Politics and the Patient Protection and Affordable Care Act-Main Post

Winning an election or reelection can be an expensive and time-consuming process. The primary goal of legislators is to be re-elected, requiring financial and political support. However, the legislator’s cost-benefit values are not the cost-benefit value to society. In contrast, the benefits are the additional political support a legislator will receive from supporting a particular policy or the loss of support that may result from a stance on a policy. In the 2016 election, the realization that policymakers are not always focused on how the public may be affected by specific policy changes and are often more focused on election results came even more apparent (Milstead & Short, 2019).

The Affordable Care Act (ACA), enacted in 2010, includes multiple provisions to expand healthcare coverage, offset taxes, and slow the amount of Medicare spending. Repealing the entire ACA would leave no money to “replace” legislation and would require further deficit reductions to eliminate adding to the debt. Repealing the ACA would also leave millions of people uninsured (CRFB). The cost-benefit analysis regarding reelection affected the attempts to repeal/replace the ACA because many Americans and some Republican policymakers support the ACA, or at least portions of the act (Willison et al.,2017). Regardless of political affiliation,  repealing/replacing the ACA caused increased political conflict, involving political party support and dividing the American public opinions. For example, less affluent Americans may favor the ACA because it helped them access affordable health care, while more affluent Americans may be opposed to paying more in Medicare taxes (Jacobs & Mettler, 2018). The first attempt by Republicans to replace the ACA was unsuccessful. The conflict also caused divisions between conservative and moderate Republicans. To gain support, Republicans scheduled a vote on the repeal/replacement of the ACA, which did not have enough votes to pass. The attempts of the Trump administration to unify Republicans and repel the ACA came with risks to the public, making Congress hesitant regarding a full ACA repeal (Willision et al.,2017).

Voter’s views may affect decisions by legislative leaders in the positioning of national policies in that incumbents can choose to support policies with the most media coverage and voter popularity to increase their chances of election (Milstead & Short, 2019). However, while there is a link between the public and policy outcomes, some studies argue that the connection between policy and public opinion is not that strong. Gilens (2012) demonstrated that policy in the United States is more responsive to the affluent population than it is to the less affluent. Moreover, the link between public preference and the political parties often weakens once the political party is in office (Romeijn, 2018). With policies such as the ACA affecting Medicare and Medicaid, voters tend to have a stronger opinion than other policies, as changes can significantly affect the American people. However, while public officials may attempt to take public opinion into account and avoid decisions believed to be unpopular, in general, public opinion does not influence the details of most policies (Britannica, n.d).

References

Britannica. (n.d.). Public opinion and government (W. P. Davidson, Ed.). Encyclopedia Britannica. https://www.britannica.com/public-opinion-and-government

Gilens, M. (2012). Affluence and influence: Economic inequality and political power in America (56053rd ed.). Princeton University Press.

Jacobs, L. R., & Mettler, S. (2018). When and how new policy creates new politics: Examining the feedback effects of the affordable care act on public opinion. Perspectives on Politics, 16(2), 345–363. https://doi.org/10.1017/s1537592717004182

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

Romeijn, J. (2018). Do political parties listen to the(ir) public? Public opinion–party linkage on specific policy issues. Party Politics, 135406881878734. https://doi.org/10.1177/1354068818787346

The committee for a responsible federal budget. (2017). The cost of full repeal of the affordable care act. https://www.crfb.org

Willison, C. E., & Singer, P. M. (2017). Repealing the affordable care act essential health benefits: Threats and obstacles. American Journal of Public Health, 107(8), 1225–1226. https://doi.org/10.2105/ajph.2017.303888

Molly,

Nice post! I appreciate your emphasis on affluence and the role it plays in policy approval and implementation. I have read a lot of discussion posts and I have not seen this pointed out as eloquently as you have. The Working with Legislators video (Laureate Education [producer], 2018) talks about what you bring to the table. What do you say is the most powerful thing you bring to the table if you were sitting across from your representatives? I see this view on affluence having a role. What else do you bring?  Dr. Braun

Laureate Education (Producer). (2018). Working with Legislators [Video file]. Baltimore, MD: Author.

