Politics and the Patient Protection and Affordable Care Act

Legislators Decisions in National Policies

The cost-benefit analysis of legislators, whose main goal is reelection, would play a big part in a decision to repeal or replace the Affordable Care Act (ACA) (Courtemanche et al., 2020). Where a candidate’s personal beliefs or loyalty to the party may be a factor in decision-making, many legislators may care more about how that decision would resonate with voters (National Council for the Social Studies, n.d.). The costs of repeal or replacement would be significant for legislators in districts where voters largely support the ACA (Schatman et al., 2020). These voters, especially those who depend on the ACA’s protections for pre-existing conditions and benefit from reduced insurance rates, would likely react strongly against efforts to dismantle it (Schatman et al., 2020).  Repealing the ACA without an equitable replacement could lead to backlash, jeopardizing the legislator’s reelection chances (Schatman et al., 2020; Courtemanche, 2020). While supporting repeal might earn favor with party leadership or a conservative base, the political risks of deterring the broader electorate are high (National Council for the Social Studies, n.d.; Schatman et al., 2020).

If voters in the legislator’s district oppose the ACA, then the benefits of repealing or replacing outweigh the risks (Kearney, 2020; Courtemanche et al.). A repeal and replacement effort that satisfies this district’s voter values, such as offering market-based alternatives, might ensure that the legislator gets reelected (Kearney, 2020).  However, if there is no suitable replacement plan, there is a risk of alienating swing and undecided voters (Courtemanche et al.). Also, this risks potentially losing voters from their base if those people lose access to healthcare (Courtemanche et al.). Ultimately, if a legislator wants to be reelected, voter views must be analyzed (National Council for the Social Studies, n.d.). A lot of calculated risks are involved as legislators balance satisfying party leadership, fulfilling campaign promises, and responding to shifting public opinion (National Council for the Social Studies, n.d.). As a result, considering voter sentiment could lead to legislators making less bold approaches to national policy decisions, particularly regarding programs that directly affect millions of Americans, like healthcare, in efforts to lessen the risk of losing reelection (Schatman, 2020; National Council for the Social Studies, n.d.).

Resources

Courtemanche, C., Marton, J., & Yelowitz, A. (2020). The full impact of the Affordable Care Act on political participation. Journal of social sciences, 6(2), 179–204. Retrieved September 10, 2024, from https://doi.org/10.7758/RSF.2020.6.2.08

Kearney, A. (2020, November 2). A conundrum: Majority of Republican voters want to overturn ACA but keep protections for people with pre-existing conditions. KFF. Retrieved September 10, 2024, from https://www.kff.org/policy-watch/a-conundrum-majority-of-republican-voters-want-to-overturn-aca-but-keep-protections-for-people-with-pre-existing-conditions/

National Council for the Social Studies. (n.d.). How legislators make decisions. Retrieved September 10, 2024, from https://www.socialstudies.org/advocacy/how-legislators-make-decisions

Schatman, M. E., Shapiro, H., & Fudin, J. (2020). The repeal of the Affordable Care Act and it’s likely impact on chronic pain patients: “Have you no shame?”. PubMed Central. Retrieved September 9, 2024, from https://doi.org/10.2147/JPR.S289114

Main Discussion Post

The Affordable Care Act (ACA) became law in 2010 with the overall goal of improving health equality and decreasing health disparities. Implementation of the ACA was met with challenges and disregard for the law in some states, which was clearly a political and partisan issue (Walden university, 2018). Hoping to capitalize on their party’s agenda, lawmakers currently seeking reelection may not support bipartisan efforts with partisanship plaguing healthcare policy since the inception of the ACA (Oberlander, 2020). Recent bipartisan discussions on improving healthcare for Americans looked promising; however, the ACA continues to face repeal.

The ACA provides lower cost healthcare and improves access to quality care for Americans. Repeal of the ACA would eliminate the significant protections provided by the ACA ensuring an increase in healthcare costs and a decrease in the availability of healthcare for many Americans (The United States Government, 2023 & 2024). Repealing ACA will also impact Medicare and Medicaid recipients who are already at significant risk for health disparity (Oberlander, 2020). If the ACA is repealed, progress toward improving health equity and decreasing health disparities would be lost. The ACA provides subsidies to assist at risk populations in obtaining healthcare, improving equitable access to care, without which many would not be able to afford access to healthcare (Grogan, 2017).

Oberlander states “The ACA’s enactment demonstrated that major progress is possible in US health policy” (2020). Improving health equity and decreasing health disparities requires ongoing and thoughtful analysis and evaluations with appropriate legislative changes. As nurses, we offer unique perspectives to assist legislators in developing meaningful healthcare legislation.

