My colleague Sara,

I liked your post on The Affordable Care Act. Yes, many low-income families would have died or struggled to pay medical bills without health care coverage. Thanks to   President Barack Obama’s plan. The Affordable Care Act was signed into law on March 23, 2010. The Affordable Care Act created great peace for many American families, dealing with several underlying medical conditions.  This comprehensive health plan has implemented a change in how Americans receive health care.  Insurance companies now can no longer deny low incomes families, the elderly, and people living with debilitating conditions such as HIV and AIDs insurance coverage. I agreed with you Sara 100%, for example, children born to low incomes mothers should not be denied health care coverage due to the lifestyles of their parents.   The elderly population should not be denied prescription drug coverage for any chronic conditions that he or they have been dealing with for decades.  The Affordable Care Act will ensure a sense of security, and stability for low-income Americans.

The Cost-benefit analysis helps lawmakers determine the effects of The Affordable Care Act. According to (CDC, 2020) The Centers for Disease Control and Prevention supports the affordable care act. More healthcare centers are open, and patients can now receive the healthcare needed to live longer. This gives more access to patient wellness such as early health screenings for certain cancers, HIV/AIDS, and STD screening without coming out of pocket. In my hospital, Kaiser Permanente, California I have seen an increasing number of patients coming in for healthcare screening such as wellness exams, blood pressure, and diabetes screening.

The Department of Human Health uses The Affordable Care Act to expand and strengthen cultural competency training for all healthcare workers to provide more equality that will reduce healthcare disparities.

52% of registered voters supported the affordable care act. In August 2022 President Joe Biden signed into law The Inflation Reduction Act to extend plans to support the affordable care act.

References:

Centers for Disease Control and Prevention. (2010. March 23). The Affordable Care Act

Care act. policy and laws.

HTTPS:// www.cdc.gov.policies.acaLinks to an external site.

Census. Bureau. (gov). 2022

https:// www.healthline.comLinks to an external site. health

The Republican party has largely opposed the passing of the Affordable Care Act (ACA) from the time of its inception to present times. “From January to December of 2011, the (Republican controlled 112^th Congress) House voted on ACA changes or repeals 24 times (Williams & Anderson, 2020),” even going so far as “declining to fund the federal government unless the implementation of the ACA was delayed (Williams & Anderson, 2020)” in 2013. Because there has been such staunch opposition to the ACA from Republican politicians, repealing or replacing the ACA has now become part of the Republican party’s platform and a core political position for many Republican politicians who seek re-election, although repealing or even simply replacing aspects of the ACA would have a significant impact on the availability of affordable healthcare for many of their constituents and would cost the federal government millions. Even simply removing the Medicaid expansion package from the ACA or decreasing federal funding for Medicaid would have a significant impact on healthcare coverage and access to healthcare for people of color (Williams & Anderson, 2020), and a full repeal of the ACA would cost the federal government an estimated $350 billion through 2027 (Committee for Responsible Federal Budget, 2017).

Because fully repealing the ACA will have a significant impact on healthcare coverage and access to healthcare for millions of potential voters, many Republican lawmakers have openly opposed only certain aspects of the ACA, while advocating for either ACA reform or replacement rather than full repeal to not damage their chances of re-election while still staying within their party’s political platform guidelines.

Committee for Responsible Federal Budget (2017). The cost of full repeal of the affordable care act. Retrieved December 14, 2022 from https://www.crfb.org/papers/cost-full-repeal-affordable-care-act

McDonough, J. E. (2017). Health and taxes and the values at stake in the aca debate. Milbank Quarterly, 95(2), 237–240. https://doi.org/10.1111/1468-0009.12251

Williams, N. D., & Anderson, E. A. (2020). A critique of repealing the affordable care act: implications for queer people of color. Analyses of Social Issues & Public Policy, 20(1), 195–210. https://doi.org/10.1111/asap.12197Links to an external site.

Health insurance in the United States is a misnomer: What we are actually purchasing is sickness insurance (Milstead & Short, 2019). Like other forms of insurance, health insurance is a form of collectivism in which people pool their risks – in this case, the risk of incurring medical expenses (Milstead & Short, 2019). The health insurance mandate in the Affordable Care Act (ACA) provided for the enlargement and balance of the risk pool (Milstead & Short, 2019). Without the option to refuse to cover preexisting conditions the insurance market would collapse: in 2017, many insurers pulled out of the Health Insurance Exchanges because of uncertainty about the continuation of the mandate (Milstead & Short, 2019). Congress and the Trump administration were engaging in a debate over how to “repeal, replace, repair, or starve” healthcare finance in the United States (Milstead & Short, 2019). The American public is strongly divided about how to finance health care in the country (Milstead & Short, 2019).