Hi Dr. Braun,

The Working with Legislators video (Laureate Education [producer], 2018) talks about not underestimating what nurses can bring to the table regarding health-related policies. Moreover, although legislators are knowledgeable, educated people, they may have little understanding of medical/nursing terms and issues. Although the role money plays in policymaking may make nurses uncomfortable (Milstead & Short, 2019), nurses can bring knowledge and expertise to the table. The most powerful thing I could bring to the table is my years of experience working in the field with real people and experiences. The video also mentions establishing common ground with legislators and having your facts down. I think describing scenarios and experiences is beneficial. Most people, even legislators have had experiences in health care that might not have turned out the way they had wished it had. Talking openly about issues in health care, with facts to back it up could potentially lead to gaining legislative support.

Thank you,

Molly

Resources

Laureate Education (Producer). (2018). Working with Legislators [Video file]. Baltimore, MD: Author.

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

Thank you, Molly, for sharing your post. I strongly agree that a stand on a specific policy by a legislator seeking re-election can either jeopardize or escalate chances for re-election. You also mentioned analyzing the cost-benefit value for both the legislator and the society. I believe a legislator seeking re-election should focus on value for the community since the voters decide who will hold the position. According to, approximately 31 million benefited from ACA, and the number of insured people grew significantly (Glied & Jackson, 2017). As such, repealing and replacing the Act would reduce the number of uninsured people, and others would not afford quality care. Many Americans were against the replacement, and a legislator’s stance on the same would affect their political interest. Thus, some republicans would not support the policy, which saw a division among the Republican Legislators. I, therefore, agree that legislators seeking re-elections must prioritize the cost-benefit value of voters for specific procedures.

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. https://doi.org/10.2105/ajph.2017.303665

Hi Molly,

It is true that running for office is expensive and comes with a lot of different obligations once you receive financial and political backing during a campaign run. I like that you touched on how media coverage and voters perceptions has an influence on the way legislative leaders show case a new policy or bill and how negative media views and public opinions can cause legislation to change their tactics. Because election results directly influence who will be elected to sit in a given position, it is important that one should consider the cost-benefit prior to making statements regarding their plans for policies. When considering the cost-benefit analysis of repealing the ACA during the time when Donald Trump ran for office, the conversations began to grow regarding repealing and replacing Obama Care (Milstead, 2019).

Thank you for sharing!

– Emily

References

Coln, J. (2020). The ACA, Repeal, and the Politics of Backlash. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20200305.771008/full/

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

Cost-Benefit Analysis

The implementation of the Affordable Care Act (ACA) is noted to be one of the most pivotal moments in healthcare reform since the introduction of Medicare. As many know, the democratic party is in favor, and the Republican party aims to repeal or replace the ACA. During the 2016 election, the ACA was under colossal debate. Trump’s administration immediately focused on repealing or replacing the ACA, as mentioned as a highlight during the election. This change brought both republican and democratic legislator’s concern. According to Milstead and short (2019), legislators cast their votes on policies with worries of their re-election. The full repeal of the ACA would abruptly leave a large number of American citizens without health coverage leading to more harm than good, leaving the majority to vote against the repeal (Willison & Singer, 2017).

Voter views influence legislative policies and decisions by communicating their stance on an issue, the politician’s stance on the subject, and the legislator’s eagerness to be re-elected to achieve a common goal (Stubager & Seeberg, 2016). The political view of the voting population affects the policies set in place due to politicians’ primary purpose of being re-elected (Milstead & Short, 2019).

References

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurses guide (6th ed.). Jones & Bartlett Learning.

Stubager, R., & Seeberg, H. (2016). What can a party say? how parties’ communication can influence voters’ issue ownership perceptions. Electoral Studies, 44, 162–171. https://doi.org/10.1016/j.electstud.2016.08.013

Willison, C. E., & Singer, P. M. (2017). Repealing the affordable care act essential health benefits: Threats and obstacles. American Journal of Public Health, 107(8), 1225–1226. https://doi.org/10.2105/ajph.2017.303888

Peer Response #2

Ellise,

Awesome post! The Affordable Care Act is by far one of the most essential statutes signed into law for the greater good of America in regards to healthcare. It was interesting to learn how both opposing parties viewed ACA and their reasoning why. The ACA made a milestone in healthcare providing the opportunity for all to obtain healthcare coverage, regardless if they had a pre-existing medical condition or not, that is affordable. “While gaining coverage from Medicaid and the most affordable private health insurance plans enabled newly insured patients to experience an improvement in accessing care, gaps remained in the depth of covered services and willingness of all providers to accept them” (Ercia, 2021). The number of citizens who hold health insurance coverage went up significantly after this Act had been enacted into law.