References

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

Oberlander, J. (2020, March). The Ten years’ war: Politics, partisanship, and the ACA. Health Affairs, 39(3), 471-478. Retrieved from https://www.proquest.com/docview/2375460897?accountid=14872&sourcetype=Scholarly%20Journals

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

The United States Government. (2023, February 28). Fact Sheet: The Congressional Republican Agenda: Repealing the Affordable Care Act and slashing Medicaid. The White House. Retrieved 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/

The United States Government. (2024, March 26). Fact Sheet: As House Republicans release budget to increase health care costs and take away coverage, President Biden and Vice President Harris fight to lower health care costs and protect and strengthen the ACA, Medicaid, and Medicare. The White House. Retrieved from https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/26/fact-sheet-as-house-republicans-release-budget-to-increase-health-care-costs-and-take-away-coverage-president-biden-and-vice-president-harris-fight-to-lower-health-care-costs-and-protect-and-strengt/

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

Legislator’s Decisions in National Policies:

Legislators’ decisions regarding policy-making can be easily persuaded by several factors. The desire to be re-elected, accepted amongst their constituents, or even the popularity of policy, and balancing their supporters’ desires are all factors. Legislators have to weigh the consequences vs benefits with any decision. Attempting to find a middle ground between national and local interests, they often opt for gradual changes to sidestep major opposition and effectively handle public responses to maintain their chances of re-election. The decision to repeal/replace the Affordable Care Act (ACA), also known as Obama Care, is no different. Political forces and the opinions of voters that shape the making of laws, especially about Obama Care and broader policies such as Medicare and Medicaid must be examined. Taking into account the cost-benefit evaluations that lawmakers carry out, balancing their ideological beliefs, the impact on various groups involved, the economic consequences, and the views of the electorate, all backed by recent studies to gain a thorough grasp of how these elements influence their attempts to either repeal or amend the ACA and their suggestions for new policies.

Cost Benefit Analysis of Voter Views and Legislative Decision-Making:

Republican lawmakers aimed to repeal the ACA to gain support from their base, but it also posed risks as more people appreciated its benefits. Joel Teitelbaum makes points on how future policy makers have to consider the possible negative reactions from those who benefited from the ACA versus their party’s principles (Walden University, 2018). Republican legislators faced pressure from party leadership and conservative factions to support repeal efforts due to political dynamics and election proximity. The failure to repeal the ACA highlights the interplay between ideological commitments, stakeholder influence, economic considerations, and voter sentiment in legislative decision-making. The healthcare industry opposed ACA repeal due to financial and political risks. Repealing it could lead to uninsured Americans, job losses, and economic disruptions with severe electoral consequences, especially in swing states (Willison & Singer, 2017). Grasping what voters want is essential for lawmakers when suggesting or placing countrywide strategies such as Medicare and Medicaid. Lawmakers depend a lot on survey results and feedback from voters to understand what the public thinks. This numerical information guides the development of policy stances that are expected to gain the backing of voters. For example, safeguarding Medicare and Medicaid is frequently viewed as vital among the elderly, who constitute a large and engaged group of voters.

Conclusion

As noted by Short, “Policymakers and elected officials seeking reelection, therefore, have incentives to put health issues on their agenda, to be seen offering solutions, and to avoid blame for problems or inaction on salient health matters” (2022, p. 59). Congress, facing the complexity and risks of public harm that come with repeal, may remain hesitant about a full ACA repeal, sparing the EHBs (Willison & Singer, 2017). Legislators use constituent feedback, polling data, and strategic communication to match their positions with the preferences of voter population. In addition to balancing their supporters’ desires regarding programs Medicare/Medicaid which against the risk of alienating themselves from their peers. Suggesting reductions or changes that diminish benefits could be risky politically since these programs are highly favored and offer essential services to numerous Americans.

References:

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

Walden University, LLC. (Producer). (2018). Contemporary Issues in Public Health Policy with Joel Teitelbaum [Video file]. Baltimore, MD: Author.

Willison, C. E., & Singer, P. M. (2017). 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

Week 3: Discussion

Vladimir Berrios- Student ID A01238310

MSN-PMHNP, Walden University

NURS-6050C-40: Policy & Advocacy for Pop Hlth-Fall 2024

Dr. Crystal Dodson

The cost-benefit analysis in terms of legislators being reelected plays a significant role in efforts to repeal or replace the Affordable Care Act (ACA). For many legislators, supporting or opposing ACA repeal efforts is often influenced by the political views of their voters. Therefore, legislators from a district that leans strongly conservative may support repeal efforts, aligning with the voters that view the ACA negatively, possibly because of their concerns of government overreach (Wilison, 2017). Conversely, legislators representing destrings where the ACA has been popular, usually among the lower-income voters benefiting from expanded Medicaid, may hesitate to support repeal fearing backlash and potential electoral consequences (Baicker, 2019).

This interplay demonstrates conclusively that the primary job of a legislator is reflection, so they are motivated to align their policy positions with the preferences of their voter base. Supporting a repeal of the ACA in a district that benefits from it could spell political self-sabotage and doom. All but ensuring that the legislator will not be voted into office again.

In terms of how voter views affect legislative leaders in setting national policies, legislators closely watch public opinion on key issues, such as Medicare or Medicare, particularly due to the popularity of these specific programs. Cutting the funding to these programs could alienate the elder population that statistically speaking have high voter turnout rates. Even if the legislator is a party whose goals are to defund the ACA, they may be reluctant to propose or endorse significant changes.