The realization (for better or worse) that policymakers are not necessarily focused on how real people will be affected by changes to Obamacare or Medicare and Medicaid but rather on how the changes will affect their own re-election chances (Milstead & Short, 2019). For example, political interference in sexual and reproductive health research and health professional education threatens the health of women and men (Taylor et al., 2017). While some may find this focus disturbing, it demonstrates not just that elections results do matter but also that even the threat of an upcoming election cycle affects what policymakers are willing or able to do (Milstead & Short, 2019). Timing is everything (Milstead & Short, 2019).

Awareness can be used in developing strategies for appealing to what really matters to policymakers (Milstead & Short, 2019). Deciding which of several policy options will lead to the greatest benefits and the fewest costs, in a world where re-election is a key consideration and media are a relentless presence, means the best solution may not be the path ultimately chosen (Milstead & Short, 2019).

References

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

Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook, 65(2), 346–350

Politics and the Patient Protection and Affordable Care Act

Based on the shared goals of the legislators recently elected into congress, there have not been efforts to repeal or replace the Affordable Care Act (ACA) but to “protect and build on” the act instead (Unknown, 2020, para 8). Current President, Joe Biden, started his presidency with plans to strengthen the ACA by closing loopholes that allow the rich to avoid taxes on capital gains (Unknown, 2020). Instead, people making over $1 million will pay the top rate on capital gains and double their typical tax rate on possessions such as their assets (Unknown, 2020). Overall, by taxing the rich, President Biden hopes to strengthen the ACA by doing things such as; lowering healthcare premiums and out-of-pocket costs, easing the enrollment of affordable coverage, expanding Medicaid services in remaining states, improving home care for older Americans and Americans with disabilities, introducing new options for people with a mental health crisis, and extending postpartum coverage during the first year after delivery (The United States Government, 2022).

The voter’s view can significantly influence the decisions of legislative leaders. According to Figure 10-3 in the text Health Policy and Politics, the views on repealing the ACA were split almost evenly, with 45% saying they should vote to repeal, 51% saying they should not vote to repeal, and 6% undecided or refused to answer (Milstead & Short, 2017). With this being said, the voters who share their views also vote for each legislator’s re-election. To analyze further, each legislator can research the majority’s view regarding Medicare and Medicaid. For example, suppose most voters would feel they would benefit from Medicare or Medicaid changes. In that case, the legislator should feel the need to represent those changes to impress the voters.

References

Unknown. (2020). Plan to protect and build on Obamacare. Democratic National Committee. Joe Biden for President: Official Campaign

Website. https://joebiden.com/healthcare/#

The United States Government. (2022). Fact sheet: Biden Harris Administration proposes rule to fix “Family glitch” and Lower Health Care Costs.

The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2022/04/05/fact-sheet-biden-harris-administration

-proposes-rule-to-fix-family-glitch-and-lower-health-care-costs/

Milstead & Short. Health Policy and Politics (6th ed.). Jones & Bartlett Learning. https://mbsdirect.vitalsource.com/books/9781284155235

Affordable Care Act Winners and Losers

The Affordable Care Act is a comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”).

The law has three primary goals:

• Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty levelLinks to an external site. (FPL).
  • If your income is above 400% FPL, you may still qualify for the premium tax credit in 2022.
  • If your income is at or below 150% FPL, you may qualify to enroll in or change Marketplace coverage through a Special Enrollment PeriodLinks to an external site..
• Expand the Medicaid programLinks to an external site. to cover all adults with income below 138% of the FPL. (Not all states have expanded their Medicaid programs.)
• Support innovative medical care delivery methods designed to lower health care costs generally (HHS, 2022).

When it comes to reelection, many campaigns’ cost-benefit analyses depend on the success of either replacing or repealing Obama care. Many Republicans, for instance, look to pull back the affordable care act as they believe it is an overreach of power from the government (Hollingsworth et al., 2019). On the flip side, the democrats, when supporting Obama care, felt that there was a lack of coverage for Americans seeking treatment that could not afford it. To completely pull back healthcare coverage that the ACA has provided to many Americans would not be a popular position; I do not see that happening in future administrations, considering it would affect many.

