Cost-Benefit Analysis and Legislator’s Reelection
The cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the Affordable Care Act in numerous ways. Many variables affect legislative decisions: legislators, constituents, special interest groups, lobbyists, committees, chief executives, legislative aids, and many more (Milstead, 2019). Another complication to the process is if an interest group has enough money to support a legislator to be reelected. In return, that legislator could put the interest group’s views before their views on policy decisions. (Milstead, 2019). Therefore the cost-benefit analysis can be misconstrued by the reelection supporter views (wealthy people or special interest groups) being the main goal is to be reelected (Milstead, 2019).
Nurses bring a valued insight into the healthcare system, allowing them to present what is improving the health of their patients (American Nurses Association, n.d.). A rational nurse can stand behind “the ultimate point in participating in policymaking is to improve patient outcomes.” (Milstead, 2019, p. 39) This conflicts “the realization that policymakers are not necessarily focused on how real people will be affected by the changes to Obamacare or Medicare and Medicaid but rather on how the changes will affect their reelections chances.” (Milstead, 2019, p. 40) Nurses who are passionate about something they would like on the agenda could be overridden by a particular interest group with the funds to support the legislator. The reelection supporter may think in the opposite way of the legislator but will have a voice in the policymaking decision because of their money. It is understandable how nurses are overwhelmed with the policy process being there are many complexities to the equation.
The analyses of voter’s views impact national policies broadly. If the main goal for a legislator is to be reelected, they have to have the votes. This can make the Affordable Care Act and other health care system solutions so tricky. While half of the population wants to leave the Affordable Care Act in place, 19% wants to repeal and replace the Affordable Care Act, and 24% wants to know the replacement plan before the repeal (Milstead 2019). That makes it difficult on when to make healthcare policy moves and how to make them. With 20% of the United States on Medicaid in 2017 and 55.5 million on Medicare in 2015, the voters’ views will immensely impact Congress’s decisions (Milstead, 2019).
On the positive side, if legislators or other government officials were not voted in, they would not consider what the people want or what they believe is best. In that situation, we would have someone making all of our decisions without thinking twice about what the voters think. The Affordable Care Act did not have any republican signatures when it came into place (Laureate Education, 2018). As a result, half of the states (republican lead states) are going against the law (Laureate Education, 2018). All voters’ views must be under consideration because even if a policy is put into place, the other half of the population may stand up against the policy and make it unsuccessful. This is why President Trump should consider changing parts of the Affordable Care Act instead of getting rid of it completely.
References
American Nurses Association (n.d.). Health Policy. https://www.nursingworld.org/practice-policy/health-policy/
Laureate Education (Producer). (2018). Contemporary Issues in Public Health Policy with Joel Teitelbaum [Video file]. Baltimore, MD: Author.
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Working with Legislators Program Transcript
FEMALE SPEAKER: The people who you are talking with in an elective office or their staffs are extremely bright. Having said that, do not assume that they know what you know. That’s what you bring to the table.
[MUSIC PLAYING]
These may be individuals that have never been in the hospital except for the day that they were carried out in their mother’s arms. They may not have had ongoing, extensive exposure to the challenges of the populations you’re serving. So you’re the voice to that. So bright people, but do not underestimate what you bring to that conversation.
FEMALE SPEAKER: I’ve always told students, if you ever go into a legislator’s office and heart conditions are your thing, don’t ever talk about all the CABGs that have been done. That’s a coronary artery bypass graft. They don’t know what a CABG is. They think a CABG is something that looks kind of like a lettuce, only it’s tougher.
We know not to use that kind of terminology with patients. We know not to use it with legislators, even though they may be lawyers and attorneys. They don’t understand medical terminology.
FEMALE SPEAKER: So it’s really important for people that you’re talking to know your background, to know that you’re a registered nurse, that you have a master’s degree, and your specialty is in a particular area. So you’re talking about the population you work for and maybe even where you work. That’s information that they need to know about you, because how they process the rest of what you tell them will be informed and influenced by their knowledge of your background.
So be sure that that’s the first thing you say to them. This is my name. This is what I am. And here’s where I’m from.
It’s really important to have your facts down, and that if there’s a question you’re asked and you don’t know the answer to it, to know that that’s OK, that you do the follow up coming back to them and letting them know, I don’t know the answer to that question. But I’ll be sure to get it for you. And then do it, and do it quickly.