In conclusion, unfortunately, legislators’ actions can be disingenuous. Especially, when it comes to high stakes issues such as healthcare, where their decisions are based not on personal belief but rather perceived electoral consequences. In an attempt to keep their political careers afloat, legislators must weigh the costs and benefits of their positions, paying close attention to whether those choices will align with their voters’ views and increase their chances of reelection.

References

Willison, C. E., & Singer, P. M. (2017). 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

Baicker, K., & Finkelstein, A. (2019). The impact of Medicaid expansion on Voter Participation: Evidence from the Oregon Health Insurance Experiment. Quarterly journal of political science, 14(4), 383–400. https://doi.org/10.1561/100.00019026

Persad G. (2015). Priority Setting, Cost-Effectiveness, and the Affordable Care Act. American journal of law & medicine, 41(1), 119–166. https://doi.org/10.1177/0098858815591511

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS medicine, 16(2), e1002752. https://doi.org/10.1371/journal.pmed.1002752

Daniels, M. et al (2017). The cost of full repeal of the Affordable Care Act. Committee for a Responsible Federal Budget. https://www.crfb.org/papers/cost-full-repeal-affordable-care-act

The Cost-Benefit Analysis is a table that calculates the costs and benefits of a proposal or project to decide if it works from a business standpoint (Harvard Business School, 2019). Each legislator has their own intention with their policies and that can affect the number of votes to be reelected.

The Affordable Care Act (ACA) was instituted in March 2010 with three primary goals in mind such as having affordable health insurance available to more Americans, expanding the medicaid program to cover all adults with lower income, and to support medical care methods to decrease medical care costs (U.S. Department of Health and Human Services, 2022). With the ACA, over 35 million people reported to have insurance coverage due to the plan being put into place (U.S. Department of Health and Human Services, 2022). If this was repealed, then what would happen?

Repealing of the ACA has been up for debate within the last couple of years. Would the costs of repealing save more money for America? Yes, but with the repeal then the number of people who benefitted from the ACA would be at risk for paying higher health care costs and losing health coverage (The White House, 2023). Without this in place, the majority of people would not be supported and able to receive healthcare insurance which would result in the legislators’ drop in numbers and decreased support from the people.

Ultimately, the support to be reelected determines the legislators support on repealing or reinstatement of the ACA. If a legislator is unable to meet the needs of the people, there is a low chance that the legislator would be reelected.

References:

Harvard Business School . (2019, September 5). Cost-benefit analysis: What it is & how to do it. Business Insights Blog. https://online.hbs.edu/blog/post/cost-benefit-analysis

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/

U.S. Department of Health and Human Services. (2022, March 16). About the ACA. HHS.gov. https://www.hhs.gov/healthcare/about-the-aca/index.html

Cost benefit analysis in terms of legislators being re-elected plays a significant role in shaping their stance on efforts to repeal or replace the Affordable Care Act. Legislators typically weigh the political costs and benefits to supporting versus opposing policy changes. They factor in how these decisions might affect their re-election.

Repealing or amending the Affordable Care act could cause many issues. For one the loss of voter support. The Affordable care act provides healthcare coverage to millions of Americans, getting rid of or repealing ACA would mean that millions of Americans could lose healthcare coverage. This could potentially anger voters and would affect the way that they vote. The public may see this as a threat because healthcare is so important, any action towards removing such an act would cause a great deal of backlash for any candidate. Legislators could also face media and public scrutiny. Given the importance of healthcare, legislators might face negative media coverage and pressure from advocacy groups, further harming their chances of re-election.

The benefits of repealing or amending the Affordable Care Act include cost reduction, improving access to care and supporting employers. Cost reduction meaning that insurance premiums can be reduced and reducing Medicaid expansion could mean lowering federal healthcare spending. Improving access to care means more choices for consumers, which will improve the overall health of Americans. Lastly by amending ACA employers could have improved support. Employers with more than fifty employees are required to provide health insurance for their employers which could really burden many businesses. Making changes to the ACA could really lighten that burden and in return create more jobs for more people.

Legislators who prioritize their re-election prospects will likely consider, voter demographics and the political climate. In terms of demographics legislators look to see if their district or state has a large number of voters who benefit from the Affordable Care Act, depending on the area in which there in this could cause hesitation in supporting a repeal. If repeal efforts are unpopular in that time, then legislators may shift their stance to avoid backlash.

An analysis of voter views plays a crucial role in legislative leader decisions on recommending or positioning national policies. Legislative leaders look closely at public opinions and gauge where voters stand on various issues. If polls are showing that the majority of voters are in support for example of the Affordable Care Act, then they are less likely to push for a full repeal. These leaders tend to position their policies in a way that reflects what the voters may be looking for. An example could be that voters are complaining of high healthcare costs. Legislators may propose reforms or improvements to the ACA rather than a full repeal. These leaders want to present themselves in such a way that is appealing to the voter. They will look at the bigger picture and decide what approach will be best to sway voters in their direction.

