Feb 23, 2024 NURS 6050 Politics and the Patient Protection and Affordable Care Act
NURS 6050 Politics and the Patient Protection and Affordable Care Act
NURS 6050 Politics and the Patient Protection and Affordable Care Act
The Affordable Care Act (ACA) was enacted in 2010, and it considerably changed the U.S. health care landscape. The goals of the ACA were to make insurance coverage more affordable, reduce the number of uninsured, and expand access to care. To attain these goals, the ACA expanded eligibility for Medicaid and established new marketplaces where Americans without employer coverage could purchase policies directly from insurers (Oberlander, 2017). The ACA faced strong opposition from Republicans, who described it as unrealistic because it required every American to have medical insurance (Oberlander, 2017). When the Trump administration took power in 2017, the president and Congress members of the Republican Party vowed to replace the ACA. However, one year after taking office, Republicans could not agree on whether to repeal the ACA immediately, repeal right away and replace it later, or repeal it later after establishing a replacement strategy (Oberlander, 2017). Although the Republicans repealed parts of the ACA, including the budgetary and fiscal provisions, they did not replace it.
The Senate Republicans’ failure to honor their promise of passing a bill to replace ACA, can be attributed to the unpopularity of this bill to the public. The legislators had to assess the political impact of repealing the ACA with no replacement on their chances of being reelected (McCarthy, 2017). They had to perform a cost-benefit analysis on the cost of repealing the ACA on the future chance of being reelected and the benefits of repealing it. For instance, if the Senate replaced the ACA right away, with no replacement, the number of uninsured Americans would increase drastically, which would be opposed by their voters (McCarthy, 2017). This would negatively affect the public view of the lawmakers on their constituents, and lower their odds of being reelected if they did not have a better plan to replace the ACA. Besides, the cost-benefit analysis can explain why the Republicans had two canceled votes in March 2017 and had to introduce a new amendment to the American Health Care Act to unite the party behind the bill (McCarthy, 2017). The failure to replace the ACA as promised shows that lawmakers can be unwilling to support bills that are a potential threat to their election results in upcoming elections.
Legislative leaders’ decisions regarding recommending or positioning national policies are often influenced by their voters’ views. Voters are known to influence legislators’ policy choices and are at times forced to compromise their choices including partisan politicians (Pacheco & Maltby, 2017). Lawmakers have to consider their voters’ views before making a policy decision that affects their constituents to maintain a positive public image (Pacheco & Maltby, 2017). In the case the voters’ views contradict a legislator’s decision regarding a policy, the lawmaker is forced to compromise their position on the policy and move to the center.
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Failing to take the voters’ views can have negative consequences on the law maker’s future elections. Furthermore, to continue supporting and voting for a legislator in future elections constituents must remain convinced that their lawmaker is listening to them and consider their views (Pacheco & Maltby, 2017). For instance, members of congress had to assess the voters’ view on repealing the ACA provisions that would cut funding for Medicaid or change Medicaid to a block grant program. Since many Americans benefited from the expansion of Medicaid, it affected Congress’ decision to pass bills that would hinder their voters’ access to the program and ultimately affect their public image.
NURS 6050 Politics and the Patient Protection and Affordable Care Act References
McCarthy, M. (2017). U.S Republican attempt to repeal and replace Affordable Care Act collapses. https://doi.org/10.1136/bmj.j3508
Oberlander, J. (2017). Repeal, replace, repair, retreat—Republicans’ health care quagmire. New England Journal of Medicine, 377(11), 1001-1003.
