Health insurance coverage continues to be one of the many topics that the United States is working towards making improvements on. It has been an ongoing issue and something that has been addressed among politics for many years. For a long time, many did not have adequate or any health insurance coverage due to the cost of the coverage causing medical encounters to be very expensive. Many were not getting health insurance coverage due to cost but some were not able to receive health insurance coverage because insurance companies found the patients to be a risk due to their medical history. “Barring the participation of individuals who already have disease or injury (preexisting conditions) allows insurers to manage adverse selection” (Milstead & Short, 2019). This meant that the insurance companies would prevent them from being covered by health insurance companies because the health insurance would be at a loss if they had to pay all the medical bills for these patients. For those with preexisting conditions, they had to ultimately choose if they wanted to pay for these astronomical medical expenses due to not being offered adequate coverage to get the treatment they needed or choose not to receive the treatment and not have to worry about paying for any medical expenses. In the long run, it wouldn’t be beneficial for the patient because then they would get so sick, they would need medical care regardless or even worse lose their life due to not seeking out treatment.

It wasn’t until President Obama was able to implement the Patient Protection and Affordable Care Act in March 2010 that the United States would see an improvement in this ongoing battle with health insurance coverage. The Affordable Care Act was introduced into law with three primary goals. The law was implemented to “make affordable health insurance available to more people, expand the Medicaid program to cover all adults with income below 138% of the federal poverty level, and support innovative medical care delivery methods designed to lower the costs of health care” (Assistant Secretary for Public Affairs, 2022). Once this Act was passed a significant number of people were able to obtain health insurance coverage regardless of pre-existing medical conditions but there still remains to be a large number of people who still do not have adequate health insurance coverage. “While much has been accomplished in the last ten years, more is needed to achieve our goals of an affordable, equitable, and accessible health care system – one that promotes positive health outcomes while reducing unnecessary costs” (Silberman, 2020).

With the significance of the effects of the ACA, legislators have to keep in mind how long things take to change and be implemented in politics. Legislators term is only a matter of 2 years which may seem like a long time but from a political standpoint it is significantly short. In order for laws to be enacted and things to be changed, everything is directed through a process that thoroughly evaluates all information and is dissected for its importance and its long-term effects on the U.S. “The interest in developing long-term solutions to challenging problems has been replaced with a more incremental immediate approach that focuses on short-term solutions rather than on the underlying cause of the problems” (Milstead & Short, 2019). The political dynamics of the cost-benefit analysis in terms of legislators is that the legislator’s decisions and their standpoint would be re-evaluated due to whether or not it would get them re-elected into office.

“Deciding which of several policy options will lead to the greatest benefits and the fewest costs, in a world where re-election is a key consideration and media are a relentless presence, means the best solution may not be the path ultimately chosen” (Milstead & Short, 2019). This was extremely important for legislators especially when the Trump administration was debating and discussing the effects of the Affordable Care Act and how they should proceed forward due to its effects on healthcare as a whole and financially. Legislators were divided on how whether or not to repeal or replace the ACA. They have to look at how it presented by said official and the effects it will cause on healthcare as a whole mainly due to its effects on healthcare finance. Pending on their views would ultimately affect them on whether or not they would be re-elected or will be in the future when addressing the ACA. “Changing the manner in which all American obtain health insurance is extremely complex; any changes enacted by legislators will take years to implement” (Milstead & Short, 2019). With legislators being in office only for two years, time is limited which means quicker and smaller solutions towards the ACA is what will happen as this ACA continuously is addressed. Unfortunately, one of the biggest factors that has influence into that is money and with election costs alone a significant amount of money is spent to campaign. Legislators then also consider the cost and effect of what repealing or replacing the ACA would do and reconsider the idea as a whole. They are going to consider what is most cost effective that will win them a vote in re-election. The ACA assisted in making some improvements but will continue to seek assistance in being able to conquer the need for health insurance coverage across the U.S. as a whole until legislators can find a balance between all factors.

The voters views would significantly affect decisions made by legislative leaders in recommending or their positioning of national policies. Legislators should base their decision of what they feel is morally right after understanding the significance of the issue presented but in order to get re-elected, they have to cast their vote based on how the majority of the voters feel on the discussed issue. “When one thinks like a politician, it means he or she is looking beyond the issue itself and considering other forces and factors that affect what is likely to work and what has no chance of success” (Milstead & Short, 2019). If a legislator chooses to go against majority of the voters, it could then impact the voter’s decision on whether or not to reelect said legislator or deny them the privilege of the job position when it’s time for election decisions to be made. With how influential the voters decisions are will cause the legislator to do what will benefit them in order to get the support from the voters.