For those that didn’t obtain a health plan, “the ACA required citizens and legal immigrants to pay a penalty” (Milstead & Short, 2019). Just like anything else, the ACA consisted of positive and negative effects pending on what population it is compared to. When looking at the population as a whole with healthcare coverage it mainly had influenced a positive impact. When broken down, the republican party had viewed this act as something that wouldn’t be in the best interest for America. The fact that the Trump administration wanted to repeal this act is interesting seeing how it would hurt those who are in need of affordable healthcare coverage especially those with pre-existing conditions. This population struggled significantly prior to the ACA because insurance premiums and coverage were outrageously priced leaving many uninsured and unable to be compliant with their’treatment plans. If the ACA was repealed then a large portion of the population would negatively be affected by this.

“Changing the manner in which all Americans obtain health insurance is extremely complex; any changes enacted by legislators will take years to implement” (Milstead & Short, 2019). This is due to their short term of 2 years in office. In order for anything to proceed to be enacted into the law, it takes a significant amount of time which is not in the best interest in the eyes of the legislators. They implement and move forward with matters that take a short amount of time that the voter has somewhat of an influence on. As you discussed, it’s the legislator’s job to understand the stance on the voters views in order to be re-elected. This causes the legislators to consider and potentially support the voters regardless of the consequences that may follow if it means that they will be re-elected.

References:

Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Services Research, 21(920), 1-9. https://doi.org/10.1186/s12913-021-06961-9

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

With the American people being so divided on whether to repeal the Affordable Care Act (ACA) or not, it is leaving our legislators just as divided. Legislators also have to conduct a cost-benefit analysis on the matter to determine whether or not the repeal is worth attempting. Repealing, replacing, and repairing the act can prove to be draining to the economy; the ACA has insured 31 million people since it was put into place (Assistant Secretary for Public Affairs (ASPA), 2022). To take insurance away from that amount of people at once would be costly to the healthcare economy. During the repeal and replacement process, that amount, and likely more, would become uninsured once again.

“Any changes to the ACA should be designed to reduce, not increase, the unsustainable growth in the federal debt. Savings from repealing parts of the ACA must be large enough to not only finance repeal of any of ACA’s offsets, but also to pay for whatever “replace” legislation is put forward. This is not an easy task, and it will likely require policymakers to retain or replace the majority of ACA’s health and revenue offsets (Committee for a Responsible Federal Budget, 2017). The cost of changes to the act; if not covered by money saved from the repeal, would be expected to be replenished by the legislators; thus cutting into their budgets for reelection.

A legislator’s decisions are made with a few things in mind: their personal views, morals, knowledge, and understanding of the issue at hand, and then how the voters view the issue. While ultimately the deciding factor in their vote is themselves, they are supposed to consider how the majority of their voters feel about the policies. This can affect how a legislator votes because voting with your people could increase the likelihood of your reelection, just as going against your voters could have the opposite effect.

References

Assistant Secretary for Public Affairs (ASPA). (2022, April 18). New HHS data show more Americans than ever have health coverage through the Affordable Care Act. HHS.gov. Retrieved June 14, 2022, from https://www.hhs.gov/about/news/2021/06/05/new-hhs-data-show-more-americans-than-ever-have-health-coverage-through-affordable-care-act.html

Committee for a Responsible Federal Budget. (2017, January 4). The cost of full repeal of the Affordable Care Act. Committee for a Responsible Federal Budget. Retrieved June 14, 2022, from https://www.crfb.org/papers/cost-full-repeal-affordable-care-act

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

Caitlin,

Thank you so much for your insightful post! You have made so many critical points. The opening paragraph for this module/discussion indicates that it is not uncommon to feel that governments are affected by interests that have nothing to do with the betterment of society (Walden University, 2021). How do you see that playing out with the ACA and during this COVID pandemic in your own life?

