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

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The Patient Protection and Affordable Care Act and politics

Divided politics and divisiveness have made it difficult for American leaders to reconsider long-delayed healthcare reforms. Some argue that the current healthcare system under the Affordable Care Act is cost-effective. For a program to be cost-effective, its benefits must outweigh the costs associated with its implementation, according to a cost-benefit analysis (Milstead & Short, 2019). The Act provides healthcare services to the vast majority of residents; therefore, repealing it could result in legislators losing electoral support.

Some political leaders believe that if the Affordable Care Act is repealed, a large number of people will lose their health-care coverage (Hagan et al., 2017). There is also concern that repealing the Act will result in a significant loss of employment due to fewer people having access to insurance coverage. For example, if the Act is repealed, a large number of people who obtained insurance through the Affordable Care Act will lose it automatically. Many Americans will become uninsured as a result of the loss of Medicaid coverage for millions of low-income earners. This will have an impact on their ability to access and afford healthcare treatments.

According to Feldstein, legislators are unlikely to support repealing the Affordable Care Act. This is because, according to a cost-benefit analysis, legislators will only support a legislative initiative that benefits them more (Feldstein, 2006). According to this logic, repealing the Affordable Care Act is unlikely because it would be detrimental to the American people. This is demonstrated by the fact that, despite President Trump’s efforts, he has been unable to repeal the Act. Even when Republicans controlled Congress, they were unable to muster the necessary support to overturn the law. In this case, the advantages of the coat (political support) outweigh the disadvantages (losing political support). As a result, they are unlikely to support the repeal.

Individuals, regardless of political orientation, frequently get anxious when they contemplate the government’s perceived competing interests and their impact on issues of personal interest. Healthcare is no exception. Certain individuals believe that municipal, state, and federal policies and legislation can be aided or harmed by interests other than the greater good of society.

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

Consider that the primary responsibility of a legislator is to be re-elected. Costs can be expressed in both votes and dollars. Thus, it is critical to examine the legislator’s position while deciding whether to support or oppose a certain effort in the political scene.

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Politics and the Patient Protection and Affordable Care Act SAMPLE

Politicians’ main interest is to be re-elected to continue maintaining their political positions. The interest of being reelected every campaign has greatly impacted the policymaking process. Politicians would rather support what

Discussion Politics and the Patient Protection and Affordable Care Act NURS 6050

looks good in the eyes of people to ensure they do not lose quorum (Milstead & Short, 2019). Since President Trump became the president of the United States of America, he has been against the Affordable Care Act. As a result, he has tried to repeal the policy but the efforts have failed. President Trump’s administration has not given up since many trials to repeal the Affordable Care Act are expected. Most probably, the repeal trials have failed so that politicians can safeguard their likelihood of being re-elected. This paper explains how the cost-benefit analysis in terms of legislators being re-elected affected efforts to repeal/replace the ACA. It also explains how analysis of the voter views may impact politicians’ recommendations about the Medicare Prescription Drug Savings and Choice Act of 2019….

RE: Discussion – Week 3

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Similarly, like many of my classmates, I had no idea what a cost-benefit analysis (CBA) was, and in order to answer this week’s discussion question, I had to first research the definition of CBA. CBA is a method of comparing the costs and benefits of a monetary intervention. I was able to apply this concept to legislators and their relationship with the Affordable Care Act (ACT) in the hopes of re-election. The ACA was signed into law in 2010 with overwhelming Democratic Party support and without a single vote from the Republican Party. H.R. 3590 became law in 2010 with 60 votes in favor and not a single conservative vote (Patient Protection and Affordable Care Act, 2009). In terms of their chances of re-election in future elections, this was a watershed moment for democratic legislators.

