Politics and the Patient Protection and Affordable Care Act Discussion Essays

On March 11, 2021, President Biden signed the American Rescue Plan Act that added several  new benefits to the Affordable Care Act (ACA) (Keith, 2021).  The changes that were made benefited the low-income population as well as the middle-income people. For the first time, people that made too much money to receive Medicaid or other insurances, are now eligible to buy a health plan through the health care market place (Keith, 2021). I think this is a huge help to people who don’t have health care insurance because they were not eligible. The Biden Administration has worked hard to help American obtain and retain health care coverage.

According to Milstead and Short (2019), policymakers are not interested in helping the American people  and introduce laws that can get these politicians re-elected. I believe until we learn to value one another, politicians will always do things that benefit them first, then the people of the United States. The prices on prescription drugs and the fact that Medicare patients have no dental, vision or hearing services demonstrates the selfishness in law makers. People who have worked all of their lives and payed their taxes deserve to be taken cared of once they retire.

References

Keith, K. (2021, March 17). New ACA subsidies available on April 1: Health Affairs Blog. Health Affairs. Retrieved December 17, 2021, from https://www.healthaffairs.org/do/10.1377/hblog20210316.222833/full/

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

Claudia,

I completely understand with your sentiments. In contrast to the Biden Administration, the most previous presidential cabinet believed it best to attempt to repeal and replace the ACA rather than amend it. In their point of view, it’s mere existence did more harm than good. Current president Joe Biden has a different approach, looking to improve upon the ACA, through strategies like the American Rescue Plan Act you mentioned (Keith, 2021). Politicians will try to win favor and in turn votes for reelection by promising voters change and depending on the demographic of the voters and popular opinion at the time this could either be against or in support of the ACA.

References:

Keith, K. (2021, March 17). New ACA subsidies available on April 1: Health Affairs Blog. Health Affairs. Retrieved December 17, 2021, from https://www.healthaffairs.org/do/10.1377/hblog20210316.222833/full/

            One of the cornerstones of former President Trump’s campaign was repealing the ACA. Since its passage in 2010, the ACA has divided congress politically along party lines. Democrats, who were responsible for the development and passage of the ACA, argued that the benefits of the ACA, including expanding affordable insurance options to lower-income Americans, far outweighed any downsides of the plan (Improving Health for All Americans, 2017). Republicans, on the other hand, felt that enforcing individual penalties for lack of insurance coverage and requiring small businesses to pay into SHOP programs to provide coverage for employees violated civil freedoms and was an overreach on the government’s behalf (Melillo, 2020).

 For republican politicians, the benefits of attempting to repeal the ACA are obvious: many republican voters and business owners staunchly opposed having to pay into government-sponsored insurance programs and cast their votes for senators and congressmen who promised to help repeal the ACA. Repealing the ACA became a significant foundation of any successful republican campaign. Unfortunately, the lawmakers of the republican party continued to act in the interest of re-election versus social responsibility, and they were unable to put forth a replacement plan for the ACA that would still afford the basic protections that the ACA established for the American people (Melillo, 2020). 

 Despite the fact that many republicans were unhappy with the ACA, and voted along those lines, the costs of repealing the ACA are very high. Many Americans, especially the working poor who make slightly above the Medicaid eligibility financial cutoff, would lose insurance coverage entirely (Willison & Singer, 2017).  Additionally, the government would have to find some way to ensure that private insurance companies continued to provide the essential health benefits (EHB) that were built into the ACA. EHBs set forth a minimum standard that all insurance companies have to provide for patients (Willison & Singer, 2017).  Ultimately, the republican party was unable to find solutions to either of these glaring problems and were therefore unsuccessful in their efforts to repeal the ACA during the 4 years of President Trump’s term. 

References:

Improving Health for All Americans. (2017). Whitehouse.Gov. https://obamawhitehouse.archives.gov/the-record/health-care

Melillo, G. (2020, July 30). Trump administration, Republican Attorneys General ask supreme court to repeal AKA. AJMC. https://www.ajmc.com/view/republican-attorneys-general-file-briefs-to-repeal-aca 

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

There has been a lot of discussion lately about removing some of the financial pull in politics, such as limiting contributions,  and even limiting terms for congress. What do you feel the outcome of some of those battles would be? And if lobbying and large campaign contributions from special interests are eliminated, what would the outcome be, in your opinion?

Dr. Mooring

I believe that removing financial pull and instituting term limits is a move that would only benefit the American people. As party politics have become increasingly divisive in our country in recent years, many people are looking for solutions to drive positive change in our federal government. Instituting term limits would motivate representatives to remove inefficiencies in our congressional system and would ensure that new, hopefully younger voices could be heard in congress (Schindler, 2020). Currently the vast majority of our elected officials are at or near retirement age, and making positive social change can be difficult amongst this age group (Schindler, 2020). Eliminating campaign contributions from special interest groups would be equally beneficial for our government. When candidates accept money from special interest groups, such as pharmaceuticals or gun lobbyists, there is an unspoken understanding that the money changing hands will influence that elected official’s policy decisions (Foreman, 2018).

