Politics and the Patient Protection and Affordable Care Act Discussion

In 2010 the Affordable Care Act (ACA and also known as “Obamacare”) was established (Milstead & Short, 2019). This act was supposed to offer insurance coverage for all Americans and improve health care for everyone. The ACA has been successful in decreasing the number of uninsured individuals from 48 million in 2010 to 30 million in 2020 (Bosworth et al., 2021). Although, these numbers look promising, there has been controversy about the quality of care for individuals as well as the rise in premiums and out-of-pocket costs for those with employer sponsored health insurance. According to KFF, (2020), premiums have risen dramatically for families. They have increased, since 2010, a whopping 55%!  For a middle-class family, this increase in cost is significant when compared to the rise in cost of living. While there are many pros and cons for the ACA, legislation has not been able to reform the policy.

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                Congress attempted to reform parts of the ACA policy starting in January 2017 by passing a motion to begin debating a budget bill (Ballotpedia, n.d.). After multiple attempts and meetings, on September 26, 2017, Bill Cassidy stated that there would be no vote on the bill (Ballotpedia, n.d.). He explained that they would postpone the bill because they did not have the support and it would ultimately get blocked from being signed. Not suprising Kaiser health tracking polls found an increase in support for the ACA (Brody et al., 2017), up to 51% approval and 41% with unfavorable views, in the same year.

Legislators are driven by voting numbers. They are hired to do a job that the public sector can approve. Without these approval odds, they will be ultimately be removed from office and out of a job. Depending on perception, this could be a good or a bad thing. While their decisions are influenced by the majority, the majority is often influenced by other factors such as, poverty, lack of education, or even wealth and political influence.  Ultimately, until America demands reform to ACA, there will not be one, regardless of the need.

References

Ballotpedia. (n.d.) 2017 Timeline of ACA repeal and replace efforts. Timeline of ACA repeal and replace     efforts – Ballotpedia

Bosworth, A., Chu, R.C., Conmy, A., Finegold, K., Sommers, B. (2021, February 11) Trends in the US uninsured population, 2010-2020. Assistant Secretary for Planning and Evaluation; Office of

Health policy. trends-in-the-us-uninsured.pdf (hhs.gov)

Brodie, M., DiJulio, B., Hamel, L., Kirzinger, A., Wu, B. (2017, June 23) Kaiser Health tracking poll-June

2017: ACA replacement plan and Medicaid. Kaiser Health Tracking Poll – June 2017: ACA, Replacement Plan, and Medicaid | KFF

KFF. (2020, October 8) Average family premiums rose 4% to $21,342 in 2020, benchmark KFF employer

health benefits survey finds. Average Family Premiums Rose 4% to $21,342 in 2020, Benchmark KFF Employer Health Benefit Survey Finds | KFF

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

Jones & Barlett Learning

If politicians are more interested in gaining political power, and are willing to support issues that violate the best interests of their constituents, who is keeping the people at the forefront? And if no one is, what will be the cost?

Dr Mooring

Dr. Mooring,

There are checks and balances that help keep legislation from gaining too much power. The president alone can veto any bill

presented by legislation. This can however, be overturned with a two-thirds vote from the House (StudyHQ, 2019). Legislation

can create bills and present them to congress but, that doesn’t mean that they will get passed. This is the way in which we keep

Americas best interest at the forefront.

References

StudyHQ. (2019, June 2). Checks and balances: presidential system of government.  Checks And Balances: Presidential System

Of Government — StudyHQ.net (2021 PDF)

Hi Charity,

I do agree there are some improvements that can be made to the ACA. When the ACA was enacted, I assisted my brother with his enrollment. I recall the experience being somewhat chaotic. The enrollment process was difficult to maneuver or understand different plan options. Reviewing the costs and benefits with each plan was also time consuming.

Affordability continues to be one main issue with the ACA. Through the American Rescue Plan (ARP) introduced by the Biden-Harris administration, there have been significant changes to the ACA to improve affordability for Americans. According to HHS.gov (2021), the ARP reduces the cost of healthcare by ensuring consumers eligible for premium tax credits have at least a few plan options costing no more than 8.5% of their household income per year, expands the number of people eligible to save money on health care coverage, and addresses racial health inequalities by expanding coverage and reducing costs. I believe these cost improvements will lead to even more enrollment and strengthening of the ACA, not repeal. Repealing the ACA would lead to detrimental affects including 20 million people losing coverage, 135 million Americans with pre-existing conditions facing discrimination from insurance companies, and no requirement for insurance companies to issue rebates when they overcharge (Rapfogel, Gee, & Calsyn, 2020). In my opinion, the benefits of reforming the ACA far outweigh the repercussions of repeal. What are your thoughts on this?

