Discussion: Politics and the Patient Protection and Affordable Care Act

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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

NURS 6050 Discussion Politics and the Patient Protection and Affordable

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.

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.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:

Week 3 Discussion

ORDER NOW FOR AN ORIGINAL NURSING ESSAY ASSIGNMENT ON: Discussion: Politics and the Patient Protection and Affordable Care Act
Grading Criteria

To access your rubric:
Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:
Week 3 Discussion

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

 Chapter 3, “Government Response: Legislation” (pp. 37–56)
 Chapter 10, “Overview: The Economics and Finance of Health Care” (pp.
180–183 only)

Congress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

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.

United States House of Representatives. (n.d.). Retrieved September 20, 2018, from
https://www.house.gov/

United States Senate. (n.d.). Retrieved September 20, 2018, from https://www.senate.gov/

United States Senate. (n.d.). Senate organization chart for the 115th Congress. Retrieved
September 20, 2018, from https://www.senate.gov/reference/org_chart.htm

Document: Legislation Grid Template (Word document)

Required Media
Laureate Education (Producer). (2018). Working with Legislators [Video file]. Baltimore, MD:
Author.
Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel
Teitelbaum [Video file]. Baltimore, MD: Author.
Credit: Provided courtesy of the Laureate International Network of Universities.
Laureate Education (Producer). (2018). Contemporary Issues in Public Health Policy with Joel
Teitelbaum [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). Peter Beilenson: Population Health [Video file].
Baltimore, MD: Author.

RE: Discussion – Week 3

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Module 2 Discussion: Politics and the Patient Protection and Affordable Care Act
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 (6^th ed.). Burlington, MA: Jones & Bartlett Learning.

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.

RE: Discussion – Week 3- Initial Post

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Ever since The Patient Protection and Affordable Care Act (PPACA, Affordable Care Act, ACA, or Obamacare) was signed into law in 2010, Americans have always been on the divide. The ACA was passed without any Republicans’ signature. After its passage and implementation, half of the states, mostly led by Republicans, challenged the law (Walden University n.d.). The ACA is an example of a significant federal policy that aimed to improve people’s access to health care. Health care access means having the ability to receive the right type of care when needed at an affordable price (Mason et al., 2020). Americans were skeptical initially because of the number of regulations, taxes, mandates, and subsidies. Opinions changed when the number of uninsured Americans went down.

With the Trump administration and Congress continue to show interest in repealing the ACA, more people said the ACA had a mostly positive effect on the country. More Americans have access to health care without the fear of being denied because of a pre-existing condition. Several ACA provisions make it easier for individuals to get and keep insurance (Patient Protection and Affordable Care Act, 2020).

With the global pandemic, it is essential to have insurance. With millions of Americans who lost their jobs, millions of them become uninsured. But with ACA, the newly unemployed were able to get health coverage through the ACA marketplace with financial assistance to make their coverage affordable or through Medicaid expansion. The COVID pandemic has influenced public opinion regarding health insurance coverage. The public influence will then affect their legislator’s view as the legislator needs votes to get reelected. If they represent an area with high unemployment, they will most likely be on the side to keep the ACA or replace it with another program that offers even more health insurance exchanges.

References

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2020). Policy & politics in nursing and health care – E-book. Elsevier Health Sciences.

Patient protection and affordable care Act. (2020, March 26). Brain Injury Association of America. https://www.biausa.org/public-affairs/public-policy/patient-protection-and-affordable-care-act

Walden University. (n.d.). An Introduction to Health Policy and Law Program Transcript. https://class.content.laureate.net/9e8e1f08ee35476e91f0bca97ae86ae1.html#section_container_20

RE: Discussion – response 2

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Karen, I enjoyed reading your post and you offered a lot of information regarding the ACA. While I agree that the purpose of passing the Affordable Care Act was in the best nature of the Americans it was meant to serve, it was met with opposition from the conservative party. Gardner (2013) wrote that creating a new health care structure that involves fundamental change in how providers are paid, how consumers are insured, and how medical care and public health are integrated to safeguard the nation’s health at a sustainable cost, will not happen without difficulties along the way. Although the ACA offers progress on getting more Americans insured it did not transition smoothly with many Americans and legislators alike.

When President Trump took office, his main goal was to repeal the ACA, however without another plan to implement millions of Americans would lose healthcare. Those that opposed the ACA described it as a policy that allows for big government intrusion into individual freedom (Gardner, 2013) which has been the basis for several Supreme Court cases that challenge the validity of the ACA and President Trumps stand on taking away the rights of American freedom to choose.

As congress prepares for their re-election they have been faced with the pressure of repealing/replacing or fixing a broken ACA health care plan. According to Fontenot (2014) it undoubtedly becomes harder to push for repeal as Americans get used to benefits offered through the ACA, but it would also appear the country is simply tired of arguments about the law. The American people want progress and legislation on both sides, but to this day there is still question on the security of our nation’s health care system. According to an article in the Washington Post “some conservative advocates still push legal challenges to the ACA. But overall, Republicans lawmakers, faced with the pandemic’s health-care crisis, have slowed or stopped their efforts to terminate benefits that votes have come to expect (2020). Officials are faced with tough decisions to protect the American people they were elected to serve and balance the opposition to secure a job in the next election. With the expansion of Medicaid those people that have lost their jobs due to the global pandemic can still obtain health insurance coverage in the event they are impacted medically by the pandemic. Many lawmakers have done a cost-benefit analysis based on the goal of securing a their job in the next election and attempting to repeal a law that has provided health care coverage to so many impacted by the pandemic would be political suicide.

Resources

Fontenot, S. F. (2014). Politics And A Broken Promise: The ACA Faces Another Election Cycle. Physician Leadership Journal, 1(2), 48-50. POLITICS AND A BROKEN PROMISE: THE ACA FACES ANOTHER ELECTION CYCLE.: @ Walden University Library (waldenulibrary.org)

Gardner, D. (2013). Health Policy and Politics. ACA Implementation: A Vulnerable and Misunderstood Endeavor. Nursing Economics, 31(6), 307-306. Health Policy and Politics. ACA Implementation: A Vulnerable and Misunderst…: @ Walden University Library (waldenulibrary.org)

Jacobs, L. R., Mettler, S., & Zhu, L. (2020, April 27). Republicans are relying on the Affordable Care Act to respond to the pandemic. The Washington Post. Facing the coronavirus, Republicans now support the Affordable Car Act – The Washington Post

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6050_Module02_Week03_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)
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.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module02_Week03_Discussion_Rubric