Reference:

Schindler, I. (2020, January 20). Isabelle Schindler: The need for congressional term limits. UWIRE Text, 1.

Andrea, in an open letter in 1788, Roger Sherman wrote that “nothing renders government more unstable than a frequent change of the persons that administer it” (Burgat, 2018). In my view, congressional term limits can be argued as an easy mechanism for improving the effectiveness of Congress and government at large (Miller et al., 2017). Term limits would allow members to spend less time dialing for dollars and more time on policymaking, allow them to make unpopular but necessary decisions without fear of retaliation at the ballot box, and avoid the corruptive influence of special interests that many assume is an inevitable result of spending too much time in Washington, D.C. However, limiting the number of terms members can serve would also take power away from voters, severely decrease congressional capacity, and limit incentives for gaining policy expertise. What do you think?

References

Burgat, C. (2018, January 18). Five reasons to oppose congressional term limits. Brookings. https://www.brookings.edu/blog/fixgov/2018/01/18/five-reasons-to-oppose-congressional-term-limits/

Miller, S. M., Nicholson-Crotty, J., & Nicholson-Crotty, S. (2017). Reexamining the institutional effects of term limits in U.S. state legislatures. Legislative Studies Quarterly, 36(1), 71–97. https://doi.org/10.1111/J.1939-9162.2010.00004.X/ABSTRACT

Hi Andrea!

Over the past ten years, there have been many attempts to repeal or replace the Affordable Care Act (ACA), all of which have been unsuccessful. For example, one proposal for replacement was the American Health Security Act in 2011, a comprehensive single-payer plan creating a single-tiered coverage model. The effects of a single-payer plan would give all US citizens health insurance, increasing the national healthcare spending by $435 billion and the federal by $1 trillion. However, when considering the implementation and savings in medication and physician prices, the average amount saved would be $556 billion (RAND, n.d.). Another replacement proposed was the American Health Care Act. It contained an amendment that involved changing the age costs, charging individuals older than 47 five times more than individuals younger than 47. Needless to say, both of these proposals were quite controversial, which contributed to them getting shut down in Congress.

Voters do have the power to influence government policies. They can make an impact on certain policies causing legislators to find a middle ground to appease them (Lee et al., 2004). In some cases, legislators may change their vote on a policy if they fear that this may affect their re-election chances. Legislators want to be re-elected, and to do so; they must listen to their voters’ opinions. They can choose to either lean towards and support their voters’ views, or they can go against them and risk being re-elected in the next election.

References

Lee, D. S., Moretti, E., & Butler, M. J. (2004). Do voters affect or elect policies?. The Quarterly Journal of Economics, 119(3), 807–859. https://doi.org/10.1162/0033553041502153

RAND. (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

Marissa,

Thank you for your response. Replacing the ACA would be a monumental undertaking for congress, and it is not surprising that it has not been managed yet. Thank you for bringing to light the proposed American Health Security Act of 2011. As a health care professional, I see so many potential benefits from a single-payer health insurance company, equating to the type of universal health care that they have in Canada and much of the EU. That being said, I also understand that given the population size and the state government structure of the US, instituting such a policy will be very difficult. I hope that during our children’s lifetimes perhaps the US manages to institute a system like the one proposed in the AHAS act of 2011. I do believe strongly that health care is a universal right and I would love to see our country reflect those same values.

Response

Hi Andrea thanks for your post. You know, the controversies surrounding the ACA is a lot but in the long run whatever decision that will be made on this act has to be one that will benefit the general population. With my experiences as a home care nurse, I see how beneficial Medicaid is to most of the elderly population I take care of. There are people who live alone and need assistance in the house but due to the insurance they have like Medicare, they do not “qualify” for assistance, but Medicaid qualifies them for many aide like transportation assistance, HHA care, among others. With ACA being big on Medicaid, I think care really has to be taken when it comes to repealing it. According to an online article, “The Affordable Care Act expanded Medicaid and increased federal funding for community health centers” (Seo et al. 2019), and there is reduction in the barriers of care for people with Medicaid as compared to those with no insurance: therefore “policies that increase disruptions in Medicaid coverage could adversely impact access to care, even among those with available safety net care” (Seo et al. 2019).

Medicaid plays an integral part of our health care system and eliminating ACA could affect it. As mentioned in Milstead & Short, “Medicaid fills large gaps in the U.S. health insurance market, finances the lion’s share of long-term care, and provides core support for the health centers…and millions of others (pg. 182).

References

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

Seo, V., Baggett, P. T., Thorndike, N. A., Hull, P., Hsu, J., Newhouse, P. J., & Fung, V. (2019). Access to care among Medicaid and uninsured patients in community health centers after the affordable care act. BMC health services research. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4124-z

President Trump fought to repeal the ACA, finally agreed to make changes only. However, we failed to see that. We see many pros and cons of Obama Care, mainly cost is the negative. You are taxed even when not having Obama Care. Insurance costs rose, but availability increased, thus wait times are longer in facilities (Gaille, 2018).

References

Gaille, L. (2018). 19 Key Obamacare pros and cons. Retrieved on December 19, 2021, from https://vittana.org/19-key-obamacare-pros-and-cons