Pacheco, J., & Maltby, E. (2017). The role of public opinion—does it influence the diffusion of ACA decisions?. Journal of Health Politics, Policy and Law, 42(2), 309-340.https://doi.org/10.1215/03616878-3766737
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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 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
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How The Cost-Benefit Analysis in Terms of Legislators Being Re-Elected Affected Efforts to Repeal/Replace The ACA
The ‘Obamacare’ commonly known as the Affordable Care Act was launched by President Barack Obama. The policy has enabled most Americans to receive health insurance. However, the repeal process has failed perhaps because election matters a lot to politicians. Just within a year of Trump’s inauguration, Republicans began the debate to repeal ‘Obamacare’ and revise the long-standing Medicare and Medicaid programs (Obama, 2017). Because replacing the ACA would result in many people losing their insurance and this would limit medical care, it would impact negatively the 2018 election. Many leaders who supported the repeal would lose their seats. The leaders could not support the repeal upon realizing that it would negatively impact their reelection. A clear picture here is that political leaders do not care about how repealing the Affordable Care Act would affect Americans but how it would affect their reelection chances (Taylor et al., 2017). Therefore, it is clear that not just election results matters to politicians but also the threat of upcoming elections.
The Medicare Prescription Drug Savings and Choice Act of 2019
Politicians’ interest in being reelected also impacted the Medicare Prescription Drug Savings and Choice Act of 2019. This bill was introduced by the representative for Illinois’s 9th congressional district who is a Democrat (Congress.Gov, 2020). The bill is still in the first stage of the legislative process. It was introduced to Congress on 21st October 2019. It must be first considered by the committee before it is send to the House or Senate as a whole. Politicians will have to examine this bill to identify whether or not it will impact the upcoming election. This bill touches part D of Medicare, which is a voluntary program that helps pay for outpatient prescription drugs (Congress.Gov, 2020). This section, therefore, might affect many Americans. How this bill will influence the next election will determine whether or not it will be passed as a part of the law that governs Medicare operations in the United States. The cost-benefit analysis in terms of politicians being reelected therefore has a significant influence on their recommendations and positioning of legislative policies (Dickinson & Reinmuth, 2017, October).
NURS 6050 Politics and the Patient Protection and Affordable Care Act References
Congress.Gov. (2020). H.R. 4769: Medicare Prescription Drug Savings and Choice Act of 2019. Retrieved from https://www.congress.gov/
Dickinson, M. J., & Reinmuth, K. (2017, October). Trump, Congress, and Health Care: All Politics Is National. In The Forum (Vol. 15, No. 3, pp. 431-450). https://rowman.com/ISBN/9781538105740/The-Trump-Presidency-Outsider-in-the-Oval-Office
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Obama, B. H. (2017). Repealing the ACA without a replacement—the risks to American health care. Obstetrical & Gynecological Survey, 72(5), 263-264. doi: 10.1056/NEJMp1616577
Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook, 65(2), 346–350. doi:10.1016/j.outlook.2017.05.003
I couldn’t agree with you more, and I appreciate Dr. A.E.’s intentions in prompting this question and mentioning social determinants of health. Healthcare quality and access to health care is a major obstacle in healthcare reform. The ACA and AHCA not only strategize to increase access to health care by providing Americans affordable insurance options, but also include interventions to force the improvement of healthcare quality, which becomes a major source of contentions for economic healthcare stakeholders.
NURS 6050 Politics and the Patient Protection and Affordable Care Act
An example of this can be explored by discussing the AHCA element of transitioning care from a fee-for-service reimbursement model to a value based reimbursement model. This AHCA enforced change resulted in a major shift for many health care organizations. Fee-for-service reimbursement rewarded providers for the volume of services they provide, while the value-based approach payments are rendered based off of meeting agreed-upon quality and performance measures directly tied to patient outcomes. According to McHugh, M. D., et al, (2013), the AHCA’s Hospital Readmissions Reduction Program (HRRP) highly invests and highlights the value of quality measures and services offered by health care professionals outside of the provider, specifically nurses.
HHRP penalizes hospitals with excessive readmission rates of Medicare beneficiaries; the primary objective of the HRRP is to reduce the rate of readmissions in accordance with the hospitals’ financial incentives with payers’ and patients’ quality goals (McHugh, M. D., et al, 2013). According to McHugh, M.D., et al, (2013), hospitals with higher nursing staff had 25 percent lower odds of being penalized compared to other similar hospitals with lower staffing. One can see why penalties like these would create resistance and motivation for repeal of the AHCA in primary healthcare economic stakeholders and highly influence their political affiliation despite social determinants of health.