In order to be re-elected, legislators must weigh the benefits and drawbacks of supporting repeal/reform of the ACA. A legislator must decide where they stand on a topic that is fair to both sides of the political aisle and the people they represent. If they are either too conservative or too liberal, they should be prepared to lose those votes in the next election. The decision will be difficult for any elected official seeking re-election. Physicians and other health care professionals have traditionally been the largest source of federal campaign contributions within the health care sector; however, when comparing the dollars coming from physician-related entities as opposed to significantly less than the amount given to physician groups (Milstead & Short, 2019, p 45), it plays a role in which way a legislator may lean when there is monetary loss or gain to influence them. When it came to repealing the ACA, deciding which side to take was a tricky balance of monetary reward and possible re-election or loss of re-election and financial support.

Voters are the backbone of legislators who are up for re-election. Voter attitudes, which are frequently captured in polls, influence legislative decisions and policy positions. One surprising example I saw was a Kaiser Family Foundation poll that found a large majority of the public did not want the ACA repealed, including a majority of Democrats (91 percent), independents (81 percent), and Republicans (66 percent), but three-fourths of Republicans still want the entire law repealed (Kirzinger et al, 2020). Voter preferences influence whether legislators support policies or oppose them in the hope of re-election.

This year marks the tenth anniversary of the Affordable Care Act, which has been the subject of litigation since its inception and will continue to be scrutinized as legislators debate who has the better plan to protect the American people. On November 10, 2020, the Supreme Court will hear a case involving the complete repeal of the ACA, which will affect millions of people, including those with disabilities and pre-existing conditions. The American College of Physicians (ACP) emphasized that the ACA is critical to the operation of the United States’ health-care system (Inserro & Melillo, 2020). Legislators will not only listen to their constituents’ opinions, but will also rely on the expert knowledge of key players such as the ACP and the American Nurses Association to guide and educate them on the importance of health care legislation. President Trump signed an executive order ensuring that people with disabilities will not be denied coverage, but experts say it will be meaningless if the ACA is repealed. Legislators run for office to serve the American people, and if they hope to be re-elected, they must strike a balance, which can be a difficult task for them. According to Forbes, 55% of respondents view the ACA favorably overall (Forbes, 2020), and conservatives, while still in favor of repealing the ACA, have begun to change their stance on the ACA with one goal in mind.

Resources

Inserro, A. & Melillo, G. (2020). Supreme Court Signals Willingness to Uphold ACA. AJMC. Retrieved from Supreme Court Signals Willingness to Uphold ACA (ajmc.com)

Durkee, A. (2020). Poll: Most Americans Don’t Want Supreme Court To Overturn Affordable Care Act. Forbes. Retrieved from Poll: Most Americans Don’t Want Supreme Court To Overturn Affordable Care Act (forbes.com)

Kirzinger, A., Lopes, L., Kearney, A., & Brodie, M. (2020). KFF Health Tracking Poll-October 2020: The Future of the ACA and Biden’s Advantage On Health Care. KFF. Retrieved from KFF Health Tracking Poll – October 2020: The Future of the ACA and Biden’s Advantage On Health Care | KFF

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

Patient Protection and Affordable Care Act, H.R. 3590, 111^th Cong. (2009). H.R. 3590 (111th): Patient Protection and Affordable Care Act — GovTrack.us

Testimony/Advocacy Statement

Good afternoon. My name is Erin Littlepage, and today I will be discussing the importance of passing the H.R.4769 bill, also known as the Medicare Prescription Drug Savings and Choice Act of 2019. Compared to other highly developed countries with decent healthcare, the United States has substantially higher prices for the cost of drugs. There are many bills that have been introduced to the House of Representatives in order to combat these high prices that we as Americans face every day, and the Medicare Prescription Drug Savings and Choice Act of 2019 bill is especially important.

Under the current administration, as of December 18, 2019, Donald Trump has announced plans to allow states to purchase prescription medications from Canada to help lower the costs of Americans purchasing their medications. The fact that our medications are so expensive, we must go to another country to purchase prescription drugs is a disturbing fact. However, if the plan goes into action, the Medicare expenses will be lowered from state to state which would be a huge push in the right direction of lowering our prescription drug costs (Williams, 2019).