In conclusion legislators’ cost-benefit analysis in terms of re-election heavily influences their decisions in the healthcare reform. Similarly legislative leaders carefully consider voter views when positioning national policies, using public opinion to navigate the political landscape so that they can maintain support from both their base and swing voters.

References

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

House, W. (2023a, 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/

Kulachai, W., Lerdtomornsakul, U., & Homyamyen, P. (2023). Factors Influencing Voting Decision: A Comprehensive Literature Review. Social Sciences, 12(9), 469. https://doi.org/10.3390/socsci12090469

Legislative decisions regarding the Affordable Care Act and reelection 

                In March 2010, President Obama signed the Affordable Care Act into law to provide improved access to affordable health insurance coverage to everyone and protect those same people from unfavorable practices by insurance companies. Since being enacted into law, the Affordable Care Act has remained a point of contention between partisan parties, with the political divide to repeal, replace, or update only growing larger over time. This partisanship gap growth divide continues to be the strongest determinant of the overall opinion of the ACA (Brodie et al. 2020). Because of this substantial partisan and political divide, legislators seeking reelection must be more cognizant than ever of where their constituents’ views, beliefs, and needs lie. Thus, there is a need for legislators to conduct a cost-benefit analysis to determine political career viability in either supporting or opposing healthcare reforms such as repealing, replacing, or updating the Affordable Care Act. Repealing or replacing the ACA could affect many voters directly with the possible loss of healthcare benefits such as subsidies for insurance and protections for preexisting conditions. This could lead to potential backlash from voters and thus jeopardize reelection. Meanwhile, continued support for the ACA or updates to the ACA help legislators seeking reelection align with specific political party stances on healthcare, which allows for campaign support, endorsements, and funding from other legislators or party leaders. Therefore, it is imperative for legislators seeking re-election to balance party views with constituent concerns when supporting or opposing healthcare reform. 

             When positioning themselves on policies that affect the nation, legislators must use the cost-benefit analysis and be attuned to the constituents’ views. Medicare and Medicaid, for example, if many in the constituency depend on these government-based plans, decisions that have a negative impact are more likely to be opposed. Voter views and dependency create a strong motivation for protecting these plans, ensuring continued voter support in upcoming elections. According to McIntyre et al 2022, in terms of satisfaction with their own experiences with healthcare, people who want to keep the ACA are more like people who are in favor of replacing the ACA with a state-based option than those who prefer Medicare for all.  Legislators must also be flexible, as voter views can change over time, causing the need to adjust the political position or risk losing voter support and, thus, the reelection. Therefore, legislators seeking reelection need to find a balance of not only aligning with their political party views and goals but also ensuring that constituent views and concerns on policies affecting the nation are addressed to ensure continued political viability.  

 References

Pacheco J, & Maltby E. (2019). Trends in state-level opinions toward the Affordable Care Act. Journal of Health Politics, Policy and Law, 44(5), 737–764. https://doi.org/10.1215/03616878-7611635 

Brodie, M., Hamel, E. C., Kirzinger, A., & Altman, D. E. (2020). The past, present, and possible future of public opinion on the ACA. Health Affairs (Project Hope), 39(3), 462–470. https://doi.org/10.1377/hlthaff.2019.01420 

McIntyre, A., Blendon, R. J., Benson, J. M., Findling, M. G., & Schneider, E. C. (2020). The Affordable Care Act’s missing consensus: values, attitudes, and experiences associated with competing health reform preferences. Journal of Health Politics, Policy & Law, 45(5), 729–755. https://doi.org/10.1215/03616878-8543222 

The Affordable Care Act was a health care program, created by the Obama administration in 2010. The primary goal was to “achieve universal health insurance coverage by facilitating cooperation among employers, citizens, and the government.” (Isola & Reddivari, 2023) They wanted everyone to access affordable healthcare while reducing unnecessary spending and advocating for primary care. While this is beneficial, some are against this because they feel they have been forced to have insurance they don’t want or feel they don’t need.

When talking about lawmakers either taking away or “fixing” healthcare acts such as the ACA, I thought the “Iron Triangle of Health Care” was a good read. It breaks down as cost of care, quality of care, and access to care. The model represents relationships amongst each other and how when one area is affected, the others will be affected, and a “tilt” effect will happen. When I consider all that comes into play when legislation needs to change a healthcare model, I know it cannot be easy, or cheap. The cost of running for legislation can be expensive and many need to fundraise to obtain the funds needed for election. This means those running need to be in favor of the public eye to gain attention and votes. When a legislature changes a bill or healthcare act, they need to consider who is voting for them. They tend to turn more toward higher socioeconomic backgrounds for more monetary donations. In the case of the ACA, it has been scrutinized more by the republican party, so a legislature with a republican following must think about what they can do to make the republican party look at the act without turning it away automatically. This goes for the democratic party as well.