References

Rapfogel, N., Gee, E., Calsyn, M. (2020, March 23). 10 Ways the ACA Has Improved Health

Care in the Past Decade. CAP. https://www.americanprogress.org/article/10-ways-aca-

improved-health-care-past-decade/

U.S. Department of Health and Human Services (2021, March 12). Fact Sheet: The American

Rescue Plan: Reduces Health Care Costs, Expands Access to Insurance Coverage and

Addresses Health Care Disparities. HHS.gov.

https://www.hhs.gov/about/news/2021/03/12/fact-sheet-american-rescue-plan-reduces-

health-care-costs-expands-access-insurance-coverage.html

Tamisha,

I agree with you about the loss of uninsured if ACA was totally repealed. The one thing that ACA has accomplished is insurance coverage for a greater number of people. However, I feel that there are parts of the plan that need to be replaced. ACA claims to be coverage for all but, that’s not entirely true. There are stipulations for being covered under ACA, the biggest being income. ACA only covers individuals between 100% to 400% of the poverty line. An argument could  be made that those who make over 400% could or should pay for private insurance. This is a reasonable argument however, private insurances do not all cover preexisting conditions. For those who make less than the poverty line and do not qualify for Medicaid, what is their solution? I think that if ACA claims to be “coverage for all,” then it should be just that.

Refernces

Healthcare.gov. (n.d.) Federal poverty level.  Federal Poverty Level (FPL) – HealthCare.gov Glossary | HealthCare.gov

Robertson, L. (2014, April 2) Not “everybody” is covered under ACA. FactCheck.org: A Project of the Annenburg Public Policy Center.  Not ‘Everybody’ Is Covered Under ACA – FactCheck.org

 Hello Charity,

Rhetoric and public perception influence the general population regarding policies. Politicians can use their words to assert their power over others and use this perception of power to create a positive perception regarding policies. When the ACA is discussed, it is presented to the public as a healthcare plan that is accessible to all, however, as you mentioned, for many, the plans available within the ACA are not financially attainable (Published: Apr 28, 2021)  Poverty has been linked to a host of healthcare issues and so for the poorest people to not benefit from this plan ultimately means that this plan is failing at its primary goal (Murray, 2006).

References

Published: Apr 28, 2021. (2021, October 28). 2021 Health Insurance Marketplace calculator. KFF. Retrieved December 17, 2021, from https://www.kff.org/interactive/subsidy-calculator-2021/

Murray, S. (2006, March 28). Poverty and health. CMAJ. Retrieved December 17, 2021, from https://www.cmaj.ca/content/174/7/923.short

Charity,

You highlighted a key point that the Affordable Care Act. The American Journal of Public Health outlined that the Affordable Care Act has assisted in insuring many Americans.  One con to the situation includes some people’s premiums increasing. (Glied, 2021). The truth is no one is affected the same financially from the proposed changes added to help everyone receive coverage.  Recently, the Journal of Pediatric Health Care article included more coverage opportunities for pediatrics and their families in conjunction with providing Covid relief funds. (Fry-Bowers, 2021).   Again, this new policy that was passed is beneficial to many but someone is paying for it, literally.

References:

Fry-Bowers, E. K. (2021). The Affordable Care Act, COVID-19, and Health Care Insurance for Children. Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners, 35(6), 639–643. https://doi.org/10.1016/j.pedhc.2021.07.010

Glied, S. (2021). Continue Moving Forward on the Affordable Care Act Path. American Journal of Public Health, 111(4), 612–613. https://doi.org/10.2105/AJPH.2021.306175

Precious Dixon

Walden University

NURS 6050C

Dr. Mooring

12/15/2021

Politics and the Patient Protection and Affordable Care Act

Despite expanding and improving healthcare coverage in the United States, the Affordable Care Act (ACA) has remained a divisive policy across the political divide, mainly due to the unique visions and philosophies advanced by different political parties.  Whereas certain ACA components are popular among Republican policymakers, such as Medicaid expansion and insurance for preexisting conditions, they have persistently and unsuccessfully attempted to repeal the law since its enactment (Willison & Singer, 2017). Among the reasons for the failed ACA repeal, there is the cost-benefit effect of the legislative efforts on lawmakers (Milstead & Short, 2019). For instance, the first attempt by the White House and Congressional Republicans to replace ACA with the American Health Care Act (AHCA) failed because some moderate Republicans feared losing political support of their constituents in the subsequent elections (Willison & Singer, 2017). Generally, legislators prioritize their monetary interests by supporting legislation that endears them to their voters.

Voters’ views may significantly affect the legislative leaders’ decisions in recommending national policies. In this case, the citizens’ concern for healthcare access and quality, as well as the economic impact of the proposed laws influence their legislators’ voting on the bills. For instance, proponents of the ACA may petition their leaders to reject the AHCA to safeguard their coverage interests provided by Medicaid (United States Senate, n.d.). Whereas the House Democrat-supported ACA focused on increasing coverage and reducing insurance premiums, the House Republican-sponsored AHCA intends to repeal the employer and individual mandate, as well as dramatically reduce Medicaid eligibility and spending, eliminate tax credits, abolish come high earners’ taxes, and restructure the procedures that govern preexisting condition coverage (Hirsch ET AL., 2017). Ultimately, a replacement or repeal of the ACA would require a majority vote support by the two congressional houses and the presidential assent to the bill.  From the policy advocate’s perspective, the suitability of the bills is determined by their ability to increase healthcare access to Americans and reduce the cost of medical services without imposing excess taxes on the citizens.