There are opponents to the bill, unfortunately. Large drug companies must increase the prices of medications in order to make a profit for themselves. This does not benefit the American consumer, however. So many Americans fail to take their medications as prescribed by their provider because they do not have the money to pay for them. I have worked on Medical Surgical units for my entire nursing career, and the amount of admissions and readmissions based on the mere fact that the patient cannot afford their drugs, and come in with acute symptoms that could be regulated with medication administration, is astounding. While it appears as if the pharmaceutical companies will just continue increasing their drug prices, I think the only way to address these opponents is to have this bill and other bills related to drug pricing passed to Congress and have them take strong action to manage the issue.

An amendment I would propose in regard to this bill, is laid out in the Medicare Drug Price Negotiation act, which would allow the secretary of Health and Human Services to negotiate drug prices for drugs under Medicare. This in turn, would lower drug prices. Currently, the secretary of HHS is not permitted to negotiate on pricing so they must accept the numbers given by the pharmaceutical company.

In conclusion, the high prices of medications will continue to be an issue nationwide as long as Congress sits back and allows pharmaceutical companies to take advantage of innocent Americans. The Medicare Prescription Drug Savings and Choice Act of 2019 will allow the Center for Medicare and Medicaid Services to negotiate with pharmaceutical companies to keep pricing reasonable for drugs and offer alternatives medications that are of equal value, but of lower price. These companies have time and time again shown their greed, and that a profit is more important than the life of American citizens. This issue is long overdue to be solved and will continue until Congress takes a stand, starting with the passing of this bill and others related to the issue.

RE: Discussion – Week 3

COLLAPSE

When new topics of interest rise to the government level and grasp the attention of legislators it is important that they factor in cost, voters’ interest, and reelection when making their decision. The same is expected when legislators are faced with the duty to repeal or replace a bill. In regards to the Affordable Care Act (ACA) analysis must be drawn considering whether its existence or its eradication is in favor of the legislator. Researchers projected that the affordable care act reduced health care spending a total of $2.3 trillion (Emanuel, 2019), benefiting millions of Americans and depending on which part of the spectrum you fall (democrat or republican) this may or may not be favorable numbers. For decades the basis of the Democrats’ campaign was the fight for security in healthcare for Americans and are commented on preserving and protecting the ACA (Democrats.org, n.d.). The projected savings for healthcare and the grand number of persons benefiting from the ACA favors cost control and proves beneficial in cutting costs for American citizens and the Government at large.

On the other hand, the republicans oppose the ACA and have vowed to repeal it, arguing that less than 50% of Americans benefit from it (Dalen, et al., 2015). They have strategies thru TV ads shaming and discrediting the ACA as a way to turn Americans against it and secure trust in Americans that they can provide better for them in hopes to secure the majority of votes.

Buettgens, et, al. (2016) in their article “The cost of ACA repeal” states that repealing the ACA would reduce federal government spending on health care for the nonelderly, which appears to be one of the goals of those advocating repeal, by $90.9 billion in 2021 and $927 billion between 2017 and 2026. However, a repeal would also mean more persons would become uninsured, State spending would increase by $68.5 billion between 2017 and 2026 as reductions in Medicaid spending would be more than offset by increases in uncompensated care (Buettgens, et, al, 2016). This is where legislators must make a decision based on the best interest of their constituents, as they are the ones responsible for reelecting them. Also, one must take into consideration; is repealing the bill going to save the government money or in the end, cost them a lot more.

References

Buettgens, M., Blumberg, L., Holahan, J., & Ndwandwe, S. (2016). The cost of ACA repeal. Retrieved December 16^th, 2020 from

http://www.urban.org/sites/default/files/publication/81296/2000806-The-Cost-of-the-ACA-Repeal.pdf

Dalen, J., Waterbrook, K., & Alpert, J. (2015) Why do so many Americans oppose the Affordable Care Act? American Journal of Medicine, 8(8), 807-810,

doi: 10.1016/j.amjmed.2015.01.032

Democrats.org. (n.d.). Healthcare: Democratic party platform. Retrieved December 16, 2020 from

https://democrats.org/where-we-stand/the-issues/health-care/

Emmanuel, E. (2019). Name the much-criticized federal program that has saved the U.S. $2.3 trillion. Hint: it starts with Affordable. Retrieved December 16^th, 2020 from

https://www.statnews.com/2019/03/22/affordable-care-act-controls-

costs/#:~:text=One%20month%20after%20the%20ACA,record%2Dkeeper%20estimated%20that%20health