We also should never stretch the truth, deviate from fact. If what we’re sharing is an opinion, we ought to let them know it’s an opinion. Now, I would say it’s an expert opinion, probably, on health care, because of our background. But be able to distinguish, my opinion is this, or based on my experience, this is what I see.
Additionally, it’s so important for us to be members of professional nursing organizations. It’s important, because it’s so challenging these days to stay abreast of the issues, challenges, problems, policies that are resonating at state and federal levels. So I stay in close touch through email communication that I get from the professional associations of which I’m a member. And when they ask me to do something, I act on it.
It doesn’t mean you have to be full-time in health policy to do this. It does mean that on occasion, spending five minutes to read up on an issue and then sending an email consistent with what my professional association is asking me to do, that might be at least as important as what you do for a patient or for family or for a community that day, because engaging there might actually be part of the trigger to get a policymaker to do something different than they may or may not have done otherwise.
FEMALE SPEAKER: It’s fine to disagree. But let’s work on what is going– that we can get done successfully together, though. And that’s been my whole thing with policy, collaboration across parties, working together to get things done.
When we have a disagreement, we disagree without hostility, but we certainly disagree clearly and reinforce our position with data, anecdote, things that will help communicate why we believe so fervently in the importance of a particular piece of legislation, a particular regulation, a particular program or policy.
So you can let them know that their position is not one that you agree with, that you have a different view. And you’d want to give them the information about why your view is different. But a tone of hostility is not helpful.
The other point I’d make is starting with common ground, trying to establish common ground. I know you care deeply about your constituents. I know you care deeply about mothers who are struggling as single parents and who frequently are living in environments that are impoverished, where it’s difficult for them to put food on the table and also pay for medications for their children. I know you care about that. And then taking that issue from there. So starting with common ground is important.
And absolutely thanking members of Congress and being there for them, or state legislators, when you think they’ve done the right thing. I can’t begin to tell you how much public thanks, and private thanks too, matter to people who are really working hard, from their vantage point, trying to do the right thing.
Communicating what the positions are of individuals, whether they’re for a position or they’re against it, it’s really important for us to communicate that, not just to the individual but more broadly to the public, in part because the public can help us leverage members of Congress and state legislators to do the right
thing too. So don’t keep it to yourself. Don’t even keep it within the nursing community. Push it out.
[MUSIC PLAYING]
Working with Legislators Additional Content Attribution
Trowell‐Harris, I. (n.d.). Various Photographs [Photograph]. Used with permission of Irene Trowell-Harris.
Wakefield, M. (n.d.). [Photograph]. Used with permission og Mary Wakefield WAL_NURS6050_NIH-SenatorDanielInouye
Official White House Photo by Pete Souza
GettyLicense_769805145
Akepong Srichaichana/EyeEm / EyeEm / Getty Images
Politics and the Patient Protection and Affordable Care Act
Citizens of the United States were presented with a new healthcare reform act known as the Patient Protection and Affordable Care Act in 2010. The Patient Protection and Affordable Care Act also known as Obamacare was intended to develop healthcare and health insurance businesses in America. The main aim of Obamacare is to increase new benefits for healthcare, more patient rights, more patient protection, and making healthcare more affordable and accessible to the citizens in the United States. Attempts to repeal and replace Obamacare has been a subject matter constitutionally contested and have the subtle meaning of egotism by politicians to capitalize on voter support. From a cost-benefit approach, for a system to be cost-effective, the benefits must be higher in comparison to the amount acquired during the enactment of the program (Milstead & Short, 2019). When the Patient Protection and Affordable Care Act was developed, it made access to healthcare available to most of the American citizens, and thus, repealing and replacing the act will make political lawmakers lose voter support.
Despite reported accomplishments by the Affordable Care Act, there is still political deliberation to repeal and replace. Many political leaders are concerned that if the Act is repealed many Americans will lose coverage by insurance companies (Taylor, et al., 2017). Consequently, many low-income or middle-class families insured under the Act by the Medicaid program will lose their coverage. A study by DaVanzo (2016), projected that if the Affordable Care Act is repealed, by 2026 the number of uninsured persons would have increased by 22 million persons which can lead to an unparalleled heath crisis as persons would no longer be covered and able to receive the care they need.