References

Hirsch, J. A., Rosenkrantz, A. B., Nicola, G. N., Harvey, H. B., Duszak, R., Jr, Silva, E., 3rd, Barr, R. M., Klucznik, R. P., Brook, A. L., & Manchikanti, L. (2017). Contextualizing the first-round failure of the AHCA: Down but not out. Journal of Neurointerventional Surgery, 9(6), 595–600. https://doi.org/10.1136/neurintsurg-2017-013136

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

United States Senate. (n.d.). https://www.senate.gov/

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

 One thing we see from research in the social sciences, is that social determinants of health also equate to determinants of success in other areas, such as education. The AHCA and the current administration have vowed to give more power back to the individual states, but do you feel this will lead to improved quality health care for our patients?

Dr. Mooring

The Affordable care act, popularly known as the Obama care is a topic that has been up for many political discussions with the interest of politicians winning more votes from voters. Every Presidential candidate has had his or her view on it. Let me start by explaining a bit what the Affordable Care Act (ACA) is and what it was intended for. The Affordable Care Act is a reform that was passed in 2010 by President Obama’s administration to make health care more accessible to Americans and to decrease the amount of people without health insurance, especially those in the low and middle income range and also increase access to Medicaid. With this act, individuals and their families are able to obtain health insurance through the “marketplace” without going through any employer: meaning, whether one is employed or not, he or she can attain health insurance. According to an online article, “an estimated 20 million previously uninsured individuals have gained coverage” (Kominski, et al. 2017), through the affordable care act.

Of course, there is always an advantage and a disadvantage to everything and people always have opinions about things. What one sees or perceives to be good might not be as such for another, and such is in the case of the affordable care act. This legislation has gone through a lot of political discussions including substituting it and even revoking it all together. There have been many suggestions when it comes to eliminating or substituting the affordable care act. The first suggestion is leaving it alone and not doing anything to it, but with politics, there is always a win-lose situation. It always goes in favor of one. With this first suggestion, it will be beneficial to those (voters) receiving and could receive insurance only through this act; however the voters who are concerned about federal government spending, would not like this idea.

The second suggestion is to substitute the affordable care act with the American Health Security Act or the Health Insurance solution. Now if this plan is implemented, the federal government will save, and there will also be a cut on taxes but it will cause an increase in people without health insurance in the country, meaning, those in support of cutting down federal spending and tax trouble will cast their votes for politicians with this plan, but the uninsured will not.

The third plan also requires revoking this act to prevent the government from spending all of that money on Affordable care act and to put it towards other events. If this is implemented, the cost of insurance will rise by 8%, and more than 12 million people will be without insurance, meaning, politicians who come up with this plan will only receive votes from those that can afford health care on their own, even if there is no ACA. The ones that can only afford ACA will not be happy and for that matter, will not cast their votes for the politician.

The last, but not the least suggestion is also to substitutes and just like the second proposal, this also goes in the direction of saving for the government while depriving many Americans health insurance coverage. If this plan is implemented, again, those without insurance will not cast their votes for this politician who comes up with this suggestion, but the other group would (The future of U.S. health care, n.d.).In the nutshell, as to whether a politician would come to power or win an election will all depend on what voters anticipate. Definitely, the whole population will not want the same thing; everyone has his or her own preferences, but being that “The number one job of the legislator is to be re-elected”, legislators need to make decisions that would benefit majority of the population while also watching how their decisions can affect their political career (Milstead & Short, 2019).

References

Kominski, F. G., Nonzee, J. N., & Sorensen, A. (2017). The Affordable care act’s impacts on access to insurance and health care for low-income population. PMC.  Annu rev public health. 2017 Mar 20; 38: 489-505. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886019/

The future of U.S. health care: Replace or revise the affordable care act? ( n.d.). RAND corporation. https://www.rand.org/health-care/key-topics/health-policy/in-depth.html

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

When deciding the agenda, many issues need to be considered. Cost is important to both parties, but they view them in different ways. If ACA/AHCA change annually, how will we have time to truly evaluate its effectiveness? if you were in control, what data would you gather, and how would you make the decision to change things?

Dr. Mooring

Hi Dr. Mooring, thanks for your question. I believe with every policy implemented, there has to be an evaluation to assess the effectiveness. If I were to be in control, I would set aside a committee that would evaluate the ACA yearly and the data that would be used will be a qualitative data. Qualitative data uses surveys, questionnaires etc to collect data. In the case of the ACA, the group or committee set aside to evaluate its effectiveness would go on to the market place to check for those that enrolled that year, then they will send surveys to obtain information on how the ACA is working for them and in what areas we could improve on. Now, based on the majority response, the ACA could be revised if needed to meet the need of the people.

References

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4^th ed). Burlington, MA:  Jones & Bartlett Learning.

I found your post very informative. The second suggestion you mentioned, repealing the ACA and replacing it with the AHSA, would result in a greatly increased percentage of uninsured Americans. That got me thinking: when uninsured patients go to the hospital and are unable to pay their medical bills, who really ends up footing the bill for that? The answer is complicated, but ultimately the federal government ends up covering many of those costs anyway, in the form of financial bail-outs for hospitals to keep them open when patients or insurance companies can not cover their operating costs. The estimated total annual cost of services obtained by uninsured patients is $35 billion per year (Institute of Medicine (US) Committee on the Consequences of Uninsurance, 2003). Although our elected representatives shape policy in line with their voting constituents because re-election is their number one priority, I wonder if the people were to become aware of the high costs of reinsurance that they would then vote for legislation that continues to expand insurance coverage for all Americans. Many younger Americans tend to view health care as a universal human right and have distrust in private insurance companies (American Hospital Association, n.d.). This gives me hope that there will be positive changes made to expand government insurance programs in coming years.