“Medicare and Medicaid are publicly funded social entitlement programs and are the “third rail” of healthcare politics.” (Short, 2022, p 239) These programs are available for everyone, regardless of government funding and spending. If a governing body is not spending money appropriately there might not be enough funds for services such as Medicare and Medicaid. If one’s services are not provided by their insurance company, the family has a right to sue which could lead to more financial difficulty for the governing body.

Depending on what is wanted and needed at that time during election time, the legislation will focus heavily on that. If there is a specific bill that they notice taxpayers aren’t happy about they will change it according to what will make them the happiest. I feel that many in government have a “do something, then ask for forgiveness later” policy. That usually keeps everyone on their toes.

References:

Isola, S., & Reddivari, A. (2023, July 10). Affordable Care Act. NIH. https://www.ncbi.nlm.nih.gov/books/NBK549767/

Persson, M. (2021, December). From opinions to policies: Examining the links between citizens, representatives, and policy change. Science Direct – Elsevier. (https://doi.org/10.1016/j.electstud.2021.102413).

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

Cost for Legislators Repealing the ACA

Cost-Benefit Analysis

In 2010, the Affordable Care Act (ACA) was placed into legislation in hopes to benefit millions of Americans without health insurance or to make those with pre existing health insurance coverages more affordable. The ACA established a “healthcare marketplace” where consumers could shop and compare coverage and cost that would most benefit the individual and their families. The ACA also aided in repairing the effects of  Americans socioeconomic status by efforts like expanding medicaid coverage to families with incomes up to 138% above the poverty level, and covering preventive health services like immunizations and health screening to improve health outcomes in individuals (Levine et al., 2022). It is apparent that every president that wants to remain in office will attempt to reform and exclude policies and practices that they feel do not best benefit the population. Upon assuming office, the former President Trump opposed the Affordable Care Act (ACA) and attempted to repeal it by enacting new laws aimed at increasing employment opportunities and lowering taxes, thus nullifying the law’s requirement that every American obtain health insurance. (Aron-Dine,2019). According to Collier (2017) this would come with a cost for Americans, particularly those with Medicaid, where it would cut “$880 billion from Medicaid over a decade, and would eventually cost 53 million Americans their health insurance, including 14 million in the first year”. This is one of the reasons many citizens, including those of the former President’s republican party, became unsupportive of this attempted policy reform (Collier, 2017).

 Analyses of the voters’ views

Consumer satisfaction and the benefits of laws and policies must be maintained for legislation to be favorable for reelection. Legislators prioritize implementing crucial health coverages like Medicaid and affordable insurance because they want to concentrate on what is best for the public and how they can put it into practice. It would be advantageous for the policy maker to modify their plans and strategies in order to maintain support if modifications and fresh ideas are not welcomed by the electorate. The number of insured coverers did decrease as the Trump Administration attempted to undermine the Affordable Care Act, leading to consumer and political reaction when the party broke its pledges (Ortiliza and Cox, 2024). In response to voter needs, the Biden Administration strengthened its support for the Affordable Care Act (ACA), and between 2000 and 2024, the number of those covered under the ACA increased once more (Ortiliza and Cox, 2024). The Congressional Record (2023) reported, “over 16 million Americans signed up for health coverage under the Affordable Care Act. That is about a 100-percent increase from the first year’s enrollment in 2014”. This strengthens my belief that legislators recognize the value of hearing concerns and taking appropriate responses. The varying levels of support for the Affordable Care Act alone, during several administrations, indicate that lawmakers must retain voter expectations and adjust policies to satisfy them in order to win reelection.

References

Aron-Dine, A. (2019, February 6). Impact of the administration’s policies affecting the Affordable Care Act. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/impact-of-the-administrations-policies-affecting-the-affordable-care-act

Collier R. Why Trumpcare failed. CMAJ. 2017 May 1;189(17):E645-E646. doi: 10.1503/cmaj.1095414. PMID: 28461382; PMCID: PMC5415398.

Congressional Record. (2023, February 1). https://www.congress.gov/congressional-record/volume-169/issue-21/senate-section/article/S188-2

Levine, D. M., Chalasani, R., Linder, J., & Landon, B. (2022, June 17). Association of the ACA with ambulatory quality, patient experience, utilization, and cost, 2014-2016. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793491

Ortaliza, J. & Cox, C., The Affordable Care Act 101. In Altman, Drew (Editor), Health Policy 101, (KFF, July 2024) https://www.kff.org/health-policy-101-the-affordable-care-act/ (09, September 2024).

          Whether big or small, each decision should be accompanied by a pros and cons list. The weight, rewards, and consequences that influence individuals toward one choice rather than another have a detrimental effect on the result or the reason for the decision (Short, 2022). This ideation affects every realm of society, especially healthcare and politics. When the decisions being made involve the combination of healthcare and politics, in-depth analysis must be involved. These two entities affect more than just one person; they affect populations of citizens and multiple large corporations, resulting in a tedious process often seen in healthcare reform and policymaking (Short, 2022). The Affordable Care Act (ACA) has been at the forefront of healthcare reform for over a decade because many consider it ethically and financially controversial. This allowed politicians to leverage whichever side voters were on to gain voters’ support through different types of analysis. Two types of analysis that appealed to voters who were against the ACA were cost-benefit analysis and analyzing voters’ views.