References:

Assistant Secretary of Public Affairs. (2022, March 17). About the Affordable Care Act. U.S. Department of Health & Human Services. Retrieved June 15, 2022, from https://www.hhs.gov/healthcare/about-the-aca/index.html

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

Silberman, P. (2020). The Affordable Care Act: Against the Odds, It’s Working. North Carolina Medical Journal, 81(6), 364-369. https://doi.org/10.18043/ncm.81.6.364

Hi Britney,

I enjoyed reading your post – when reading the section about the short period of time it is required for policy makers to make changes in laws – I was struck by the period of time it took for the Affordable care act to become law. Milton and Stead (2019) describe the lengthy process of getting a law to the stage where it has been agreed in the senate and house and how this has to happen in under two years. Obama care was first revealed by Nancy Pelosi in July 2009 and was signed in March 2010. Davalon (2022) describes the long process and the ways in which the democrats had to alter the bill and use a budget reconciliation to get it approved as this needed fewer senator votes to pass. It seems amazing to me when I read this that it was ever passed, with such opposition.

References

Davalon. (2022, January 21^st) History and timeline if the affordable care act (ACA). eHealth.

https://www.ehealthinsurance.com/resources/affordable-care-act/history-timeline- affordable-care-act-aca

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

HI Britney,

I enjoyed reading your post.

One of the benefits of the ACA was the establishment of a minimum standard of insurance benefits for addiction and treatment. This enactment required state Medicaid programs to make changes to their addiction treatment plans.

Despite improvements in addiction treatment benefits and reductions in controls on their use, important gaps remain. With fifteen states prohibiting coverage for short-term residential treatment, and twenty-five states providing coverage for long-term residential treatment, people with severe addiction who require crisis stabilization and access to a structured, supportive recovery environment are left with few options. There is still work that needs to take place.

The nursing workforce is the largest among all the health care professions and is nearly four times the size of the physician workforce. It is evident that our healthcare systems need some refining. Nurses must come out of our comfort zones and be at the forefront for policy change to occur. The key is how do we begin the conversation.  I’m thinking that we need more café conversations with our legislators. We need the legislators to put in the work for our vote.

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

Andrews, C. M., Grogan, C. M., Smith, B. T., Abraham, A. J., Pollack, H. A., Humphreys, K., Westlake, M. A., & Friedmann, P. D. (2018). Medicaid benefits for addiction treatment expanded after implementation of the affordable care act. Health Affairs, 37(8), 1216–1222. https://doi.org/10.1377/hlthaff.2018.0272

                                                                         Politics and the Patient Protection and Affordable Care Act

According to Milstead and Short (2019), policy making is like marriage vows. Are we going to commit to our vows temporarily or at the end? To be re-elected to the office is the purpose of legislators rather than meeting the needs of the people. Legislators’ perception of Obamacare and changes to Medicare and Medicaid must encompass a political interest and benefit. Nurses must understand the political system and legal system operate hand in hand. To relate to the political milieu, nurses must comprehend the establishment of laws and who are the game changers in the lawmaking process.

Politics played an essential part in the design and outcome of the Patient Affordable Care Act. (Walden University, LLC., 2018). ACA leads us closer to the concept of health insurance being a right vs. a privilege. ACA accomplished this through the rules for new health insurance markets. Even though many Americans have health insurance, all do not; at least it points in the direction of Universal Health Care for the future. (Walden University, LLC., 2018). Regarding legislators re-elected to repeal or replace ACA, it depends on the projected cost and the benefits associated with the plan. The political environment must be fertile since the ACA barely passed because of Republican opposition.

Because ACA was considered a thorn in the Republican’s side to repeal or replacing it at this stage may be unwise and untimely. (Walden University, LLC., 2018). As we contemplate what is critical at present, perhaps we would agree the mindset of most of the population focus is stability in their life related to inflation, and voters desire an immediate decrease in inflation rather than a repeal, replacement, or amendment to health insurance.

A few contemporary trends may interest health care in the future. Two areas of concentration are (1) an increase for better mental health care and (2) an increasing call for Universal Insurance. The ACA got us halfway there by ensuring about 50 million people but leaving about 25 million uninsured. Universal Health Insurance is a significant reform. We do not want to regress at the time by repealing and replacing ACA.

Finally, money is critical to elections and re-election, not the voters or legislators. The wealthy and special-interest groups sponsor campaigns. Investors must see a return on their contributions and a benefit to increase donations. (Milstead & Short, 2019). Because money plays a significant role, it causes concerns for nurses and other health professionals. But we must continue to unite and fight for a change in health laws for the patients and the public. Because of our experience, health care is our personal story.

References

Milstead, J. A. & Short, N.M. (2019). Health policy and politics: A nurses

             guide (6th ed.). Jones & Bartlett Learning

Walden University, LLC. (Producer). (2018). Contemporary Issues in 

              Public Health Policy with Joel Teitelbaum [Video file].

Baltimore, MD: Author.

Walden University, LLC. (Producer). (2018). Introduction to Health 

              Policy and Law with Joel Teitelbaum [Video file].

Baltimore, MD: Author.

Hello Hana,

“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). You are stating that money is a critical factor in reelections, which is correct. While repealing/replacing seemed like a good plan at the time, I don’t think that it was thought through to the fullest where the funds might come from to help with these changes.

More nurses and practitioners should be involved in policy-making; we are the ones on the front lines of healthcare delivery, and we should have more of a say regarding decisions of this nature. We shouldn’t be okay with people who don’t have the proper knowledge of the healthcare system’s inner workings to make our policies.

