Feb 23, 2024 NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act
NURS 6050 Week 2 Discussion: Politics and the Patient Protection and Affordable Care Act
A Sample Answer For the Assignment: NURS 6050 Week 2 Discussion: 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 Although the Republicans repealed parts of the ACA, including the budgetary and fiscal provisions, they did not replace it.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.
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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.
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.
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
Discussion: Politics and the Patient Protection and Affordable Care Act
The five social determinants of health include: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context (U.S. Department of Health and Human Services, 2021).
Out of the 5 social determinants of health, healthcare quality and access to health care appears to be one of the domains the nation struggles with the most. The social determinates of health have such a major impact on individuals’ lives that Healthy People 2030 created one of their goals specifically based on these concepts.
Their goal related to SDOH is as follows: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all (U.S. Department of Health and Human Services, 2021).”
In regard to repealing and replacing the ACA with the AHCA, this would be counterproductive in overcoming the social determinants of health. These determinates are linked to a lack of resources and a lack of opportunity (CDC, 2019). If the AHCA was passed, millions of people would have lost their insurance and lost access to quality healthcare.
This is a prime example of a lack of resources and a lack of opportunity. These determinates are all linked to each other. For example, if someone with no insurance has a medical emergency and must pay for medical services out of pocket, that now affects the determinate of economic stability (U.S. Department of Health and Human Services, 2021).”
References:
U.S. Department of Health and Human Services. (2021). Social determinants of health. Social Determinants of Health – Healthy People 2030. Retrieved September 16, 2021, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health.
Center for Disease Control and Prevention. (2019). NCHHSTP Social Determinants of Health. Center for Disease Control and Prevention. Retrieved September 16, 2021, from Social Determinants of Health | NCHHSTP | CDC.
I couldn’t agree with you more, and I appreciate Dr. A.E.’s intentions in prompting this question and
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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.
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.
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
Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.
Consider for example that the number one job of a legislator is to be reelected. Cost can be measured in votes as well as dollars. Thus, it is important to consider the legislator’s perspective on either promoting or not promoting a certain initiative in the political landscape.
To Prepare:
Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).
Consider who benefits the most when policy is developed and in the context of policy implementation.
By Day 3 of Week 3
Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA.
Then, explain how analyses of the votes views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).
Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria.
Legislators who assume elective positions are always determined to support initiatives that will influence voters to re-elect them. However, due to competing interests of the government, some legislators might get concerned with the potential impacts that some bills, when signed into law, might affect their possibilities of getting re-elected (The Commonwealth Fund, 2017).
Borrowing from the events that surround the efforts to repeal/replace the Affordable Care Act (ACA), conducting a cost-and-benefits analysis, in terms of both dollars and votes, can help legislators to decide whether they should support or oppose government initiatives.
Repealing/replacing the ACA is associated with benefits and costs measured in dollars and votes. According to the Committee for a Responsible Federal Budget. (2017), the cost of repealing or replacing the ACA through 2027 is estimated to be 350 billion United States dollars. However, the United States government will save approximately 1.55 trillion through 2027 when only the coverage provisions of the ACA are replaced.
It is further anticipated that although repealing Medicare cuts would cost about 1.10 trillion United States dollars, it is likely to cause a slight improvement in economic growth, which would translate into additional net savings of about 200 billion United States dollars (Committee for a Responsible Federal Budget, 2017). As for Americans, their concern is whether they will still benefit from increased health coverage, enabling them to continue receiving affordable prescription drugs and accessing other healthcare services (The Commonwealth Fund, 2017; Willison & Singer, 2017).
In this respect, legislators will likely benefit from their political maneuvers and get re-elected only when repealing/replacing ACA increases health coverage for Americans and economic growth. In this respect, legislative leaders must analyze the voters’ views before positioning or recommending national policies.
By Day 6 of Week 3
Respond to at least two of your colleagues* on two different days by expanding on their explanation and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.
The Affordable Care Act, called Obamacare, was a significant healthcare reform passed in 2010. Its replacement became a severe issue, with various lawmakers advocating for multiple approaches based on their ideological beliefs and perceived societal benefits.
The cost-benefit analysis regarding legislators reelected significantly impacted efforts to repeal or replace the Affordable Care Act (ACA). The ACA’s new exchanges were successful, depending on where one looks, as states implemented and undercut the ACA during the Obama administration. Different states in the US that tried to create their exchanges failed, while others that appeared hostile on the surface worked with the Obama administration behind the scenes.