Walden University. (2021). NURS 6050 Policy and Advocacy for Improving Population Health. Module 2 Discussion Prompt. https://class.content.laureate.net/e8517d23c2d0ac3f4b543fdb9c5ef220.html

Dr. Braun,

Honestly, it is hard to imagine how this could play out because legislation is so evenly divided on the issue. I genuinely think that this is a critical time for healthcare workers to come together and be the voice for those who feel like they do not have one regarding the ACA and how legislation should handle matters about it. We are the ones who have worked tirelessly throughout this entire pandemic, so again it would be up to us to stand up for what we think is best and suitable for the health of our people. We also must educate people on such matters to help give our patients a voice. It is their health, and education is the best way to help our patients take care of themselves. I think we could potentially influence the decisions when it comes to the ACA through these actions.

Caitlin Waters

Thank you Caitlin! I know that was a tough question! Dr. Braun

Caitlin, I agree that American people are very divided when it comes to the Affordable Care Act, which causes the legislators to become divided as well. I also agree where you said that taking the insurance away all at once would be very costly to the economy. That statement could not be more true. If the Affordable Care Act was suddenly repealed more than 20 million people would lose their health care coverage and more than 135 million would lose protections for their pre-existing conditions (Rapfogel et al., 2021). If there are going to be changes in the ACA, it should be replaced and not repelled completely. The replacement of Obamacare or ACA should focus on the problems that need fixed within the system of financing healthcare (Moffit & DiIulio, 2020).

Moffit, R. C. J. C. E., & DiIulio, J. J., Jr. (2020). How to Replace Obamacare. National Affairs. Retrieved June 17, 2022, from https://www.nationalaffairs.com/publications/detail/how-to-replace-obamacare

Rapfogel, A., Calsyn, M., & Seeberger, C. (2021, November 7). The Chaos of Repealing the Affordable Care Act During the Coronavirus Pandemic. Center for American Progress. Retrieved June 17, 2022, from https://www.americanprogress.org/article/chaos-repealing-affordable-care-act-coronavirus-pandemic/

The Affordable Care Act (ACA) is a comprehensive health care reform law first brought about in March of 2010. It is broken down into three primary goals: 1) Make health insurance more available to more people. 2) Expand the Medicaid program and 3) Change medical care delivery to lower the cost of healthcare as a whole (HealthCare.gov, 2022). This did not improve access to care. Because election results directly influence who will be elected to sit in a given position, it is important that one should consider the cost-benefit prior to making statements regarding their plans for policies. When considering the cost-benefit analysis of repealing the ACA during the time when Donald Trump ran for office, the conversations began to grow regarding repealing and replacing Obama Care (Milstead, 2019). The support of his voters provided Trump with the support he needed to believe that the benefits outweighed the costs in his proposal. This provided a platform for many Republicans to voice opinions in favor of the repeal by making statements regarding the cons of maintaining the ACA such as higher cost private insurance and that it decreased the effectiveness of Medicare for the elderly (Coln, 2020). Due to voter responses against this change, there became worry that Donald Trump would not be re-elected (Milstead, 2019). This would mean that the cost-benefit would have to be assessed again in order to re-evaluate the angle the legislators should take in order to increase their re-election. This shows that the re-election of a legislator affects policy topics such as the repeal and replacement of the ACA as well as showing that the voters views have a significant effect on decisions made by legislative leader’s positioning on policies when there is an upcoming election (Milstead, 2019).   

References

 Coln, J. (2020). The ACA, Repeal, and the Politics of Backlash. Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20200305.771008/full/

HealthCare.gov. (2022). Affordable Care Act (ACA). Retrieved on June 14, 2022. From: https://www.healthcare.gov/glossary/affordable-care-act/.

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

Emily,

Excellent post! I appreciate your recognition of having to re-evaluate cost/benefits with each re-election. It reinforces that cost/benefit is often about perception. The opening section for this module/discussion indicates that politicians are purely focused on re-election, measuring success as votes and campaign funding (Walden University, 2021). What are your thoughts on this? Have you seen this play out in any health care legislative issues that you have encountered?

Walden University. (2021). NURS 6050 Policy and Advocacy for Improving Population Health. Module 2 Discussion Prompt. https://class.content.laureate.net/e8517d23c2d0ac3f4b543fdb9c5ef220.html

Response #1

Emily,

The cost-benefit analysis regarding the Affordable Care Act (ACA) repeal or replacement once the Trump administration took office divided policymakers. The concern of both democratic and republican legislators was that repealing or replacing the ACA would leave a large portion of Americans without coverage (Willison & Singer, 2017). As well as ultimately, the abolishment of the ACA would take effect during the next election cycle, leaving legislators concerned about being re-elected (Milstead & Short, 2019). This is an unsettling thought that decisions are influenced by policymakers’ political gain and solely for the greater good of the American people, wouldn’t you agree?