Impact of Legislation Within the Affordable Care Act

The Affordable Care Act while seemingly to be a good way for Americans to have health coverage did have its flaws. To name a few positives to the ACA it covered 10 essential health benefits, let children stay on health coverage until 26, gave coverage to preexisting conditions, and helped slowed the rise of health care cost, but did not seem to work. However, it did also have some negatives. Raised the income tax, taxed individuals who did not have health insurance, and people were losing their private insurance through their companies (Amadeo, K. 2019). “To start higher costs, cause more healthy people to drop coverage, which raises prices even more, and the cycle continues. In May 2017 the Department of Health and Human Services reported that average health insurance premiums doubled since 2013. How many families’ incomes doubled over that same period? In 2018 costs have risen by another 19 percent for high-cost plans and 32 percent for the cheapest plans, according to a study by the Urban Institute. Overall inflation for all other goods and services are running at 2 percent” (Moore, S. 2018). Whichever side of the political party you stand on. Americans do not want to lose money and see less in their paycheck. If you decided to not want health insurance the ACA would take it out of your taxes regardless. When private health insurance companies decided to drop their coverage for employees due to it being cheaper to pay the tax rather than insure workers. People were advertantly paying more for the ACA than what they previously had with their employer.

In 2018 the democratic party regained control of the House of Representatives. One key aspect to there success was the Affordable Care Act and that patients with preexisting conditions would not be singled out and that the majority of Americans were in favor of Obamacare “The rising public support for Obamacare was a winner for Democrats in 2018, and they want to capitalize on that going into 2020” (Cancryn, A. & Ollstein, A. 2019). In terms of affecting legislators for reelection and obtaining votes. I believe that the ACA can most certainly be affected by lobbyist and voters. If I were a legislator and I wanted to be reelected, then I would surely pick my decision based on what my majority of voters wanted. If they wanted to see more money in their pockets and have their own choice to have or not have coverage, then I would most certainly pick to repeal. If my voters wanted to have coverage whether that meant spending more but still having the 10 essential health benefits that ACA offered, then I would have chosen to replace Obamacare. “For legislatures to be good, they must carry out the functions we expect of them in our system of representative democracy. The principal ones are balancing power, representing constituencies and making laws” (Rosenthal, A. 1999). A legislator works for the people not themselves. It is their job to do what the people of their district want of them. To obtain the votes they have to please the people.

References

Cancryn, A., Caygle, H., Rachael, Ferris, S., & Levine, M. (2019, January 4). Democrats won

the House on Obamacare. Here’s how they plan to defend it. Retrieved from

https://www.politico.com/story/2019/01/04/house-democrats-obamacare-1060175

Rosenthal, A., & Smith, E. (1999). NCSL State Legislatures magazine, July/August 1999.

Retrieved from https://www.ncsl.org/research/about-state-legislatures/the-good-legislature.aspx

Moore, S. (2018). 8 Reasons to Still Hate Obamacare. Retrieved from

https://www.heritage.org/health-care-reform/commentary/8-reasons-still-hate-obamacare

Amadeo, K. (2019). Pros and Cons of Obamacare. Retrieved from

https://www.thebalance.com/obamacare-pros-and-cons-3306059

Politics, Patient Protection, and Affordable Care Act Discussion

Irrespective of the political affiliations, there is always an increasing concern among individuals when they consider the perceived competing interests of the government and how they impact topics that are of interest to them. Generally, a policy that is created and implemented for healthcare purposes mostly impacts the nurses and patients. However, speaking of who benefits the most from the developed policies, it all boils down to the person-in-charge of the legislation.