NURS 6050 Politics and the Patient Protection and Affordable Care Act References
McHugh, M. D., Berez, J., & Small, D. S. (2013). Hospitals With Higher Nurse Staffing Had Lower Odds Of
Readmissions Penalties Than Hospitals With Lower Staffing. Health Affairs, 32(10), 1740–1747.
https://doi-org.ezp.waldenulibrary.org/10.1377/hlthaff.2013.0613
Murphy, L. S., & Warshawsky, N. E. (2015). Nursing Education A Solution to Healthcare’s Gordian Knot?
JONA: The Journal of Nursing Administration, 45(6), 302–304. https://doiorg.ezp.waldenulibrary.org/10.1097/NNA.0000000000000203
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This is insightful. Affordable Care Act has provided opportunities for millions of Americans to get access to affordable healthcare services. The policy has greatly improved healthcare delivery processes in different healthcare institutions. Affordable Care policy was one of the focuses in the previous elections (Glied & Jackson, 2017). The creation and implementation of different policies in the healthcare system often impact a number of individuals. Particularly, nurses and general healthcare professionals, as well as patients, are mostly affected.
The legislation on the Affordable Care Act involved consideration of different factors, including insurance policies from different health insurance companies (Laureate Education, 2018). Also, there was voting based on the party line. However, some of the legislators went beyond the party requirements to consider the impacts of the policy on the citizens. The repealing of the Affordable Care Act by the Trump administration was meant to influence the voting patterns in the subsequent election (Milstead & Short, 2019). The president knew that individuals who cast their votes based on the issues around the affordable care act would remain on his side in the upcoming election.
NURS 6050 Politics and the Patient Protection and Affordable Care Act References
Glied, S., & Jackson, A. (2017). The future of the Affordable Care Act and insurance coverage. American journal of public health, 107(4), 538-540. Retrieved from: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.303665
Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel Teitelbaum [Video file]. Baltimore, MD: Author.
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
ACA was marked in history by President Obama. It is the most comprehensive healthcare reform since Medicare. This law achieved many goals including increased accessibility, affordability, and quality healthcare. However, it became insurance for many with coverage for few. Over the years Republican Members of Congress and President Trump planned and proposed to repeal and replace the ACA. The Trump Administration saw a rise in premiums and deductibles, narrow networks, and high coverage. And offered about the patient-centered healthcare system that promotes choice, quality, and affordability.
On March 2017, House Republic Leaders introduced repeal and replace of budget reconciliation legislation to repeal the ACA. And then Democratic Leaders submit a resolution, requesting President Trump to repeal and replace the ACA. Both wanted to change coverage with pre-existing condition, guarantee available covers adult up to 26 years old and renewable of coverage, and reduction of out-of-pocket expenditures.
AHCA converted Medicaid financing to a per capita structure beginning 2020. It means reduction of fund about $880 million Medicaid resulting in 14 million people loosing coverage.
ACA expanded and improved health insurance coverage by increasing access to coverage through Medicaid expansion and providing subsidies to purchase private insurance on the healthcare exchange and secondary upgrades. The quality and scope of coverage improving benefits design including implementing the essential health benefits. Due to changes of ACA as years go by, it is uncertain but it is clear that they continue to benefits of essential health benefits. Some health reform is beneficial to some individual and some are not. ACA 2020, this legislative allows the individual to have increase access to medical care bu lowering the member of uninsured resident in the country, However different reform of this law focused on the objective such as reform in health care insurance, easy access to insurance, affordable exchanges and credit that are eligible for families and individual. The cost benefit did not support the government action instead, it lead to suffering of common people and become damage to the political interest.
For the recipient who is older, sicker and poorer are unlikely able to afford the cost-sharing, and for young healthy high income would find much more affordable coverage.
One of the population health topics that has risen to the presidential agenda level in the past few years is mental health. According to a white house briefing room statement:
Our country faces an unprecedented mental health crisis among people of all ages. Two out of five adults report symptoms of anxiety or depression. And, Black and Brown communities are disproportionately undertreated- even as their burden of mental illness has continued to rise. Even before the pandemic, rates of depression and anxiety were inching higher. But the grief, trauma, and physical isolation of the last two years have driven Americans to a breaking point.