References:

American Hospital Association. (n.d.). Millennials speak up about their health care expectations: AHA. American Hospital Association. https://www.aha.org/aha-center-health-innovation-market-scan/2019-12-17-millennials-speak-about-their-health-care 

Institute of Medicine (US) Committee on the Consequences of Uninsurance. (2003). Spending on health care for uninsured Americans: How much, and who pays? Hidden Costs, Values Lost: Uninsurance in America.  https://www.ncbi.nlm.nih.gov/books/NBK221653/ 

Reelections depend on the approval of the voters, so most would hope that the politicians would be looking into the best interests of the people. Unfortunately, these days things appear to be more of a “tell them what they want to hear” type agendas and not follow through with it, for example the cancellation of student dept.

Cost-benefit analysis is “the process of comparing the costs involved in doing something to the advantage or profit that it may bring” (Cambridge Dictionary, 2020). How much is the legislator willing to spend, and what is the net gain after implementing the policy? The Affordable Care Act (ACA) was made into law in 2010 and provided insurance coverage for approximately 20 million citizens (The White House, 2016). However, conservative parties such as the Trump administration wished to appeal the ACA. One of the major concerns is the fear of the Affordable Care Act placing a negative impact on the economy due to the copious amounts of money being put into the ACA. To this day, there has been trillions of dollars put into the Affordable Care Act (ACA.)

The Health Policy and Politics book states “Moderate Republicans expressed concerns about the plan to repeal Obamacare within a year of Donald Trump’s inauguration … implementing the changes – would run up against the next election cycle in 2018” (Milstead & Short, 2019). Although many of the other republican politicians were backing President Trumps wishes to replace the ACA, many were concerned that this decision may lead to them losing their seats within the house. In my opinion, I believe that therefore it was unsuccessful to remove the ACA under the Trump administration. Furthermore, did they have the best interest of the people in mind or the best interests of themselves in mind? Health Policy and Politics says “”Politic” is defined as being wise or shrewd, while “politics” is defined as methods, opinions, or scheming” (Milstead & Short, 2019). It is hard to determine which of those two terms our legislators truly practice. Do they really care for their people, or do they care for what will bring in the most amount of money for which some of these legislators may be invested in? I believe repealing this legislation may come with too many issues and uncertainties, but a revision with more options for those who do not benefit from the current ACA would be of best interest for the people.

Resources:

Cambridge Dictionary. (2021, December 15). cost-benefit analysis meaning: the process of comparing the costs involved in doing something to the advantage or profit that it…. Learn more. https:// dictionary.cambridge.org/us/dictionary/english/costbenefit-analysis

Capretta, Joseph R. Antos James C. “The ACA: Trillions? Yes. A Revolution? No.: Health Affairs Blog.” Health Affairs, 10 Apr. 2020, https://www.healthaffairs.org/do/10.1377/hblog20200406.93812/full/.

Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics: A Nurse’s Guide (6th ed.). Jones & Bartlett Learning

I recently watched the documentary “Sicko”, and while it is absolutely biased against the US health care system, it does provide some interesting information. I didn’t realize the lengths many insurance companies go to not to have to pay on claims. It’s unfortunate, for example, that decisions are made by someone with a business background, rather than medical experience. Profitability is the main focus for most companies.  Do you feel there is any way to shift the focus back to positive patient outcomes?

Dr. Mooring

Dr. Mooring,

Your mention of the documentary “Sicko” intrigued me. I found some time this afternoon and watched it. It is certainly a documentary that I will recommend people to watch. To me, it is almost sad how that works. It makes a lot of sense now. My family and I have Tricare because we are a military family. Although it has been really good insurance thus far, it now makes a lot of sense when our referrals for care get denied for other specialty care due to them not “finding evidence of need” when it is simply due to their lack of medical experience!

I truly hope that one day we can start to shift the focus back to positive patient outcomes, but that starts with educating those making these big decisions that are affecting everyone else. For now, I feel like money rules it all.

Ms. Gabriel, I decided to respond to your post this week because I absolutely agree with your post. In an ideal world, a politician would be reelected based upon their constituents. As you stated we can see that this is not the case in today’s world. Research has shown that politicians get reelected today based on where the money is (Milstead & Short, 2019). This fact influences politicians to create policies and act in accordance with their party over the wishes of their constituents. This is evident in that a recent poll has shown that even though most  Americans disapproved of their congressmen, 87% of current congressmen were reelected (Lobbyist4good, n.d.).

References:

How Congress works – lobbyists 4 good. lobbyists4good. (n.d.). Retrieved December 16, 2021, from https://www.lobbyists4good.org/how-congress-works

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.

In 2010, Congress passed the Affordable Care Act (ACA) that provided all U.S citizens and legal immigrants the right to health care coverage. It is a bill that was introduced by the Obama administration. The purpose of the bill was to provide health insurance for the uninsured, allow people to buy plans according to their income and increase coverage on things that were not covered or had limited coverage (Eibner, n.d.). This healthcare coverage however came with a payment penalty for those people who chose not to buy coverage and included $347 for a child, $695 for an adult or 2.5% of the household total income (Milstead & Short, 2019).