According to Milstead and Short (2019), “…policymakers do not necessarily focus on how the changes will affect the people, but rather on how they will affect their chances of re-election.” An example is President Donald Trump who began his term with the Republican house immediately bringing up a repeal to Medicare/Medicaid and the ACA. They described it as a “… a law that has long been a thorn in their sides” despite the estimated 20 million people who have gained health coverage courtesy of the Affordable Care Act (Milstead and Short, 2019). In this case, repealing this Act will leave so many people without health coverage. However, the act of making this as his first decision as the president, for all the people that voted in his favor, and were strongly in support of this law, would in a strong way hold onto this moment and later vote for him again when his term elapses. Spending by the outside groups constituted 14.9% as of 2019, which was an increase of about 5% compared to 2010 (Milstead and Short, 2019). On the other hand, the individuals who are part of the large corporations or belong to organizations that belief in the new ACA reforms will supply more funds into this campaign.

Legislators are rational and make cost-benefit calculations in light of demanded legislation (Feldstein, 2006). Moreover, the cost-benefits calculations being made are not to the society, but to the additional political support that the legislator may receive from supporting that particular legislation when compared to the lost political support that they may incur from their actions (Feldstein, 2006). If the benefit (positive political support) outweighs the cost (negative political support), they will support the legislation.

The voters’ views can also affect the decision by legislators to recommend or position national policies as evident from the repeal of the ACA which has been passed without any republican signatures and is now being challenged (Laureate Education, 2018). Such impacts on ACA provisions affect adults with Medicaid coverage under the ACA rules due to the legislators. Re-election for expanding Medicaid includes the elimination of Medicaid funding, subsidies, and a loss of consumer protection. The result is a repeal of the legislation to makeover the gap brought by congressional effects and government preferences.

The analysis of votes helps to reveal issues and help the legislators when making policy choices. The outcome is for the public to limit their options once a leader’s policies are adopted. This is evident when comparing the potential loss of coverage, the associated benefits of repealing the provisions of financial assistance, and the Medicaid coverage that opposed the repeal. This affects the decisions that Congress has to make and how they impact Medicare and Medicaid coverage policies. There is always a method behind how all the decisions are made and I believe a strong consideration is made on how the decisions will impact the future votes.

References

Feldstein, P. (2006). The Politics of Health Legislation: An Economic Perspective. Chicago, IL: Health Administration Press.

Laureate Education (2018). Introduction to Health Policy and Law with Joel Teitelbaum [Video file]. Baltimore, MD: Author

Milstead, J., & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide. Burlington, MA: Jones & Bartlett Learning.

RE: Discussion – Week 3

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Hi Iyobosa,

Thank you for your informative post. The whole cost-benefit analysis idea that concerns the re-election of the legislators and pursuing a particular regulation is an unfortunate reality. Sadly, this is something that I could say inevitable because of the fact that winning an election or re-election can be very expensive. According to Milstead and Short (2019), “the campaigning for the average U.S. Congress House seat in the 2016 election cost $1 million while campaigning for the average U.S. Senate seat cost tens of millions of dollars”. For the legislators to successfully win for re-election, they will need financial resources, usually from wealthy individuals or special-interest groups who would be willing to invest; however, it is expected for these individuals to be able to get something beneficial in return, the repealing of the Affordable Care Act for instance. During this coronavirus pandemic, ACA has become a massive help for millions of people who have lost their employer-sponsored insurance (ESI). It is because of this law why “many of these newly unemployed Americans who previously were covered by employer-sponsored insurance are able to get health coverage, either through the ACA marketplaces, possibly with financial assistance to make their coverage more affordable, or via Medicaid expansion” (Rapfogel & Gee, 2020). Even with the desire of the legislators to make an acceptable policy for the goodwill, they will have to give thoughts about their financial resources’ input about the repealing.

I also agree with what you said regarding the analysis of votes as a way to reveal issues and help the legislators in policymaking. After all, these same voters are the ones that they should be serving and should be listening to. I believe that this is how good governance should be.

References

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

Rapfogel, N., & Gee, E. (2020, June 24). The health care repeal lawsuit could strip coverage from 23 million americans. Center for American Progress.