Repealing will undermine efforts to reduce the budget deficit, primarily rooted in the cost of health care in the United States. The Congressional Budget Office (CBO) addressed that the ACA will reduce the deficit by $100 billion over the first decade and by more than $1 trillion between 2020 and 2030. ACA would not diminish the rising healthcare costs. The bill incorporates many current ideas about reducing healthcare costs, which is not insufficient. Introducing cost-saving measures, such as payer rates and a public option, has become necessary.
The Democrats continue to control the Senate, and President Obama will veto any bill trying to repeal the ACA. Also, Republicans will be able to dismantle the ACA by refusing to fund it. They evaluated the healthcare system’s impact on insurance markets, healthcare providers, and the economy. The negative consequences of supporting a full repeal or replacement outweighed the benefits. They were concerned about adverse reactions and relied on the ACA for healthcare access, affordability, and protection. The lawmakers are mindful that the reelection was compromised if they supported a policy that resulted in constituents losing coverage or facing higher costs.
The ACA needed to meet the political goal of most voters about the affordability of their coverage. The law’s supporters among the public did not say making affordable care was a reason. Analyses of voter views on healthcare, such as public opinion polls, and surveys, provided insights for legislative leaders.
They allowed lawmakers to understand the concerns and priorities of constituents regarding healthcare, including Medicare and Medicaid policies.(Nahouraii et al., 2021) Legislative leaders understand that their success hinges on voter approval. Aligning their recommendations with the current voter views increases voter support and ultimately being reelected. Voter views on healthcare policies will help legislative leaders to craft effective messaging strategies.
A legislator’s job is to reelect; this does not imply that electoral considerations solely drive their decisions. Lawmakers also consider policy goals, constitutional obligations, and the long-term implications of their choices. However, voter views are critical in shaping legislative leaders’ recommendations on national policies, mainly on essential issues like healthcare that directly impact their constituents’ lives.
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Module 2 Discussion: Politics and the Patient Protection and Affordable Care Act
RE: Discussion – Week 3
The Affordable Care Act was enacted by former President Obama in 2010. The goal of the ACA was to make health insurance more affordable and available to the people, expand the medicaid programs statewide, as well as support innovative medical care delivery methods which would hopefully decrease health care costs (ACA). Health care and repealing/replacing the ACA is a hot topic among the political world. The ultimate goal of the politician or legislator is to gain votes and be reelected.
Whether a legislator truly believes repealing/replacing the ACA with something different will be beneficial to Americans, they are likely to do so anyway to gain the vote from the community. Politicians desire to secure reelection seems to cause legislators to engage in undesirable activities.
Money unfortunately plays a critical role in these election and reelection campaigns, as it costs millions of dollars to win an election even at the local level (Milstead & Short, 2019). Cost benefit analysis plays a huge part in terms of legislators being reelected. Legislators will partner with “527 committees” to gain funds for their campaigns (Milstead & Short, 2019).
This can skew their actual viewpoint and opinion on a topic, but due to the necessity of big money needed to win an election, they will partner with these wealthy individuals and employ and project their opinion on a political topic to gain money and votes (Milstead & Short, 2019).
The republican party is working on, and has been trying hard, to repeal/replace the ACA in order to gain votes of the people who are not in favor Obamacare, which in turn helps them gain votes for reelection. To do this, the republican party has tried to implement the Better Care Reconciliation Act, which has cut funding in certain areas, and cost the American people more money in ways (Amadeo, 2018).
References
ACA. (n.d.) Affordable Care Act- Healthcare.gov Glossary. Retrieved March 11, 2020, from https://www.healthcare.gov/glossary/affordable-care-act/
Amadeo, K. (2018, October 17). What a Congressional Plan to Repeal Obamacare Would Look Like. Retrieved March 11, 2020, from https://www.thebalance.com/congressional-plans-to-repeal-and-replace-obamacare-4160599
Milstead, J.A., Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed). Burlington, MA: Jones & Bartlett Learning.