The Trump administration was the first to repeal and replace the ACA. In 2017, the American Health Care Act and the Tax Cuts and Jobs Act was passed (Nadash et al., 2018). Five more bills were introduced by the U.S Senate that year but they did not pass. Efforts to repeal and replace the ACA will always exist. It is the obligation of every presidential administration to amend bills for the purpose of benefitting the people. One would think that developing policies would be a win-win situation but that is not the case all the time. People that benefit from policy development is the population that it was intended for. An example would be people with pre-existing conditions that can now be covered, people buying health care coverage according to their income and parents keeping the coverage for their kids in college. Many people can argue back and forth about politics and what changes legislators can make for the good of the people. According to Milstead and Short (2019), policymakers are more concentrated on their re-election status. Many bills are passed the most during a re-election year because policymakers want the people to see the changes they have brought to the people and how good it would be to re-elect that candidate again.

References

Eibner, C. (n.d.). The Future of U.S. Health Care. RAND Corporation. Retrieved December 16, 2021, from https://www.rand.org/health-care/key-topics/health-policy/in-depth.html

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/10.1080/08959420.2018.146283

Milstead, J.A., & Short, N.M. (2019). Health  Policy and Politics (6^th ed.). Burlington, MA: Jones and Bartlett learning

John Adams, the second president of the United States once said,  “There is nothing which I dread so much as a division of the republic into two great parties, each arranged under its leader, and concerting measures in opposition to each other. This, in my humble apprehension, is to be dreaded as the greatest political evil under our Constitution.”

Do you think the political parties should be dissolved? If so, what type of system do you feel would be a better model? How could that affect our health care policies?

Dr. Mooring

The Affordable Care Act (ACA) of 2010 was a comprehensive national health care reform aimed to expand health insurance coverage and improve access to care in the United States (Ercia, 2021). Although this policy passed in 2010, it took until 2014 for it to begin being implemented by certain states, but not all; as of 2020, there were 39 states in the United States that opted to expand Medicaid, allowing millions of uninsured Americans access to coverage (Ercia, 2021).

Changing the way the American population gets health care coverage and benefits has many complexities and can take several years to see results from these changes.  A large factor contributing to this complex process is the conflicting views from the American public, in which many folks disagree on how healthcare should be financed.  Generally speaking, views of the ACA remain divided by party, the liberal population aim to maintain the Affordable Care Act (ACA), hard-right conservatives promote a repeal and replace of the ACA, and moderate conservatives are more open to repairing flaws in the ACA (Milstead & Short 2019).

One key component that influences how much an individual pays for health care coverage is the state in which they live.  According to Milstead and Short (2019), under the ACA, all 50 states offer either the HealthCare.gov marketplace or a state-based marketplace. Biden’s health care coverage plan includes promoting the expansion of Medicaid in the 12 states that have not yet done so, which would likely have contributed to the support of voters in these particular states (Glied, 2021).

The future of American healthcare is a continual topic of lawmakers.  Repealing or revising the ACA would impact many Americans, causing many to potentially lose health care coverage.  This remains a topic of controversy between liberals and conservatives, where tension exists between many health care policy goals.

Resources

Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Services Research, 21(1), 920. https://doi.org/10.1186/s12913-021-06961-9

Glied, S. (2021). Continue Moving Forward on the Affordable Care Act Path. American Journal of Public Health, 111(4), 612–613. https://doi.org/10.2105/AJPH.2021.306175

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

When deciding the agenda, many issues need to be considered. Cost is important to both parties, but they view them in different ways. If ACA/AHCA change annually, how will we have time to truly evaluate its effectiveness? if you were in control, what data would you gather, and how would you make the decision to change things?

Dr. Mooring

The Affordable Care Act (ACA), which is also more commonly referred to as Obamacare “was designed to reduce the cost of health insurance coverage for people who qualify for it” (Kenton, 2021). Its aim was to make healthcare more affordable and accessible for those who previously couldn’t get access to much needed healthcare (these generally consisted of minority/largely underrepresented groups). However, things like this tend to have conflicting opinions and can face heavy backlash which the ACA encountered. This act provided health insurance to millions (16+ million) Americans, limited the amount of rate increases insurers could make, reduce the stress of getting life-saving medicine and procedures for people with serious health conditions by allowing them to receive coverage despite a pre-existing condition, and covered a larger number of screenings which allowed people to become more proactive in their healthcare (Roland, 2019). However, this act also affects other people as well; In order to pay for the ACA, new taxes were introduced and/or increased for other things and it ends up being a situation in which “the wealthy are helping to subsidize insurance for the poor” (Roland, 2019). It can also affect unemployment rates because of businesses reducing hours (or letting people go) so as to save money from not needing to cover employees.

After reading the article written by Amy Wang (2021), we see that cancellation of the Affordable Cares Act would result in a lack of access to health insurance in almost 31 million people and the loss of a job for about 1.2 million. Basic preventative services such as immunizations and health screenings would no longer be available to a majority of Blacks and Latinos as “after the main ACA provisions went into effect in 2014, coverage disparities declined slightly as the percentage of adults who were uninsured decreased by 7.1 percentage points for Hispanics, 5.1 percentage points for Blacks, and 3 percentage points for Whites” (ncbi,2016).