Retrieved September 17, 2020, from https://www.americanprogress.org/issues/healthcare/news/2020/06/24/486768/health-care-repeal-lawsuit-strip-coverage-23-million-americans/

RE: Discussion – Week 3

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It is to no avail that health care is one of the most important topics when it comes to the legislators and

the public. The Affordable Care Act (ACA) is the most controversial yet needed health care plans that has been

established. The ACA which was introduced in 2010 during former President Obama’s term provides health care

to millions of people young and old that would not previously have health care. The ACA’s purpose was to

expand the Medicaid program, and support innovative medical care delivery methods designed to lower the

costs of health care generally (Healthcare.gov, n.d.). The Affordable Care Act has met much debate as it has

not been as affordable as it was deemed to be. Also, it created a liability for the American people to have

insurance such as penalizing anyone who did not have insurance. One unsettling aspect was the cuts that had

to be put forward to make the ACA and expansion happen. These have been the cons of ACA that have

made for huge political viewpoints. This has been the mark for many politicians in terms of putting forth their

stance to get re-elected. Rather than caring about the actual future of health care accessibility and out of pocket

expenses that people face, the ACA is being used during this time as a re-election tool. As President Trump

wants to see the ACA depleted while others would like to see it built up, it seems legislators are either for it or

against it. The goal for their viewpoint on the matter is for support and re-election purposes. “When one thinks

like a politician, it means he or she is looking beyond the issue itself and considering other forces and factors

that affect what is likely to work and what has no chance of success” (Milstead & Short, 2019, p. 51). “The

legislators cost-benefit calculations are not the cost-benefit to society of enacting particular legislation, but the

benefits are the additional political support the legislator would receive from supporting legislation and lost

political support they would incur as a result of their action” (Milstead & Short, 2019, p55). Politicians and

legislators look for what they think will bring them success, such as staying in office for re-election. The

decisions of legislative leaders are affected through the voter’s views. According to National Council for the

Social Studies, legislators consider the Triangle Test when deciding how to vote. They think, do my constituents

care about this issue? Is this good policy for the Nation and does this make sense? Is this press worthy? (n.d.).

A legislator whose goal is to be re-elected would be smart to go with the popular vote.

References:

Healthcare.gov. (n.d.). Affordable Care Act (ACA)-HealthCare.gov Glossary. Retrieved September 17,

2020. from https://www.healthcare.gov/gossary/affordable-care-act/

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. (p.51, 55). Burlington,

MA: Jones & Bartlett Learning

National Council for the Social Studies. (n.d.). How Legislators Make Decisions. Retrieved September

17, 2020, Retrieved https://www.socialstudies.org/advocacy/how-legislators-make-decisions

RE: Discussion – Week 3

COLLAPSE

Historically, Medicare and Medicaid aside, many Americans had access to employer-sponsored health insurance programs prior to the Affordable Care Act (ACA) (Collins, 2018). In 2010, President Barack Obama signed into law a bill to address insurance gaps and provide an affordable option to health insurance (Collins, 2018). The main objectives of the ACA were to improve access for patients, improve quality of care, and reduce healthcare expenses for Americans (Collins, 2018). The ACA allowed for expanded coverage for minors under a parent’s plan until the age of 26 and gave Americans the ability to compare difference insurance plans (Collins, 2018). In 2013, the Health Insurance Marketplace offered open enrollment to allow an option for all Americans to access health insurance. Quality care is rewarded under the ACA with optimal reimbursement to incentivize meeting care and patient goals (Collins, 2018).