Health Policy and Politics: The Affordable Care Act
The Affordable Care Act (ACA), famously known as Obamacare, sought to enhance universal healthcare access by making health insurance to be inexpensive for all Americans. ACA targeted individual market, employer-provided benefits, and non-Medicare-eligible population to ensure they accessed affordable and comprehensive insurance coverage without any discrimination on the basis of their health status (Nadash, Miller, Jones, Gusmano, & Rosenbaum, 2018).
The Republican Party seeks to stop government interference in the insurance market. It has spearheaded efforts to repeal and replace the ACA through the courts terming it as unconstitutional. Additionally, several states have shown open hostility to the law since it expanded the Medicaid coverage. Besides, House and Senate Republicans have sponsored several repeal initiatives such as Better Care Reconciliation Act (BCRA) and Graham-Cassidy bills (Nadash et al., 2018).
The constant onslaught of the ACA from President Trump and Republicans has led to an increase in premiums and several insurers withdrawing from selling the insurance plans in the recent past. The early success of the ACA, whereby millions of Americans secured insurance coverage through the individual markets, subsidies for low-income individuals, and Medicaid, have been eroded.
The Impact of Cost-Benefit Analysis
Milstead and Short (2019) argued that the supporters and critics of ACA include the members of Congress whose main objective is to be re-elected during the election cycles. The opponent’s debates and efforts to repeal and replacement of ACA in both President Obama’s and Trump’s administrations are deliberate for political expediency as opposed to promoting public health and well-being.
Furthermore, the political elites do not perform a cost-benefit analysis of the effectiveness of the ACA to enable them to compromise on a bipartisan basis about the contentious issues contained in the law, such as the insurance mandates, Medicaid, insurance plans, and tax credits.
Analysis of Votes
Notably, the ACA resulted in a progressive American tax system whereby the wealthy individuals were obligated to pay higher federal taxes, 3.8% more on taxes on unearned income and a 0.9% increase in Medicare payroll taxes. The new tax revenue was earmarked to fund the expansions proposed by the ACA (Grogan, 2017).
Additionally, the law delimited the out-of-pocket costs for marketplace insurance coverage, specifically $13,200 and $6,600 for family and individual plans (Grogan, 2017). The subsidies and financing options of ACA ensured equitable access to healthcare and lowered the financial burden of healthcare costs for the majority of low-income Americans.
According to Congressional Budget Office, The Joint Committee on Taxation, and The Center on Budget and Policy Priorities (as cited in Grogan, 2017), repealing and replacing the ACA will increase Medicaid costs by over $370 billion over the next decade, which would be covered by the states. Besides, eliminating tax directives will benefit the wealthiest people since they will be able to save almost $600 billion through 2026 (Grogan, 2017).
Despite such cost-benefit analysis being conducted to determine the effect of repealing and replacing ACA, the legislators focus on their re-election prospects while discussing the merits and demerits of Obamacare. The lawmakers’ support for ACA must be consistent with the views of their electorates and donors. For instance, voting against the Act would have been contrary to the desires of most Republicans, and they risked losing their elective seats in the House or Senate.
Conclusion
It is evident that ACA not only resulted in national Medicaid expansions and subsidized Marketplace coverage, but it also reduced the cost of medical care and improved access to health services for patients in various age groups. These results would be what any leader would like to experience in their country, that is easy access to affordable and quality care for all people. Nevertheless, legislators would be willing to disregard these benefits to the society if all their chances of re-election would not be increased by them supporting the ACA.
It is on the same basis that members of Congress will make decisions on whether to reject or recommend national policies concerning Medicaid/Medicare. Politicians rely on donors and lobbyists for financial support to win their elections. In healthcare, these funders could be medical organizations that are negatively affected by the particular policy under deliberation. As such, to ensure that they continue to receive support from these agencies, legislators have to cater to the interest of their donor and vote to reject a policy that could otherwise, benefit the society.
However, this does not mean that they do not believe passing such a proposal into law would be in the best interest of the public. The members of the U.S. Congress usually align with their left- or right-wing political affiliation and support legislations to appease their electorates, lobbyists, and sponsors purposely to ensure they retain their Senate or House seats as opposed to promoting public good in a bipartisan manner.
References
Grogan, C. M. (2017). How the ACA addressed health equity and what repeal would mean. Journal of Health Politics, Policy and Law, 42(5), 985-993.
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Nadash, P., Miller, E. A., Jones, D. K., Gusmano, M. K., & Rosenbaum, S. (2018). A series of unfortunate eve
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