Upon being processed in 2009 and signed as a law in 2010 under the Obama Administration, the Republican party has sought to repeal and replace the ACA. Their attempts, like the Better Care Reconciliation Act and the Cassidy-Graham Bill, have been futile and flawed, lacking in funds and health benefits.

Depending on the political views of the legislator, and their views on this issue, it can increase the chances of that legislator getting re-elected if their views match up with those of the citizens and can decrease the chances. In order to maximize the number of people voting for a legislator to get re-elected, they has to be information/statistics about what the people are looking for, and a general consensus has to be reached.

References

Roland, J (2019, Aug 16). The pros and cons of Obamacare. Healthline. Retrieved from https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare#outlook

Kenton, W (2021, Oct 12). Affordable Cara Act (ACA). Investopedia. Retrieved from https://www.investopedia.com/terms/a/affordable-care-act.asp

Buchmueller, T et al (2016 Aug). Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940635/

Wang, A (2021, June 5). Record 31 million Americans have health-care coverage through Affordable Care Act, White house says. The Washington Post.  Retrieved from https://www.washingtonpost.com/politics/2021/06/05/record-31-million-americans-have-health-care-coverage-through-affordable-care-act-white-house-says/

Hi Blessing,

I enjoyed reading your post. You mentioned the Republican attempts to repeal Obamacare to have been flawed and ineffective. In recent years, the pandemic has made attempts to repeal even more difficult. As of last year, the 35 states (including the District of Columbia) that implemented the ACA’s Medicaid expansion were better positioned to respond to the COVID-19 public health emergency and prevent economic decline from waning access to care, financial security, health outcomes, and health disparities (Cross-Call & Broaddus, 2020). Those more at risk for contracting COVID-19, such as low income essential workers, are also protected with the Medicaid expansion. In addition to economic decline, repeal of the ACA during the pandemic individuals with pre-existing conditions, including COVID-19 survivors, would be subject to discrimination by insurance companies (Rapfogel, Calsyn, & Seeberger, 2020). In my opinion, the pandemic has strengthened the argument of those in favor of the ACA as to why it should continue.

References

Cross-Call, J., Broaddus, M. (2020, July 14). States That Have Expanded Medicaid Are

Better Positioned to Address COVID-19 and Recession. Center on Budget and

Policy Priorities. https://www.cbpp.org/research/health/states-that-have- expanded-medicaid-are-better-positioned-to-address-covid-19-and

Rapfogel, N., Calsyn, M., Seeberger, C. (2020, October 1). The Chaos of Repealing the

Affordable Care Act During the Coronavirus Pandemic. CAP.

The Chaos of Repealing the Affordable Care Act During the Coronavirus Pandemic

      Week 3 Discussion

The Affordable Care Act was established to help expand access to healthcare to many people who may now necessarily afford it otherwise. According to the Journal of Public Health article, the cost of the Affordable Care act was Billions of Dollars, and the last effects posed significant constraints on many other Americans (Glied, 2021). At first, many people were excited about having affordable healthcare coverage. The Affordable care Act has many people affected, and though many have access to healthcare, there were many people who had an increase in their premiums. According to a Health Service Research article, people have gained coverage under the Affordable Care Act and still have limitations with range. (Ercia, 2021).

BUY AN ESSAY HERE

               The Legislative Branch should provide detailed outlines how who and how people will benefit from proposed plans for future laws. A people’s Choice article outlined that those in office were in the office until the next election, which was years later ( Foremny, 2021). There is significant power in influence. One must research each proposed candidate and see what type of plans they are planning to implement to affect everyone’s future. The analysis of the voter’s views involves decisions if one is led and is more focused on pleasing the people versus the policies that will go into place. RE-election is primarily the goal for a Legislative Leader, and one pertinent observation is what the leader did while they were in that position to bring forth policies. The downside of once someone is elected, it has been proven that all laws they promised that they would pass once selected do not happen. It is factual that there is a close connection between policies being implemented and the additional agendas of others around the legislative branch. Things have to be relevant and beneficial to get put into laws, and that factor depends on other members and their topics of interest.

References:

Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona,

California and Texas. BMC Health Services Research, 21(1), 920. https://doi.org/10.1186/s12913-021-06961-9

Foremny, D., Freier, R., Moessinger, M.-D., & Yeter, M. (2018). Overlapping political budget cycles. Public Choice, 177(1/2), 1–27. https://doi.org

/10.1007/s11127-018-0582-9

Glied, S. (2021). Continue Moving Forward on the Affordable Care Act Path. American Journal of Public Health, 111(4), 612–613. https://doi.org /10.2105

/AJPH.2021.306175

Monique,

I agree that political candidates make many promises while running for office, some may not actually be put into action for numerous reasons, but I was surprised to see how voter perception of this idea can be influenced heavily by the media.  There is a public perception that politicians frequently break promises.  According to Muller (2020), many politicians do, in fact, fulfill their promises, but the broken promises are much more recognizable and memorable due to the high amount of media coverage.  According to a study conducted over 40 years and four different countries, the media reports at least twice as much on broken than on fulfilled campaign promises, skewing the public’s perception (Muller, 2020).

According to Thesen, Green-Pederson, and Mortensen (2017), a factor that determines the outcome of elections is the amount of public attention their issues receive. Voters prioritize different issues when choosing candidates or parties at different points in time.  Certain issues, such as changes to the ACA, may gain more attention from voters who can not afford the healthcare premiums.