Cost Benefit Analysis of The Affordable Care Act (ACA)

Reviewing whether the ACA makes sense from the business perspective through cost-benefit analysis demonstrated that large insurance corporations and many physicians were losing money because they had to provide insurance and care to individuals who would have previously been denied health insurance due to pre-existing conditions, ultimately increasing access to healthcare (Glied et al., 2020). The increased access was not financially favorable to insurance companies, who had to raise their acceptance rates under the ACA. After all, they were spending more money to cover the healthcare costs of sicker, chronically ill people who, without the ACA, typically would not qualify. The ACA increased access to those of low socioeconomic status with expanded Medicaid coverage, employee-based plans, and insurance market reforms but indirectly affected middle- and upper-class Americans, especially those with children, and had an intended effect on large insurance corporations (Wisk et al., 2020). The unintended impact it had on middle and upper-class Americans was that insurance companies were increasing their premiums to offset the increased payouts made by insurance companies to care for individuals who would not have qualified for coverage (Wisk et al., 2020). While the cost curve decreased on the expenditures by the government reduced, the pendulum swung the other way for everyday Americans (Buntin & Graves, 2020). A cost-benefit analysis of the ACA revealed that while more individuals had access, insurance companies and healthcare providers penalized others to compensate and maintain their revenue. Many Americans were unhappy about this, and if you were a politician trying to get reelected or elected, campaigning to repeal or replace the ACA would benefit their outcomes (Glied et al., 2020).

Voters’ View Analysis and Influence

A politician’s position regarding issues that affect the citizens they serve can make or break their political career and chances of being in office. Appealing to the emotional energy of the masses often results in victory. Politicians know this and are supported by statistical data when they survey their citizens on specific issues. These surveys not only drive their campaign but also legislation once elected. In 2016, approximately 46% of Americans found the ACA unfavorable, 43% favorable, and 11% unsure about its effectiveness (Vankar, 2023). Analyzing this data shows that approximately 46% of the votes in America can be obtained just by being against the ACA, and a potential 11% can be influenced (Vankar, 2023). President Donald Trump, a presidential candidate then, opposed the ACA. Looking back at the election results supports an analysis of voters’ views on campaigning and legislative decisions.

Conclusion

Understanding legislation’s overall effect on its citizens requires logical, evidence-based research (Short, 2022). Research coupled with public influence creates unintended bias, especially if another agenda is at play (Short, 2022). This ulterior agenda can include election, reelection, or financial gain that benefits. one individual over another. This was evident when discussing the viewpoints of the ACA.

References

Buntin, M. B., & Graves, J. A. (2020). How the ACA dented the cost curve. Health Affairs, 39(3), 403–412. https://doi.org/10.1377/hlthaff.2019.01478

Glied, S. A., Collins, S. R., & Lin, S. (2020). Did the ACA lower Americans’ financial barriers to health care? Health Affairs, 39(3), 379–386. https://doi.org/10.1377/hlthaff.2019.01448

Short, N. M. (2022). Milstead’s Health Policy & Politics (7th ed.). Jones & Bartlett Learning. https://mbsdirect.vitalsource.com/books/9781284238723

Vankar, P. (2023, April 20). Public view on ACA U.S. 2010-2023. Statista. https://www.statista.com/statistics/246901/opinion-on-the-health-reform-law-in-the-united-states/

Wisk, L. E., Peltz, A., & Galbraith, A. A. (2020). Changes in health care–related financial burden for us families with children associated with the Affordable Care Act. JAMA Pediatrics, 174(11), 1032. https://doi.org/10.1001/jamapediatrics.2020.3973

The connection between a legislator’s desire for re-election and their decision-making process, especially about attempts to repeal or replace the ACA, is a crucial illustration of how political interests intersect with healthcare policy. Legislators at the federal or state level often assess the costs and benefits of their actions while considering how those decisions will affect their re-election chances. This cost-benefit analysis involves taking into account the opinions of their constituents and the financial support from interest groups, as the primary goal of a legislator is to secure re-election (Short, 2022, pp. 97-117).

Repeal and Replace Efforts and Political Considerations

The influence of interest groups has significantly shaped the efforts to repeal or replace the ACA. This was evident in multiple legislative attempts after the ACA was passed in 2010. For instance, Republican legislators made the repeal of the ACA a central part of their platform, particularly during the 2016 election cycle, which led to Donald Trump’s election. The commitment to repeal or replace the ACA was driven by the belief that this position would attract significant support from conservative voters and financial support from interest groups such as health insurers and business associations. With their considerable economic and lobbying power, these groups opposed specific ACA provisions, such as the individual and employer mandates (Congress.gov, n.d.).

