Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act

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NRSE 6050 Policy and Advocacy for Improving Population Health

Week 3 Discussion: Politics and the Patient Protection and Affordable Care Act

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     The Affordable Care Act (ACA) was set in motion to help improve the health equity of persons in the United States. It is argued that the Trump administration has no set goal of improving health equity (Grogan, 2017). Grogan (2017) reports that the ACA proposed replacement will decrease the availability of healthcare coverage; low-income Americans will pay higher insurance premiums and remove the taxation on wealthy Americans, therefore, reducing the number of tax dollars for healthcare expenditures. Changes being proposed by the Trump administration could completely dissolve the efforts made by the ACA.  Grogan (2017) predicts if the repeal goes through, our country will be on the road to more significant health inequities and an increased amount of health disparities.

Politicians have to rely on others for financial support. Campaigns can cost millions of dollars. This money comes mostly from wealthy individuals, large organizations, or specialty groups that support the agenda or that will pay for the politician to promote their agenda. In the 2016 election cycle, I found it interesting that the healthcare sector contributed over 236,000,000 dollars, most of that to Republican parties (Milstead & Short, 2019). Although necessary to need financial contributions, I find that it is appalling that politicians would choose to support an agenda that risks the health of the American people, just for their monetary gain. Haselswerdt (2017) reports that poor health drains resources, time, and money. Americans spent 3.6 Trillion dollars in healthcare in 2018 (“Historical,” n.d.). It would seem that politicians would want to decrease the amount spent on healthcare and move to more preventative health, which would include persons being able to be insured.

 

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.

Haselswerdt, J. (2017). Expanding Medicaid, Expanding the Electorate. The Affordable Care Act’s Short-Term Impact on Political Participation. Journal of Health Politics, Policy & Law, 42(4), 668-695.

 

Historical. (n.d.). Retrieved March 10, 2020, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical

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

Week 3 Discussion

Politics and the Patient Protection and Affordable Care Act

Source: Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Chicago, IL: Health Administration Press.

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.

The suppliers of legislative benefits are legislators, and their primary goal is to be re-elected. Thus, legislators need to maximize their chances for re-election, which requires political support. Legislators are assumed to be rational and to make cost-benefit calculations when faced with demands for legislation. However, the legislator’s cost-benefit calculations are not the cost-benefits to society of enacting particular legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur as a result of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support legislation. (page 27)

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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.

The aim of this law was to improve the health care system of the U.S. by widening health coverage to more Americans, and by protecting existing health insurance policy holders.

There were several parts of the bill that had important implications for many Americans.

These relate especially to coverage for pre-existing conditions, including pregnancy, children on parental plans, and help for small businesses to have their employees insured.

Coverage for pre-existing conditions

Beginning in 2014, insurance companies could not raise premiums for infants or children because of a pre-existing condition or disability.

Adults who previously could not get coverage because of a pre-existing condition, and who had had no insurance for 6 months or more would now get insurance.

The Pre-Existing Condition Insurance Plan (PCIP) was aimed at adults who could not get coverage because of a pre-existing condition, such as diabetes or cancer. From 2014, the Act made access available to them.

As of 2018, health insurers cannot deny or cancel coverage for someone with a pre-existing condition. The insurance must also cover that condition, and insurers cannot charge someone more for having that condition. Pregnancy is still considered to be a pre-existing condition, so insurance now covers all prenatal care and the birth from day one of coverage.

However, President Trump’s administration recently said that he would no longer support this provision in the PPACA.

According to the Kaiser Family Foundation, this may head to the Supreme Court for a final ruling in 2019.

Children remain on parental plans

The Act means that young adults can stay on their parents’ health plans until they are 26 years old.

This includes:

  • those who do not live with their parents
  • those who are out of school
  • those are not financially dependent on their parents
  • those who are married

A child who has health insurance under their parents’ plan will lose coverage on their 26th birthday.

This is considered to be a special enrollment period. It means that they can sign up for a new plan without having to wait for open enrollment at the end of the year.

It is important to recognize that, under this plan, insurance does not cover spouses and offspring of adult children.

Committee chairs (appointed by the political party in the majority) are extremely influential, particularly with respe ct to the subject areas that are the focus of the committee’s work. Chairs determine which bills will be heard and when, and they estab lish the procedural framework under which the committee operates. The chair’s position on an issue can determine the fate of a bill from the outse t. Because of the extent of their power and influence, committee chairs are able to raise large sums of money from special-interest groups to support their re-election- and re-election is always an important consideration for lawmakers. The House and Senate leaders (elected by their colleagues) determine who will be named committee chairs. Certain committees are seen as more prestigious than others, so being named the chair of one of those committees is very important to an ambitious legislator. “Ranking members” are the appointed committee leaders for the political party in the minority.