References

Müller, S. (2020). Media Coverage of Campaign Promises Throughout the Electoral Cycle. Political Communication, 37(5), 696–718. https://doi.org/10.1080/10584609.2020.1744779

Thesen, G., Green-Pedersen, C., & Mortensen, P. B. (2017). Priming, Issue Ownership, and Party Support: The Electoral Gains of an Issue-Friendly Media Agenda. Political Communication, 34(2), 282–301. https://doi.org/10.1080/10584609.2016.1233920

One of the underlying sentiments I read from Feldstein’s comments is that the primary focus for each party is who gets the credit for the change. If it appears the change is positive, they want to ensure their party gets credit. And if there will be a negative outcome, they push to ensure the other party is blamed. I remember my father talking about the importance of country over party back when he was first entering the world of politics, but now that sentiment has changed, it seems. Is there a way to push the pendulum back the other way, so that what’s best for the constituents is at the forefront, even if it means collaborating with the other party?

Dr. Mooring

Monique,

I enjoyed reading your post. As I stated in my post, I too believe that many political candidates make a lot of promises while running for office that they have no intention on keeping, or at least know from the start how difficult it may be to fulfill said promise. Health Policy and Politics says “”Politic” is defined as being wise or shrewd, while “politics” is defined as methods, opinions, or scheming” (Milstead & Short, 2019). It is hard to determine which of those two terms our legislators truly practice. Do they really care for their people, or do they care for what will bring in the most amount of money for which some of these legislators may be invested in? I believe repealing this legislation may come with too many issues and uncertainties, but a revision with more options for those who do not benefit from the current ACA would be of best interest for the people.

Capretta, Joseph R. Antos James C. “The ACA: Trillions? Yes. A Revolution? No.: Health Affairs Blog.” Health Affairs, 10 Apr. 2020, https://www.healthaffairs.org/do/10.1377/hblog20200406.93812/full/.

Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics: A Nurse’s Guide (6th ed.). Jones & Bartlett Learning

When it comes to the political side of every issue Americans face today there is never a “right” answer. A big topic for years especially during election time is healthcare. Who’s going to say the right things that going to be appealing to voters in order to get more votes? Honestly, it’s hard to know who is going to act on or put into effect what they campaign for if they are elected. My first issue with government today is there are way too many politicians in seat that have been in that seat for too many years. I think every position time frame should be like the president. If elected, four years to serve then possibly a second term if re-elected. If not that then a maximum of ten years to be in one position. Now, for many years, our presidents have tried different tactics to trying to make healthcare better and more readily available to the American people. One thing President Obama did was pass the Affordable Care Act. This helped many Americans who previously couldn’t afford health insurance to be able to get it. It in most ways forced the American people to get insurance or be penalized if they didn’t. It all sounded great until the actual available plans came out and yes premiums might have been a little cheaper, but the deductibles were so high that it was like not having insurance still. It did allow increases in Medicare recipients and made getting Medicaid more accessible. But, with anything else, nothing is free. All that lead to was higher taxes for those of us who do pay taxes. So, when President Trump was elected, he almost immediately put a hold on the “Obama Care”. Now, to some it sounded great but for those who are on Medicare, it was disappointing because it made cuts to Medicare and put more guidelines on those on Medicaid. With that said, taxes went down as well as prices for other things across the board including gas. So, with both party agenda’s, the Affordable Care Act had some great qualities about it and some bad qualities too. Either way, not everyone would have been happy. Same thing goes to be said when President Trump put a hold on the Affordable Care Act. That had pros and cons too. Trying to balance out healthcare answers to every problem will always exist. That’s why we, as nurses, must stand for what we are taught and what we know and believe in.

The ACA or Affordable Care Act, also referred to as the Patient Protection and Affordable Care Act or Obamacare, was established in 2010 to provide cost-effective healthcare as well as improve the quality of care, signed into law by then president Barack Obama. A large percentage, about 87%, of the 8 million Americans that use ACA utilize it for cost assistance. Since this legislation was passed there have been differing opinions from numerous legislators on whether the act does more harm than good so it is often the main speaking point for politicians when it comes to reelection (Congress, 2021).

In recent years there have been motions to fully repeal or protect ACA put forth by politicians. H.R.185 – ObamaCare Repeal Act, backed by Iowa Republican House Representative Steve King, looks to completely repeal the ACA. There is division amongst the Republican party of whether there should be a replacement plan in place before repealing the act but King, being a strict conservative, believes that first the ACA should be repealed then replaced. He had a firm belief that the act was doing more damage the longer it continued and that the country would be “better off” repealing the act without any back up plan established. King stated that state tax dollars were the key to solve the issue of healthcare affordability, specifically for those with preexisting conditions. His views were controversial within his party and the push to immediately repeal the act lost him favor with his peers. A year after he proposed the bill, he lost his bid for reelection. His opposing opinions along with controversial remarks led to him as the incumbent losing the Iowa GOP Primary to Randy Feenstra. It is clear that repealing the act will have a major economical effect, that is why so many are hesitant to support such a legislation (United States House of Representatives, 2021).