References

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurses guide (6th ed.). Jones & Bartlett Learning.

Willison, C. E., & Singer, P. M. (2017). Repealing the affordable care act essential health benefits: Threats and obstacles. American Journal of Public Health, 107(8), 1225–1226. https://doi.org/10.2105/ajph.2017.303888

     The United States federal government’s legislative branch is comprised of the senate and house, a cooperatively known as congress. (U.S. Senate: House of Representatives, n.d.). Members of the house are given two years in office before needing to run for re-election whereas a senator’s term is six years. (U.S. Senate: House of Representatives, n.d.).  In March 2010 Barack Obama signed into law the Affordable Care Act, a bill enacted by the 111th U.S. Congress, with three main objectives: to expand Medicaid, reform private healthcare insurance, and change the way medical decisions are made. (Silvers, 2013). According to the United States Department of Health and Human Services, a report show that between 2010 and 2016 the number of uninsured adults decreased by 41 percent, a fall from 48.2 to 28.2 million Americans followed by reports of several states reducing their uninsured rate by at least half from 2013 to 2019. (Affairs (ASPA), 2021). In May 2017, The 115th House of Representatives voted to pass the Americana Health Care Act as a concealed effort to repeal most of the Affordable Care Act (Bryan, 2017) According to a Kaiser Family Foundation summary the AHC act would strip provisions that gave health insurance coverage to over 20 million Americans, fortunately, the bill failed to pass the senate. (Summary of the American Health Care Act, 2017).

     Congress with its two-year election cycle reflected short-sited provisions and repeals under American Health Care Act and showed no cost-benefit to Americans in terms of health insurance coverage.  In my opinion, Congress, then a republican majority, sought to appeal to the favor of its constituents and President Trump’s administration who had vowed to oppose and repeal the ACA without consideration to the millions of Americans already insured under the ACA. Political infighting and partisan antics in an effort to retain office and maintain allegiances in the House and Senate have led to bills that repeal that threaten the health insurance coverage and affordability of millions of Americans and that’s why it’s important for the individual American citizen to be informed about what they are voting for when it comes to new healthcare proposals as it may not be formed with their best interests in mind.

Charles,

Thanks again! Your posts are always insightful and speak well to not only what you are reading but also to your own experiences. One thing I have been thinking about…The Peter Beilenson video (Laureate Education [producer], 2018) talks about loss of productive life lost. You mention your opinions about the ACA repeal and how it will negatively impact those already insured. How could you build the Beilenson argument into your post? Dr. Braun

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

Dr. Braun

In the video Peter Beilenson explains that loss of productive life as a health issue that robs the lives of a population from their average life expectancy such as Aids. (Laureate Education [producer], 2018). In his example of using just Aids alone, he claims productive life loss of up to 40 years or more. I would use this example to emphasize that repealing the ACA would then leave more than 20 million Americans uninsured, which means that every single health ailment is a potential cause of productive life loss for those Americans. Quite frankly, a staggering amount of life taken away from Americans for simply not being insured.  Mr. Beilenson also utilizes a needs assessment and I would simply apply the same assessment as to see what part of the population is uninsured and follow through with policy development and assurance for that population. Fortunately, policy development is already in progress with Medicaid expansion giving coverage to nearly all adults up to 138% of the federal poverty level as of June, 2022 from a status report published by the Kaiser Family Foundation. (Kaiser Family Foundation, 2022).

References

Charles,

Thank you! Your points was well stated and substantiated. It is a perspective I had not considered prior to watching that video and I appreciate how you brought the AIDS example forward. Dr. Braun

Week 3 Discussion-Policy

According to the Department of Health and Human Services, the Affordable Care Act (ACA) was signed into law in 2010. It addresses health insurance coverage, health care costs, and preventive care in the United States (2017). The act has been challenged in federal or state court almost 2000 times since being enacted (Pitsor & Garcia, n.d.). Regarding re-election, money is critical, and lobbyists spend a lot of money on their interests. In 2009, more than 1.1 billion dollars were spent lobbying the ACA for and against (Open Secrets, 2021). Milstead and Short describe the hesitancy of republicans in trying to repeal the ACA right after Trump’s inauguration since it could affect his re-election and, in turn, affect the overall Republican majority in both federal chambers (2019). They go on to explain the disregard for how the legislators’ actions would affect the American people, but they were worried most about their re-election. However, since the ACA gained 20 million Americans with coverage, not all Republicans were on board with changes that could affect many Americans and their re-election.