Voter decisions and views directly impact legislation; to move legislation forward, one has to have the support of their constituents. Depending on the demographic and needs of the voter, those running have to ensure they can meet their needs. Those on Medicare and Medicaid will rely heavily on the government for their care. Legislators have to consider those individuals’ needs to secure their votes.

Hollingsworth, A., Soni, A., Carroll, A. E., Cawley, J., & Simon, K. (2019). Gains in health insurance coverage explain variation in Democratic vote share in the 2008-2016 presidential elections. PloS one, 14(4), e0214206.

U.S. Department of health and human services. (2022, March 17). About the affordable care act. HHS.gov. Retrieved December 13, 2022, from www.hhs.gov

When discussing cost-benefit analysis in regard to legislators, the cost of supporting or opposing policies can either aid a legislator in gaining votes or losing votes which in turn will hinder their likelihood of being re-elected. America is politically divided by two main parties, Republicans and Democrats, that being said in the last two decades opposition between the parties is more widespread than it has ever been (Pew Research Center, 2014). Since the political parties are increasingly polarized and hostile in their conflicting views this makes it even more difficult for politicians to please the public. Legislators must weigh what their constituents want when taking their own political stance, but also must interpret how it will likely affect their political standing.

The Affordable Care Act (ACA) otherwise known as Obamacare is a perfect example of division among the American people. The ACA was signed into law on March 23, 2010 and has three main goals. First, to provide affordable health care to more Americans by providing individuals with subsidies that decrease health insurance premiums especially for those in the middle- and lower-income classes (HealthCare.gov, n.d.). Second, the ACA aims to grow Medicaid so that adults with an income 138% below the federal poverty line would be covered and lastly the law encourages change in the way medical decisions are made by lowering healthcare costs in general (HealthCare.gov, n.d.).

Through the ACA, uninsured rates fell from 18% to 13.4% in roughly one year (Dalen et al., 2015). Obamacare has faced public scrutiny and multiple attempts have been made to repeal and replace the act. Ultimately, the public was divided according to a survey coordinated by the Pew Research Center (2012), that found “48% of the general public disapprove of the 2010 Affordable Care Act, while 43% approve” (para. 2). The public is almost evenly split on their views of the ACA which makes the decision for legislators difficult in whether or not they should support the act in its entirety or repeal and replace. Most notable in trying to reconcile the ACA is the American Health Care Act of 2017 (AHCA), proposed by the House Republicans and fully endorsed by Trump which would dismantle the ACA’s premiums and penalties and instead of generalized healthcare for all the AHCA would put more control into the states which would end up in Americans having to expend more money for chronic or pre-existing conditions (Ballotpedia, n.d.). Many Americans would argue that the power given to the states is justified and since it would cut taxes on the middle and upper class this would be a discernible win; however, the AHCA cuts to just Medicaid would end up in 14 million Americans losing health insurance (Nadash et al., 2018). This would greatly affect poverty stricken older adults and those that are no longer able to work because of health-related issues or other reasons, thus this a large portion of the country that would be against and/or wary of repealing or replacing the ACA.

Overall, the role of a legislator is not an easy undertaking, and there will constantly be voters for and against their decisions. Voters will support who they feel will best represent their morals and views and impact political changes in favor of their opinions. Legislators will support policies that they feel constituents want which in turn will aid them in being re-elected in the long run.

References

Ballotpedia. (n.d.). Obamacare overview. Retrieved December 9, 2022, from https://ballotpedia.org/Obamacare_overview

Dalen, J. E., Waterbrook, K., & Alpert, J. S. (2015). Why do so many Americans oppose the Affordable Care Act? The American Journal of Medicine, 128(8), 807-810. https://doi.org/10.1016/j.amjmed.2015.01.032

HealthCare.gov (n.d.). Affordable Care Act (ACA). Retrieved December 9, 2022, from https://www.healthcare.gov/glossary/affordable-care-act/

Nadash, P., Miller, E. A., Jones, D. K., Gusmano, M. K., & Rosenbaum, S. (2018). A series of unfortunate events: implications of Republican efforts to repeal and replace the Affordable Care Act for older adults. Journal of Aging & Social Policy, 30(3-4), 259-281. https://doi.org/10.1080/08959420.2018.1462683

Pew Research Center. (2012). Obama health care law: Where does the public stand? Retrieved December 9, 2022, from https://www.pewresearch.org/politics/2012/06/15/obama-health-care-law-where-does-the-public-stand/

Pew Research Center. (2014). Political polarization in the American public. Retrieved December 14, 2022, from https://www.pewresearch.org/politics/2014/06/12/political-polarization-in-the-american-public