When the Affordable Care Act was being drafted, America was in a recession with many citizens losing both health insurance coverage and work (Silberman, 2020). In 2010, more than 46 million Americans were without health insurance while others were afraid of losing the coverage they had (Silberman, 2020). The ACA required states to expand Medicaid coverage and mandated large employers to offer affordable coverage options to their employees, which was later brought to the Supreme Court to challenge its constitutionality (Silberman, 2020). A replacement bill was proposed by Congress that repealed Medicaid expansion along with the coverage mandates, but Obama had vetoed the legislation (Levitt, 2017). When President Trump entered office, his platform was partially built on the repeal of “Obamacare” or the ACA. Trump’s 2018 budget proposal included Medicaid cuts, reduced public funding for the Food and Drug Administration, the National Institute of Health, and the Centers for Disease Control and Prevention, and overturn the requirement of insurances to cover some preventive services such as contraceptive birth control for women (Jost, 2017). During the Trump administration, nongroup market premiums increased, but increased coverage for services including maternity, mental health, and substance use treatment (Jost, 2017).

Glied (2021) writes that many fundamental problems behind the high cost of employment-based coverage, premiums, and cost sharing are too high due to the high cost of health care. Despite the United States spending more per capita on health care than Canada, the United Kingdom, France and Japan, life expectancy is less than these counties (Milstead & Short, 2019). Glied (2020) argues that government intervention through direct regulation is a means to cap prices. While the intention of the ACA was to improve access and coverage for many preventive services, procedure cost-sharing rates for colonoscopy and mammography remain virtually unchanged (Elwood, 2015). New models in healthcare are shifting from fee-for-service to value-based care, as patients seek better quality care, increased involvement in care decisions, and improved customer service for their increased cost responsibility (Elwood, 2015).

Both Democrats and Republicans have declared drastically differing opinions on the ACA while arguing the motives of the other party. When it comes to reelection, time and climate play large roles in political success (Milstead & Short, 2019). Republicans saw opportunity to repeal or replace Obamacare in the early days of the Trump administration but from the debates on how to make these changes, many politicians realized there may be implications that would affect their re-election (Milstead & Short, 2019). The implementation of any changes would be during the 2018 election cycle and possibly impact the Republican party’s ability to maintain majority in Congress. Milstead and Short (2019) argue that policymakers do not care about the people affected by the ACA, but rather how changes will impact their ability to be re-elected.

The American Care Act is challenged in that it does not provide coverage for everyone. There are states that do not uphold the Medicaid expansions and many Americans unable to afford the Marketplace options (Silberman, 2020). Silberman (2020) argues that the COVID-19 pandemic brought to light how little the country has invested in public health to protect the population, and that improving health involves investing in prevention and addressing social determinants of health. COVID has also shown that the current employer-based system supplemented by federal programs has worked, as the rate of insured dropped only about 1.5% through September of 2020 (Glied, 2021). The removal of the ACA would leave millions uninsured and the process of changing how Americans obtain insurance would take years to implement (Milstead & Short, 2019). When considering voter views, the American opinion remains divided when it comes to how the American Care Act should be replaced, repealed, or maintained (Milstead & Short, 2019). The ACA offers many benefits and shortcomings for providing healthcare coverage, but ultimately the direction that legislation takes is dependent on legislators’ agenda, along with timing and constituent views.

References

Collins, B. L. (2018). The affordable care act: 8 years later. Nursing Management, 49(8), 42–48. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NUMA.0000538917.37912.d4.

Elwood, T. W. (2015). Elected officials travel in parallel universes regarding the affordable care act. International Quarterly of Community Health Education, 36(1), 19–34. https://doi-org.ezp.waldenulibrary.org/10.1177/0272684X15613906.

Glied, S. (2021). Continue moving forward on the affordable care act path. American Journal of Public Health, 111(4), 612–613. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2021.306175.

Jost, T. S. (2017). ACA replacement battle moves to senate. Health Affairs (Project Hope), 36(7), 1173–1174. https://doi-org.ezp.waldenulibrary.org/10.1377/hlthaff.2017.0688.

Levitt, L. (2017). What might an ACA replacement plan look like? JAMA, 317(8), 795–796. https://doi-org.ezp.waldenulibrary.org/10.1001/jama.2017.0661.

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

Silberman, P. (2020). The affordable care act : Against the odds, it’s working. North Carolina Medical Journal, 81(6), 364–369. https://doi-org.ezp.waldenulibrary.org/10.18043/ncm.81.6.364

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