repeal of the ACA. The affects of repealing the ACA may cause changes that include a large cut to Medicaid, which could cause people lose their coverage, increase in medical bills for consumers, decrease in preventative care coverage, an increase in cost of prescription drug for consumers, and decrease access to opioid and mental health treatments (The White House, 2023).

During President Trump’s presidency he attempted to replace the ACA with the American Health Care Act or Trumpcare. This attempt failed and only 17% of Americans supported him, of those that were Republican only 24% supported the bill (Collier, 2017). Such low approval rates can cost a candidate a reelection and due to the different fews of how health care should be managed by each political party, the stance on healthcare highly affects a candidates election on federal and state levels.

References

Collier, R. (2017). Why Trumpcare failed. CMAJ: Canadian Medical Association Journal = Journal de I’Association Medical Canadienne, 189 (17), E645-E646. https://doi.org/10.1503/cmaj.1095414

Health and Human Services (HHS). (n.d.). About the Affordable Care Act. Retrieved on Sept 10 2024 from https://www.hhs.gov/healthcare/about-the-aca/index.html

Levitt, L. (2024). The politics of health care and the 2024 election. KFF. Retrieved on Sept 10 2024 from https://www.kff.org/health-policy-101-the-politics-of-health-care-and-the-2024-election/?entry=table-of-contents-introduction

Short, N.M. (2022). Milstead’s health policy and politics: A nurse’s guide. Seventh Ed, p. 230. Jones & Bartlett Learning.

The White House. (2023). Fact sheet: The congressional republican agenda: Repealing the Affordable Care Act and Slashing Medicaid. Retrieved on Sept 10 2024 from https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/28/fact-sheet-the-congressional-republican-agenda-repealing-the-affordable-care-act-and-slashing-medicaid/

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Nicole Greco Carl

Sep 10, 2024 7:47pm | Last reply Sep 13, 2024 9:18pm

Reply from Nicole Greco Carl

How cost benefit analysis in terms of legislators being reelected affected effects to repeal/replace the ACA.

All of this comes down to the population a legislator is appealing to. Part of the American Care Act (ACA) is to “expand Medicaid to cover all adults with income below 138% of the FPL”(The United States, 2023). The population that I serve in downtown Los Angeles, through my Hospital specifically, gets a majority of patients that have Medicaid and are low-income. Now, if a legislator wants to do well with this population, it would benefit them to not repeal the ACA. In a state like New Hampshire, which has the lowest poverty rate according to the US Census Bureau, a legislator could fare very well in the state since the ACA is not as beneficial to this population and might not be as big a topic for reelected compared to a place like downtown Los Angeles.

Analysis of the voter’s view may affect decisions by legislative leaders in recommending or positioning national policies.

For a legislator to be reelected the legislators need to “be aware of not only the political climate but also be aware of how certain votes will affect their ability to stay in office. They must consider the will of their constituents, the needs of their state, and the desire of their party” (Ames, n.d). If the ACA was repealed, “40 million people’s health insurance coverage would be at risk.” and “tens of millions of people could see their prescription drug coverage scaled back”(The United States, 2023). This is not a small amount of our population and with the numerous individuals this affects, if they vote in their best interest for ACA then most legislatures with common sense would not repeal it. A study done to analyze voter turnout demonstrated that “Medicaid expansion led to a statistically significant 8.8 to 9.2 percentage point reduction in voter turnout in congressional elections and the private portion of the ACA led to a statistically significant increase of 5.3 to 5.4 percentage points” (Courtemanche, 2020). We the people when we show up to vote are what influence legislative decision making.

References

Affordable care act (ACA) – glossary . HealthCare.gov. (n.d.). https://www.healthcare.gov/glossary/affordable-care-act/

Ames, K. (n.d.). How legislators make decisions . Social Studies. https://www.socialstudies.org/advocacy/how-legislators-make-decisions

Courtemanche, C., Marton, J., & Yelowitz, A. (2020, July 1). The full impact of the affordable care act on political participation . RSF. https://www.rsfjournal.org/content/6/2/179

Keisler-Starkey, K. (2023, September 14). Health insurance coverage in the United States: 2022 . Census.gov. https://www.census.gov/library/publications/2023/demo/p60-281.html

The United States Government. (2023, February 28). Fact sheet: The congressional republican agenda: Repealing the affordable care act and slashing Medicaid . The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/28/fact-sheet-the-congressional-republican-agenda-repealing-the-affordable-care-act-and-slashing-medicaid/