References

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.

Great Post Ana,

I do believe that nurses can help assist and adviocate for change within legislature by making suggestions since we are more away of health care systems and delivery. Most of these policy makers have no idea how our health sustem is run daily and often their input or decision causes havoc among the health systems. As nurdse we strive to promote efficient health care for our patients and delivery of service. Nurses advocate for patient rights , safety, and policy change. “Nurses should be full partners with physicians and other healthcare profrssionals , in redesigning health care in the United States.” (Milstead,Short 2019).

References

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

         Milstead and Short (2019) discuss how “timing is everything” when it comes to lawmaking (p.40) This theory is certainly true when looking at the efforts of republicans trying to repeal the Affordable Care Act (ACA). President Obama passed the ACA into law in March 2010 (Davalon, 2020); Cohn (2020) discusses how Republicans had tried unsuccessfully to repeal bills more than 50 times between 2010 and 2016 to undermine the ACA. By 2016 when President Trump came into power, republicans promised to repeal and replace ACA and provide an alternative that would give everyone better insurance. The Trump administration reduced funding for Medicaid and proposed removing the coverage guarantees for people with pre-existing conditions – actions that would hurt the American people (Amadeo, 2018). By this time, support for the ACA had shifted and was more positive(Hamel et al., 2014). Many Republicans hoping for reelection voted against Trump’s new health bill ( American Health Care Act, AHCA) as they saw that it would be unpopular and increase many people’s health bills and cut health benefits to vulnerable people.

Legislative leaders are elected to their positions; therefore, they must carefully listen to the voters’ views in their states and districts if they want to be reelected. The case of the ACA and the AHCA show this as republicans did not all vote for the AHCA after they realized that it was not popular with many of the people they served, and it may affect their chance of reelection. Milstead and Short (2019) discuss how these changes to Medicare, Medicaid, and the ACA in the lead-up to the 2018 election cycle changed politicians’ position on the AHCA- they add that policymakers’ focus does seem to be more on reelection than the needs of American people.

References

Amadeo, K. (2022, January 29^th) What is Obamacare? Understanding the ACA and Obamacare.The balance. https://www.thebalance.com/what-is-obamacare-the-aca-
            and-what-you-need-to-know-3306065

Cillizza, C. (2017, May4th) 20 Republicans voted against the Health care bill. Here’s why. CNN

https://edition.cnn.com/2017/05/04/politics/ahca-act-vote-breakdown/index.html

Cohn, J. (2020, March 6^th) The ACA, repeal , and the politics of backlash. Health Affairs.

https://www.healthaffairs.org/do/10.1377/forefront.20200305.771008

Davalon. (2022, January 21^st) History and timeline if the affordable care act (ACA). eHealth.

https://www.ehealthinsurance.com/resources/affordable-care-act/history-timeline- affordable-care-act-aca

Hamel, L., Firth, J., & Brodie, M. (2014, March 26^th) Kaiser Health Tracking Poll: March 2014. KFF

https://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-march- 2014/

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

Response #2

Jennifer,

I enjoyed reading your post! The statement “timing is everything” regarding law making is accurate! In our previous module, we went over the window of opportunity. The window of opportunity arose when Obamacare, also known as The Affordable Care Act, was up for debate when President Trump won the election (Milstead & Short, 2019). During his campaign, Trump promised to abolish or reform Obamacare. The problem with repealing the ACA is that it would leave many people without coverage (Willison & Singer, 2017). This is a scary thought, as the population that could potentially lose their coverage could heavily rely on their insurance for life-sustaining medication coverage or treatments! If the ACA one day becomes a thing of the past, a smooth transition of coverage is a must to ease the adjustment for 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

Dysyan,

Thank you so much for your insightful comments in the discussion this week. It seems that Americans want high quality health care at a low cost. These two expectations seem to be in direct conflict. Have you had an experience when something was both of high quality and low cost? What was it and how could the ideas around that product be applied to the ACA? Dr. Braun

            Dysyan, I couldn’t agree with you more that everyone has a different viewpoint on the ACA. There is good in the Affordable Care Act and there is some bad that comes with the Affodable Care Act as well. The good that came with the affordable care act was it was designed to protect consumers from insurance company tactic to drive up the cost and restrict patient care (Roland, 2019). The bad is it increased taxes and there was a penalty if you did not have coverage. I know some places of employment does not offer insurance and to get coverage could be outrageous in the long run. Repealing the ACA act completely could be disastrous, as more than 20 million people would lose their health care coverage (Rapfogel et al., 2021).  Due to the COVID 19 pandemic, repealing the ACA would cause a lot of problems with the health care system in general (Rapfogel et al., 2021).  Replacing some of the components in the ACA would be a better route to go.

References:

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/

Roland, J. (2019, August 17). The Pros and Cons of Obamacare. Healthline. Retrieved June 18, 2022, from https://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare#:%7E:text=Conservatives%20objected%20to%20the%20tax,on%20the%20quality%20of%20care.

Assignment: Legislation Grid and Testimony/Advocacy Statement