However, when it came time to vote on repeal or replacement bills, many legislators hesitated or reversed their positions. This was partly due to a shift in public opinion. While some voters supported repealing the ACA, a growing number, including a significant portion of moderate voters and independents, became concerned about the potential loss of coverage for millions of Americans. Key elements of the ACA, such as protection for individuals with pre-existing conditions and the expansion of Medicaid, have become popular even in traditionally conservative states. Legislators from these states had to weigh the political cost of stripping away healthcare coverage from their constituents, which could result in an electoral backlash (Short, 2022, pp. 97-117). This dilemma showcases how the cost-benefit analysis regarding re-election can impact legislative efforts and underscores the power of public opinion in shaping healthcare policy.

Voter Views and Legislative Decision-Making

The voters’ opinions play a significant role in influencing legislators’ actions. Legislators must balance the preferences of their voting base with the need to secure campaign donations from influential interest groups. For instance, efforts to repeal the ACA faced opposition from voters who had gained insurance through the law and healthcare providers, hospitals, and other stakeholders who benefited from the increased coverage. Therefore, legislators must consider the potential negative consequences of alienating these groups, which could jeopardize votes and financial support. This delicate balancing act, where legislators must navigate between voter preferences and interest group influence, is a crucial aspect of legislative decision-making in the healthcare policy arena (Taylor et al., 2017).

A similar pattern can be seen in Medicare and Medicaid policies. While cutting these programs may fit with specific political or financial priorities, especially among more conservative lawmakers, such cuts can also lead to an adverse reaction from voters, particularly among seniors and low-income individuals who depend on these programs. Lawmakers are keenly aware that voters are sensitive to policies that directly impact their access to healthcare. This makes it risky to pursue changes that would reduce benefits or increase costs for constituents (Short, 2022, pp.239-249).

Legislative leaders must consider policy preferences and political strategy when supporting or opposing healthcare initiatives. If a policy is unpopular with their constituents or key stakeholders, it could threaten their re-election. Therefore, legislative leaders often prioritize positioning national policies to minimize political risk while still achieving their goals. This can involve framing healthcare reforms to protect popular aspects of programs like Medicare and Medicaid while also aiming to introduce more market-based reforms in other areas. The potential electoral backlash from unpopular healthcare policies underscores the influence of political risk on legislative decisions.

 References:

Congress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

Short, N.M. (2022). Milstead’s Health Policy and Politics: A Nurse’s Guide (7th 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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Cost-Benefit Analysis of ACA Repeal/Replace Efforts

In the case of legislators, the cost-benefit analysis may have been heavily based on how their position on the efforts to repeal or replace the ACA would affect their chances of being re-elected. It could be politically profitable to support the ACA repeal as it would be in line with the electorate’s negative attitude towards the law evaluating Republican legislators in conservative districts. These legislators could paint attempts at repeal as being in line with the campaign promises and as responding to the abuses of power. On the other hand, the Democrats and some moderate Republicans in the swing districts probably saw the defense of the ACA as being more beneficial in terms of their political interests. When the ACA helped millions of people get health insurance, voting to repeal without a plan B would put those who benefited from the law in the crosshairs. Other considerations that influenced the legislators included the possibility of losing the provisions that were popular among the public, such as provisions that protect those with pre-existing conditions. The inability to repeal has demonstrated that many legislators decided that the political costs exceeded any probable advantages. When repeal bills were introduced, it was clear that the public support for the ACA was increasing. Therefore, more lawmakers probably realized that voting for the repeal could be costly in the next election.

Impact of Voter Views on National Healthcare Policy Decisions

Concerning how voters’ perception influences legislative leaders on national health policies, the role of public opinion must be emphasized. Party leaders face the dilemma of ideological position and political realities (United et al., 2018). For instance, although there are Republican lawmakers who philosophically cannot support the enlargement of government involvement in health care, there is much political price for going after programs such as Medicare or Medicaid. When developing healthcare legislation, legislative leaders are very attentive to polling information and their constituents’ opinions (Taylor et al., 2017). Suppose the voters are very supportive of maintaining or even increasing some aspects of Medicare/Medicaid. In that case, the leaders will not want to take extreme stances for fear of facing the voters’ wrath. If data reveal that voters are worried about the costs or the financial viability of these programs, leaders may feel free to advance bolder reforms (Milstead, 2023). Party bosses, therefore, seek to satisfy their party’s hard-core supporters while at the same time wooing the swing voters. On key healthcare issues such as Medicare/Medicaid, their policy positioning is an art of walking a tightrope – promoting their party’s general partisan objectives without committing the ‘ungodly sin’ of making politically suicidal moves that endanger their majority or the re-election of key party members.

References

Milstead, J. A. (2023). Health policy and politics: A nurse’s guide. Jones & Bartlett Learning.

Taylor, D., Olshansky, E. F., Woods, N. F., 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 (2017) 242–245]. Nursing Outlook, 65(3), 346-350. https://www.nursingoutlook.org/article/S0029-6554(17)30262-2/pdf

United States SenateLinks to an external site. (n.d.). Retrieved September 20, 2018, from https://www.senate.gov/

BreAnn Norris

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Cost-Benefit Analysis

            The Affordable Care Act (ACA) remains a prime topic in politics today. “The main components of ACA were the expansion of Medicaid, changes in private (commercial) insurance coverage, and the introduction of the individual mandate” (LaFontaine, P.R., Vogenberg, F.R., & Pizzi, L.T., 2019). The ACA was initiated during the Obama presidency and was altered during the Trump presidency. Although the ACA’s main goal was to make healthcare more affordable, this came at a cost. According to LaFontaine et al. (2019), Medicaid expansion caused states to suffer financially, and the individual mandate repeal caused health insurance premiums to increase.