Not surprisingly, political considerations play a role in this entire process. Being aware of the dynamics that are the foundation of the overall committee process helps ensure more effective representation by those who want to influence the outcome of the committee’s work.

Floor Action

If a bill is able to garner committee approval, it goes to the full chamber for a vo te. The timing for scheduling a vote, as well as various attempts to amend the bill or delay the vote, are integral parts of the lawmaking process. Much maneuvering occurs backstage, and the ability to influence these less public interactions is as

 

Congressional Structure
TABLE

100 members, 2 from each stat e.

 

 

 

 

 

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.·The numberof representativesappprtione, d .

to each state chang esevery 1O years aft r the ,

. national census data are obtai.·      bra-&ing·    · —

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important as the words or concepts being debated. Again, people’s relationships and polit ics determine the ultimate results. To be effective in one’s efforts to in­ fluence outcomes, one must be aware of these relationships and take them into account. Once a bill is approved in either the House or Senate, legislators begin the process again in the other chamber.

 

Conference Committee

Seldom does a bill complete the journey through the second chamber without change, which means the originating chamber must agree to the new version of the bill. Without agreement, a bill will be referred to a conference committee made up of representatives from the House and Senate; they reconcile the differences in the two bills and ask their respective chambers to support the conference committee report. If agreement cannot be reached, the bill dies.

 

Chief Executive Signature

If the House and Senate reach agreement , the bill goes to the chief executive (president or governor), who must sign the bill before it can become law. If the chief executive vetoes the bill, it goes back to the legislature for a potential veto override, which requires a two-thirds majority of both chambers.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

  • Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
  • Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
  • One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
  • I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

  • Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
  • In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
  • Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
  • Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

  • Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
  • Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
  • I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

  • I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
  • As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
  • It is best to paraphrase content and cite your source.

LopesWrite Policy

  • For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
  • Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
  • Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
  • Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

  • The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
  • Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
  • If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
  • I do not accept assignments that are two or more weeks late unless we have worked out an extension.
  • As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

  • Communication is so very important. There are multiple ways to communicate with me: 
    • Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
    • Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

1 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)

2 https://www.congress.gov/

3 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

Note: You will access this article from the Walden Library databases.

4 https://www.house.gov/

5 https://www.senate.gov/

6 https://www.senate.gov/reference/org_chart.htm

Discussion: Politics and the Patient Protection and Affordable Care Act

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 voters 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

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

RE: Discussion – Week 3
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Initial Post

President Obama passed the Affordable Care Act (ACA) in 2010 with the intent to improve America’s healthcare system by providing Americans with more affordable healthcare options, increasing access to healthcare and improvement in the quality of healthcare received (healthcare.gov, n.d.). The ACA was not well received by the opposing political party. President Trump took the lead in efforts to abolish the ACA with the intent to create a healthcare system that would place control of healthcare back into the hands of Americans through the American Healthcare Act (AHCA) (NCBI.mln.nih.gov, n.d.).  According to Dabbous et al (2019), President Trump promised to repeal and replace the Affordable Care Act (ACA) while ensuring insurance coverage for all with no cuts to social security, Medicare, and Medicaid, and allowing health insurance to be purchased across state lines in a bid to promote competition, and to maintain protection for people with pre-existing conditions.

Cost benefit analysis is one tool regulatory decision makers use in determining how to move forward on a proposed regulation or whether to move forward at all (Foreffective.gov.org, n.d.). Legislators weigh the risks and benefits associated with a policy and how it will affect them in terms of re-election. Legislators typically pass policies that they feel will be supported by their voters. If a legislator proposes policies that opposes the views of their supporters, they risk losing voters and subsequently losing their position of power. President Trump has not been able to abolish the ACA as originally intended; however, he has made adjustments that have been favorable to the American people for example, the removal of the tax penalty for not having healthcare coverage. Because the ACA as so many benefits to Americans, it has proven challenging to replace without negatively impacting our current healthcare system, so it remains intact.

References

Dabbous, M., François, C., Chachoua, L., & Toumi, M. (2019). President Trump’s prescription to reduce drug prices: from the campaign trail to American Patients First. Journal of Market Access & Health Policy, 7(1), 1–4.

Foreffective.gov.org. (n.d.). Center for Effective Government. Cost-Benefit Analysis. https://www.foreffectivegov.org/node/3470#:~:text=Cost%2Dbenefit%20analysis%20(CBA),to%20society%20as%20a%20whole.&text=Executive%20Order%2012866%2C%20Regulatory%20Planning,any%20%22significant%22%20proposed%20regulation.

Healthcare.gov. (n.d.) Affordable Care Act (ACA). https://www.healthcare.gov/glossary/affordable-care-act/