Voter views of the ACA could affect legislative leaders in positioning national policies. While the ACA covered about 20 million previously uninsured Americans, about 7.5 million Americans made just above the cut-off for assistance that had their insurance premiums skyrocket (Rovner, 2017). Some of these Americans started to work less to get the cut-off for the government subsidies to help pay their premiums. The ACA for these families did more harm than good, and when constituents talk to their elected officials to tell their stories, it can influence policy change. On the flip side, there were Americans unable to afford insurance or denied coverage before the ACA that tell their positive stories to their elected officials. Both can influence policy at the state or federal level when a relationship is formed with representatives.

References

Department of Health and Human Services. (2017, August 4). What is the affordable care act? HHS.gov. https://www.hhs.gov/answers/health-insurance-reform/what-is-the-affordable-care-act/index.html

Milstead, J. A., & Short, N. M. (2019). Government response: legislation. In Health policy and politics: A nurse’s guide (6th ed., p. 40). Jones & Bartlett Learning.

Open Secrets. (2021, June 23). The long, costly battle over obamacare might be over. OpenSecrets News. Retrieved June 14, 2022, from https://www.opensecrets.org/news/2021/06/costly-battle-obamacare-over/

Pitsor, J., & Garcia, A. (n.d.). Legal cases and state legislative actions related to the aca. National Conference of State Legislatures. Retrieved June 14, 2022, from https://www.ncsl.org/research/health/state-laws-and-actions-challenging-ppaca.aspx

Rovner, J. (2017, October 9). Overlooked by aca: Many people paying full price for insurance ‘getting slammed’. Kaiser Health News. Retrieved June 14, 2022, from https://khn.org/news/overlooked-by-aca-many-people-paying-full-price-for-insurance-getting-slammed/

Ashley,

Great post! Thank you so much for showing us the two sides of this coin. All views are valuable in considering the political tug of war. The ACA discussion I have been seeing here is focused on healthcare coverage. The Peter Beilenson video (Laureate Education [producer], 2018) talks about the importance of developing a multi-pronged policy, which often including prevention, education, and training. How does this perspective apply to the ACA? Do you think the ACA is short-sighted given Dr. Beilenson’s observations? Dr. Braun

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

Dr. Braun,

According to the U.S. Centers for Medicare & Medicaid Services (CMS), the ACA has 3 primary goals: More affordable insurance for more people, expand Medicaid recipients, and lower overall healthcare costs (n.d.). One year ago, 11 years after the ACA was enacted, CMS announced that more patients than ever before were insured through the ACA (2021). In the decade following the enactment of the ACA, prevention of not having health insurance coverage was pushed on taxpayers by having a fine to pay to the Internal Revenue Service (IRS) if uninsured. Education and training were necessary for a spectrum of specialties including tax preparers, insurance agents, social workers, and healthcare facilities providing services that required knowledge of the coverage and penalties.

I don’t personally think the ACA is short-sighted with the goal of having more people insured since more people than ever have health insurance, however, I can’t attest to the quality of it or its cost because I have never used it. As my initial post describes, people have been affected differently by different experiences, both positive and negative.

Milstead and Short describe health insurance as “sickness insurance” and I am personally a root cause disease activist trying to avoid chronic illness in my life with a desire to help others do the same (2019, p. 175).

References

Centers for Medicare & Medicaid Services. (2021, June 5). New hhs data show more americans than ever have health coverage through the affordable care act. CMS.gov. Retrieved June 15, 2022, from https://www.cms.gov/newsroom/press-releases/new-hhs-data-show-more-americans-ever-have-health-coverage-through-affordable-care-act

Milstead, J. A., & Short, N. M. (2019). Overview: The economics and finance of health care. In Health policy and politics: A nurse’s guide (6th ed., p. 175). Jones and Bartlett Learning.