Voter View Analyses

Legislators’ goals are to be reelected. According to Short (2022), quality healthcare access for all is what the politicians want the voters to think. Since the goal is to be reelected, legislators are more likely to support the stance of most voters. Per Courtemanche et al. (2020), the debate concerning the ACA may increase the number of uninsured voters that typically do not vote. All in all, legislators’ objective is to gain votes and this is directly affected by their stance on topics such as the ACA.

References

Courtemanche, C., Marton, J., & Yelowitz, A.  (2020). The full impact of the Affordable Care Act on political participation. The Russell Sage Foundation Journal of the Social Sciences, 6(2), pp. 179-204. https://doi.org/10.7758/RSF.2020.6.2.08

LaFontaine, P.R., Vogenberg, F.R., & Pizzi, L.T. (2019). From then until now: A top-down view of the Affordable Care Act. P & T: A Peer-Reviewed Journal for Formulary Management, 44(8), pp. 467-493. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679949/

Short, N. M. (2022). Financing health care. Milstead’s health policy and politics: A nurse’s guide (7th ed., pp. 239-249). Jones & Bartlett Learning.

                                                    Cost-Benefit Analysis to Repeal/Replace the Affordable Care Act

Regarding legislators being reelected, the cost-benefit analysis changed regarding efforts to replace/repeal the Affordable Care Act (ACA). With potential backlash from their constituents, many legislators were concerned about what would happen if they supported a repeal without a suitable replacement. Facing potential electoral consequences, and fear of losing voter support influence made many legislators cautious and determined in their approach to altering ACA. Their decision-making process factored into maintaining their political positions to be reelected.  As a result, the cost-benefit analysis of being reelected plays a role in shaping the approach and decisions of legislators regarding the Affordable Care Act. ” While few question the desirability of extending healthcare to all Americans and make it affordable, attempts to do so are politically tricky and divisive, as ACA demonstrates. Yet it can be done if all players join together and contribute their share in developing an equitable and affordable universal health system that, contrary to the present one, would enable all Americans to exercise their unalienable right to life, liberty, and the pursuit of happiness instead a being driven into bankruptcy by medical bills” (Faguet, Guy).

                                                                    Voters Analysis and Legislation Decision-Making

Who benefits the most when it comes to policy formulation? During its implementation, you must ensure the intended beneficiaries are not marginalized or overlooked. The general public, marginalized communities, and specific industries may be impacted differently regarding policy decisions. It is important when making decisions to carefully consider the potential inequalities that may arise and the distribution of benefits. When concluding an analysis, it helps to ensure that policies are inclusive, effective, and fair. When policy is developed, it’s important to take into consideration who benefits the most, especially when it comes to a policy implementation such as the Affordable Care Act(ACA). “Upon his election, President Obama made health care reform the centerpiece of his agenda during his first year”(Auerbach, M. P. (2019). The Affordable Care Act, also known as Obamacare, aimed to benefit several groups of people. The Affordable Care Act (ACA), nicknamed Obamacare after the former president of the United States, Barack Obama, as a form of policy branding (Busby & Cronshaw, (2015). The ACA is to benefit individuals who couldn’t afford or qualify for health insurance, or people who were denied coverage because of pre-existing conditions. ACA is to improve access to affordable health care for these individuals and provide protection and benefits for all Americans. This policy will positively change insurance companies, healthcare providers, and healthcare systems overall. Young Adults benefit from ACA because they are allowed to stay on their parent’s healthcare insurance until they are 26. ACA supports small businesses by providing tax credits to help cover health insurance costs to their employees. ACA further benefits low-income families and individuals by expanding Medicaid eligibility in participating states. The Affordable Care Act improved access and affordable healthcare for millions of Americans.

References:

Faguet, Guy. Affordable Care Act : A Missed Opportunity, A Better Way Forward, Algora Publishing, 2013. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=1363733.

Auerbach, M. P. (2019). Patient Protection and Affordable Care Act: Overview. Salem Press Encyclopedia.Lappeman, J., Goder,

A.,Lappeman, J., Goder, A., Naicker, K., Faruki, H., & Gordon, P. (2023). Using Sentiment Analysis to Understand Public Policy Nicknames: Obamacare and the Affordable Care Act. Journal of Nonprofit & Public Sector Marketing, 36(3), 347–363. https://doi.org/10.1080/10495142.2023.2178588

Busby, R., & Cronshaw, S. (2015). Political branding: The tea party and its use of participation branding. Journal of Political Marketing, 14(1–2), 96–110. https://doi.org/10.1080/15377857.2014.990850