As if this crisis is not bad enough, several states of the United States continue closing down mental health institutions. This has led to mental health patients remaining in the community without proper monitoring and management of their various conditions. This in turn has seen to an increase in emergency room cases of mental health complications which end up being costly to treat. But then, even after these patients are treated, there is no follow-up care in the community due to the shortage of mental health professionals to manage them. This leads to a vicious circle of the patients ending up right back at the hospital.
The mental health crisis rose to the presidential level and was one of the topics covered by the two presidential candidates during their campaigns. According to the commonwealth fund publication, the candidate’s approach to the mental health crisis were:
The Trump administration seeks to repeal the Affordable Care Act (ACA). This will undo coverage and payment protections that expanded Medicaid; extended mental health parity requirements to the small-group, individual, and Medicaid managed care markets; and required coverage of mental health services as an “essential health benefit” in many private health plans. Repealing the ACA will limit patient’s access to mental health services (Nuzum & Abrams, 2020).
On the other hand:
Vice President Biden has committed to protecting and building on the ACA to ensure coverage expansion and protections for mental health services. He has pledged to “redouble efforts” to enforce existing mental health parity laws and expand funding for mental health (Nuzum & Abrams, 2020).
As we can see from the above statements, the candidates were looking at the mental health crisis from two different angles. One was for the idea of repealing the ACA which would lead to creating more problems to an already existing problem. The ACA was helping alleviate the problem by covering for mental health services. So, by repealing it, mental health services would not be covered and that would force mental health patients to go untreated, making the crisis worse. On the other hand, the other candidate’s approach of expansion and protection of mental health services would definitely reduce the mental health crisis.
What I would do differently to address this mental health crisis would be to involve healthcare professionals well vested in mental health, then have them create policy briefs. Typically, the purpose of a policy brief is to create a short document providing findings and recommendations to an audience who may not be experts in an area of interest (De Marco et al., 2012). Mental health professionals are the experts in this area of interest, facing these challenges firsthand. Therefore, they would be the best experts to come up with recommendations of solutions to this mental health crisis.
The other thing I would do differently is engage Nurse Practitioners (NPs) through political efficacy. Political efficacy is “an activity that has the intent or effect of influencing government action- either directly by affecting the making or implementations of public policy or indirectly by influencing the selection of people who make those policies” (Verba, Schlozman, Brady, & Brady, 1995, p.38). The shortage of mental health practitioners is at a record high yet some states still have laws and regulations that are limiting NPs full extent practice. Twenty-eight states have laws and regulations limiting the ability of nurse practitioners (NPs) full extent of their education and training, thereby preventing patients from fully accessing NP services (O’Rourke, Crawford, Morris, & Pulcini, 2017). By engaging NPs in political efficacy, they can advocate and influence change in the state rules and regulations which would allow them full practice. This would in turn help alleviate the problem of not having enough mental health practitioners and help solve the mental health crisis.
References
DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy briefLinks to an external site.Links to an external site.. Nursing Outlook, 62(3), 219–224.
https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/Links to an external site. (Retrieved 03.07.23)
Nuzum, R., & Abrams, M.K. “Health Care in the 2020 Presidential Election: Mental Health and Substance Use Disorders,” To the Point (blog), Commonwealth Fund, Oct. 14, 2020. https://doi.org/10.26099/j31c-mr53Links to an external site.
O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and participation of nurse practitionersLinks to an external site.Links to an external site.. Policy, Politics, and Nursing Practice, 18(3), 135–148.
Verba S., Schlozman K. L., Brady H. E., Brady H. E. (1995) Voice and equality: Civic voluntarism in American politics, Cambridge, MA: Harvard University Press.
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Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.Supported by at least three current, credible sources.Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.At least 75% of post has exceptional depth and breadth.Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).One or two criteria are not addressed or are superficially addressed.Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
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Written somewhat concisely; may contain more than two spelling or grammatical errors.
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0 (0%) – 34 (34%)
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Posts main post by day 3.
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