U.S. Centers for Medicare & Medicaid Services. (n.d.). Affordable care act (aca) – healthcare.gov glossary. Healthcare.gov. Retrieved June 15, 2022, from https://www.healthcare.gov/glossary/affordable-care-act/

Ashley,

Thank you! I too would fit in your category of root cause disease activitist. Of course the challenge is that there is no instant gratification in our world. However, I do see a gradual shift in people who are very interested in prevention. In my teaching at the undergrad level, prevention is becoming a more prominent element in the curriculum, which I think is a critical place to start. Dr. Braun

Peer Response 2

I also looked into the cost versus benefit of the Affordable Care Act. One thing I think many miss, is how unaffordable this plan can be. Especially, for how the middle class. In 2019, Americans between the ages of 55-64 dedicated an astronomical 18.9% of their income on ACA premiums (Healthcare Finance News, n.d.). Unfortunately, this 18.9% only covered the lowest-cost bronze plan, leaving patients with very little coverage. The ACA also did not make any noticeable difference in the number of medical bankruptcy’s filed (Himmelstein, Lawless, Thorne, Foohey, & Woolhandler, 2019). I can’t help but ponder how much of this is directly related to limited coverage for such a high cost for those in the middle-class range. This unfathomable cost seems to be hardly mentioned when it comes to those running for office, but I feel that if American’s really saw the cost and how limiting this program can be to those who need it most, American votes may be cast much differently.

References

Healthcare Finance News. (n.d.). ACA coverage growing less affordable for middle class families and near elderly.Retrieved June 15, 2022, from https://www.healthcarefinancenews.com/news/aca-coverage-growing-less-affordable-middle-class-families-and-near-elderly#:~:text=The%20financial%20burden%20for%20middle

Himmelstein, D. U., Lawless, R. M., Thorne, D., Foohey, P., & Woolhandler, S. (2019). Medical Bankruptcy: Still Common Despite the Affordable Care Act. American Journal of Public Health, 109(3), 431–433. https://doi.org/10.2105/ajph.2018.304901

Kasey,

Thank you for sharing those statistics. I had not looked into all of them within the middle class. I have great insurance through my employer, and since my family is middle class, I am grateful.

Ashley

Politics of the Patient Protection and Affordable Care Act 

Universal health coverage means that all people have access to health services when they need them without financial hardship. This includes health promotion, prevention, treatment and rehabilitation, and palliative care, with an emphasis on improving quality of life (World Health Organization , n.d.).  Universal Healthcare in the United States is a huge debate and disadvantages raised the significant upfront cost and logistical challenges despite leading to a healthier populace and lower healthcare costs. The advantages of universal health care are addressing the growing chronic disease crisis, reducing vast health disparities, increasing preventative health initiatives, and addressing the epidemic level of non-communicable disease. (Zieff, Kerr , Moore , & Stoner , 2020).

The Affordable Care Act (ACA) moved the United States of America closer to universal healthcare by expanding health coverage for millions of Americans (e.g., via Medicaid expansion, the launch of health insurance marketplaces for private coverage) including for citizens across income levels, age, race, and ethnicity (Kuperstein, 2017). However, during President Donald Trump’s presidency requests to repeal and replace the ACA, will leave approximately 20million people without insurance. ACA gives provisions about pre-existing conditions and preventive care and age 26 dependent coverage.

Additionally, the individual mandate, the employer mandate, and taxes on Insurers and plans are what make the coverage affordable, however, without the core structure, it’s always been questions on how ACA would be funded (Perez, 2017). One of the suggested plans is to remove parts of the ACA, however, a wholesale replacement plan is questionable due to the difficulty of ease and furthermore an understanding and agreement between the Republicans and Democrats.

References

Kuperstein, D. (2017). Why ACA repeal isn’t as easy as it seems. Employee Benefit News, January. Retrieved from https://www.proquest.com/docview/1912001972?accountid=14872

Perez, K. (2017, March). The fate of value -based care with an ACA repeal. Healthcare Financial Management, 71(3), 76-77. Retrieved from https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=6&sid=5e0c6b7e-d7b7-4bec-963f-3f5595aa1bdf%40redis

World Health Organization . (n.d.). Universal Healthcare Coverage . Retrieved from World Health Organization : https://www.who.int/health-topics/universal-health-coverage#tab=tab_1

Zieff, G., Kerr , Z., Moore , J., & Stoner , L. (2020). Universal Healthcare in the United States of America: A Healthy Debate. Medicina, 56(11), 580. Retrieved from https://doi.org/10.3390/medicina56110580