Since the Act has been enacted, it has encountered many disputes amongst politicians. Since in office, the Trump administration has attempted to repeal and replace Obamacare but has since not succeeded. During his elections, many legislators supported this idea but at present time, considers this decision a liability as they are up for re-elections (Hawryluk, 2020). Legislators are more likely to support agendas that are favorable to them based on a cost-benefit analysis. As such, repealing The Affordable Care Act will not be of benefit to them and the American people. Therefore, they are unlikely to reverse the act.
The Affordable Care Act allows for many Americans to have access to services in healthcare and repealing the Act will only make legislators lose the voter support they want. Most political decisions and policies are driven by and appeal to the expectations of their voters.
References
DaVanzo, D. (2016, December 6). Estimating the Impact of Repealing the Affordable Care Act on Hospitals. Retrieved from AHA.org: https://www.aha.org/system/files/2018-02/impact-repeal-aca-report_0.pdf
Hawryluk, M. (2020, August 28). Opposition to Obamacare Becomes Political Liability for GOP Incumbents. Retrieved from KHN: https://khn.org/news/opposition-to-obamacare-becomes-political-liability-for-gop-incumbents/
Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics: A Nurse’s Guide (6 ed.). Burlington, MA: Jones & Bartlett Learning.
Taylor, D., Olshansky, E. F., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017, May 1). Corrigendum to position statement: Political interference in sexual and reproductive health research and health. Nursing Outlook, 65(3), 346-350. doi:https://doi.org/10.1016/j.outlook.2017.05.003
Rubric Detail
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Content
Name: NURS_6050_Module02_Week03_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
Points Range: 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
Points Range: 15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
Points Range: 13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
Points Range: 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
Points Range: 12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module02_Week03_Discussion_Rubric
Under the Patient Protection and Affordable Care Act (ACA), approximately 20 million individuals gained access to health insurance. Also sometimes referred to as “Obamacare,” the ACA became highly politicized. During the 2016 presidential election, the discussion of repealing the ACA was a large point of contention that millions were concerned for (Karaca-Mandic, et al., 2017). After President Trump was elected, the bill known as the American Health Care Act (AHCA) was voted on to be passed. This bill would repeal major aspects of the Affordable Care Act. One particular point of interest was the repeal of major funding for Medicaid had this bill been passed (McCarthy, 2017).
Budget Reconciliation has been used when passing major legislation since 1980. The Congressional Budget Act of 1974 established the Congressional Budget Office (CBO) and sought to rationalize the process by which Congress set the federal budget (Hirsch, et al., 2017). In March of 2017, the CBO released its report of the potential implications of replacing the ACA with the AHCA. The report stated that if the bill was passed in 2017, by 2018, 14 million people would become uninsured (Hirsch, et al., 2017).
These legislators who sit as members of the house are up for election every two years (National Council for the Social Studies, n.d.). As a legislator’s career can be short-term, they strive to be reelected. For reelection, legislators must be viewed as making positive changes for the people they serve, rather than passing their own personal agenda. While many of the legislators working on the AHCA may have had their own agenda for wanting it passed, they could not risk millions of individuals losing their insurance. This surely would not become popular and would not warrant a reelection.
References
Hirsch JA, Rosenkrantz AB, Nicola GN, et al. Contextualizing the first-round failure of the AHCA: down but not out
Journal of NeuroInterventional Surgery 2017;9:595-600.
Karaca-Mandic, P., & Jena, A. (2017, April 1). Health care among individuals at risk for losing insurance with repeal of the aca. JAMA Internal Medicine. Retrieved September 14, 2021, from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2598797.
McCarthy M. US Representatives vote to repeal Affordable Care Act BMJ 2017; 357 :j2217 doi:10.1136/bmj.j2217
National Council for the Social Studies. (n.d.). How Legislators Make Decisions. Retrieved from https://socialstudies.org/advocacy/how-legislators-make-decisions
NURS_6050_Module02_Week03_Discussion_Rubric
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Excellent |
Good |
Fair |
Poor |
Main Posting |
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
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Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
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Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
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Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
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Main Post: Timeliness |
Posts main post by day 3.
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Does not post by day 3.
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First Response |
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
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Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
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Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
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Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
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Second Response |
Response exhibits synthesis, critical thinking, and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Response is effectively written in standard, edited English.
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Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
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Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
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Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
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Participation |
Meets requirements for participation by posting on three different days.
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Does not meet requirements for participation by posting on 3 different days.
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