Politicians are apprehensive of the potential cost of repealing or replacing the act. So although there are efforts these efforts don’t get far due to the possible repercussions. As voters and citizens, views on ACA are split as well. Many focus on the negative effects financially for the country. There are those who rely on ACA to aid in providing healthcare converge especially those of low income. Based on what a majority of voters want and the public views of a given politician, the push to alter the ACA can be swayed through reelection. Legislators will often choose decisions that will appease those that will vote for reelection., allowing voters to have influence (Buettgens, 2021).

References:

Buettgens, M., Blumberg, L. J., Holahan, J., & Ndwandwe, S. (2016). The Cost of ACA Repeal. Urban Institute

Congress.gov. (n.d.). Retrieved December 15, 2021, from https://www.congress.gov/

United States House of Representatives. (n.d.). Retrieved December 15, 2021, from https://www.house.gov/

The ACA has had repeal after repeal for 8 years, and we can’t get it right. Changes from Obama the Trump are leaving behind harsh insurance rules and limited coverage at a costly rate (Manchikanti, 2016).

References

Manchikanti, L., Hirsch, J. (2016). Repeal and replace of affordable care: A complex, but not an impossible task. Pain Physician. 19(8): 1109-111,

•             PMID: 27906931

Health care agendas are often at the forefront when politicians are campaigning. A candidates stance on health care many times will determine the outcome of an election. Repealing Affordable Care Act (ACA) would cause millions who are insured under the ACA to lose health care coverage.  The effects of a  repeal would cost hundreds of  millions of dollars in state funding for Medicaid and CHIPS programs. Many families who are currently receiving health care coverage under Medicaid and other market place insurances that have pre-existing conditions would face uninsurability if ACA were to be repealed(Rapfogel & Calsyn, 2020). 

Health care reform comes with pros and cons, above I have listed some pros of ACA, now let’s cover some cons. As many people face increased insurance premiums through ACA marketplace, taxes could increase to fund the growing cost of insurance. To add insult to injury, in an attempt to avoid paying insurance premiums for employees, employers are cutting hours in an attempt dodge the obligation that employers have to provide coverage. Employer’s who have 50 or more full time employees have to offer insurance or cover health care expenses(Roland, 8).  Low income families who are covered under Medicaid experience access to care disparities due to provider availability. A recent study in nine states who participated in expanded Medicaid services as a result of the ACA indicated that the increased demand of serving young patients who previously had no health care coverage made it difficult for primary care providers to meet the needs of the newly insured patients. This issue created longer wait times, increased travel distance to receive care and limited access to secondary care(Ercia, 2021). 

No matter what side of the aisle politicians are on, they should consider the impact that changes in health care will have on the families who stand to lose coverage.  Insuring the under insured is costly but patients seeking care while uninsured places a greater cost burden on health care facilities due to many establishments never getting reimbursed for services rendered from cash pay patients. 

                                                                               References

Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Services Research, 21(1), 920. https://doi.org/10.1186/s12913-021-06961-9

Rapfogel, N., & Calsyn, M. (2020, March 23). 10 Ways the ACA Has Improved Health Care in the Past Decade. americanprogress.org. Retrieved September 16, 2021, from https://www.americanprogress.org/issues/healthcare/news/2020/03/23/482012/10-ways-aca-improved-health-care-past-decade/

Roland, J. (8,  2019). The Pros and Cons of Obamacare. healthline.com. Retrieved September 16, 2021, from https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare

According to the Centers for Disease Control and Prevention (2021) “Cost-benefit analysis is a way to compare the costs and benefits of an intervention, where both are expressed in monetary units”. It is a system that allows the government to have an idea of how much money is needed to impose new laws and what the advantage of that outcome would be to the people of the United Sates. In order for legislators to be reelected again, the people must see the changes that individual has brought to their lives and the community.

The Affordable Care Act (ACA) is the single most important law that has been passed over the past 11 years because it affects the lives of all of the United States citizens and legal immigrants in regard to health care. Legislators create laws based on their own personal experiences, a concern sent from a voter, a special interest group, and unfortunate events that have lead for change (Milstead & Short, 2019).

Repealing ACA during the pandemic would be devastating to the many people that have been left with sequelae from COVID 19. If it is repealed, that would leave millions of people without health insurance and some of these people are already facing financial hardship (Rapfogel et al., 2021). People that have had COVID 19 no matter whether young or old can be left with lung and heart problems leading to a disability (Rapfogel et al., 2021). This means that if the ACA would be repealed, such conditions would not be covered if pre-existing conditions were no longer protected (Rapfogel et al., 2021).

During election time people vote for the candidate that will help better the ACA, not repeal it. The majority of the votes is an indicator for what the people want changed. The legislator that is elected or reelected is chosen because they have campaigned that they will enforce the ACA and make it better for the people.

References

Centers for Disease Control and Prevention. (2021, October 20). Cost-benefit analysis. Centers for Disease Control and Prevention. Retrieved December 21, 2021, from https://www.cdc.gov/policy/polaris/economics/cost-benefit/index.html

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

Rapfogel, N., Calsyn, M., & Seeberger, C. (2021, October 1). The chaos of repealing the Affordable Care Act during the coronavirus pandemic. Center for American Progress. Retrieved December 21, 2021, from https://www.americanprogress.org/article/chaos-repealing-affordable-care-act-coronavirus-pandemic/