Discussion: Two posts need reply with references


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Lovely Brown

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Blessing Okafor Wed, Sep 14, 5:57 PM
To: Lovely Brown

Politics and the Patient Protection and Affordable Care Act

One of the most important health reforms in the United States since the creation of Medicare and

Medicaid in 1965 is the Affordable Care Act (Obama, 2016). This policy was implemented a decade ago

but has come to be associated with significant improvements in the U.S. healthcare delivery system. For

instance, since it was adopted, the policy has led to increase in access to comprehensive health coverage

to millions of individuals who were previously not insured. This was achieved through the expansion of

Medicaid, the establishment of the Health Insurance Marketplace, and the passage of several consumer

protection provision that are in place to mitigate discrimination by providers as well as healthcare

systems; and to limit insurers’ ability to deny, limit, or cancel coverage (Warner et al., 2020). Notably,

even with the achievements that have been directly linked to this policy reform, the Trump administration

sought to repeal and/or replace the Affordable Care Act. This demonstrates the role of politics in in the

development of health policies. Indeed, there are interests other than those of the society that play a

significant role in the development and implementation of health policies. It is important to note that in

the process of agenda setting, health issues come to the attention of policy makers when problems,

solutions and political developments or motivations align, hence creating windows of opportunity

(Shiffman, 2016). Simply put, the personal interests of legislators, especially in regard to reelection have

significant effects on the development of health policies as it was seen in the efforts to repeal/replace the

Affordable Care Act.

Efforts to Repeal/Replace the ACA

The main job of a legislator is to be reelected. This means that the legislator has to do whatever it

takes to please his or her electorates. As such, important health issues continue to be politicized. These

are issues such as access to care, insurance coverage, and health disparities that the Affordable Care Act

was meant to address. During the process to repeal/replace the Affordable Care Act, it was clear that no

alternatives were presented. In fact, it was almost impossible for lawmakers to have a bipartisan approach

towards the implementation of further health reforms in the country. Politicking seems to be the order of

the day when it comes to discussing health issues that affect many Americans because of how much

health matters to the masses. In fact, health is always on the minds of the public and is said to always rank

among the top 3 concerns (Maddox et al., 2019). Since legislators are aware of this, their personal

interests come first and they will be easily swayed towards the making of a particular decision provided

that the decision guarantees them an office. This is despite the fact that the decision may not have any

scientific or empirical basis. In fact, in a particular survey which involved more than 12,000 American

respondents, it was established that there is public distrust with scientists because many Americans

believe that political motives influence the manner in which scientific research is done (McLaughlin et

al., 2021).

Impact of Voters Views

In recommending or positioning national policies, the analyses of voters’ views may affect the

decisions by legislators. This is because of the desire to be reelected. One of the most important

limitations of democracy is that the majority may not always be right. Voters may also be affiliated to a

political party and push for an agenda without necessarily having the right knowledge regarding the

health issue. In addition, while health policies should always be guided by evidence and scientific

research, the need to win votes creates a situation where science may not only be disregarded but

politicians may also influence the direction of scientific research in order to secure their desired positions.

This is always at the expense of population and public health. Health workers should strive to take part in

policymaking in order to ensure that evidence is considered throughout the process.


Maddox, K. E. J., Bauchner, H., & Fontanarosa, P. B. (2019). US health policy—2020 and beyond:

Introducing a new JAMA series. JAMA, 321(17), 1670-1672

McLaughlin, D. M., Mewhirter, J., & Sanders, R. (2021). The belief that politics drive scientific research

& its impact on COVID-19 risk assessment. Plos One, 16(4), e0249937

Obama, B. (2016). United States health care reform: Progress to date and next steps. Jama, 316(5), 525-


Shiffman, J. (2016). Agenda setting in public health policy. In International encyclopedia of public

health (pp. 16-21). Elsevier Inc.

Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C., … & American

Heart Association Advocacy Coordinating Committee. (2020). Advancing healthcare reform: The

American Heart Association’s 2020 statement of principles for adequate, accessible, and affordable health

care: A presidential advisory from the American Heart Association. Circulation, 141(10), e601-e614

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Lovely Brown

Respond to the post with two references

Blessing Okafor Wed, Sep 14, 5:56 PM
To: Lovely Brown

Discussion Politics and the Patient Protection and Affordable Care Act

In 2010, on March 23, the Patient Protection and Affordable Care Act1 (currently Affordable Care Act)
was signed into law with amendments from the Health and Education Reconciliation Act2. On January 1,
2014, the individual and employer accountability provisions, the operation of state health insurance
Exchanges, the expansion of Medicaid, and the distribution of subsidies to individuals and small
businesses will all go into effect. The Affordable Care Act gives a once-in-a-generation chance not only
to reform coverage and care but also to reconsider the fundamental purpose of public health in a country
where everyone has access to health insurance.

How Cost-Benefit Analysis Influence the Efforts to Repeal or Replace the Affordable Care Act

Nurses and patients are the people who are most likely to be impacted when a policy relating to health
care is formulated and put into action. However, according to Milstead & Short (2019), the people who
set policies concentrate on how the changes will affect their re-election rather than necessarily how the
changes will affect the people. For example, when President Donald Trump first took office, the
Republicans initiated the process of repealing and replacing Obamacare, also known as the Affordable
Care Act (ACA), as well as Medicaid or Medicare. This occurred shortly after President Trump was

In 2017, when Trump care was being debated and voted on in the house of representatives, the
government of President Donald Trump and Republican politicians used the American Health Care Act
(AHCA), often known as Trump care, to repeal and replace the Affordable Care Act, generally known as
Obamacare. Despite this, it didn’t take long for it to become abundantly clear that the American Health
Care Act (AHCA) would result in an increase of 23 million people who lacked health insurance (Béland
et al., 2019). In addition, the purchase of insurance under the terms of the American Health Care Act
(AHCA) would have a negative impact on 130 million people in the United States who have preexisting
health conditions, causing them to pay higher premiums and receive fewer benefits. Paying high premium
rates for medical coverage would have a significant impact on people who are already struggling
financially due to their chronic diseases. It is possible that the law that would replace Obamacare with
other coverage provisions would be costly. As a result, the people who construct the insurance would
need to keep the majority of the offsets that are currently provided by Obamacare.

Nadash et al. (2018) note that in the absence of income, the American Health Care Act (AHCA) proposes
a tax credit of $2,000 for those under the age of 30 and $3,000 for those 60 and beyond. Many people in
the United States would see their health care expenditures rise under the proposed age-based tax credit
system. Legislators and Republican party leaders were warned by a cost-benefit study that they would
lose their seats if they voted to repeal and replace the Affordable Care Act. It was already established that

the policy change, the American Health Treatment Act (AHCA), would make it more difficult for many
people in the United States to obtain low-cost medical care. This issue was the focus of President
Obama’s Affordable Care Act.

The American Academy of Family Physicians opposed the American Health Care Act (AHCA) because it
would increase health care costs and refuse to cover patients on the basis of preexisting conditions, age,
or socioeconomic position. They were against it because the ideas in the American Health Care Act
(AHCA) increased health care insecurity among Americans.

How Analyses of the Voters’ Perceptions May Influence Decisions by Legislative Leaders in
Recommending or Positioning National Policies

The legislative leaders are interested in keeping their positions. Legislative leaders, then, need to keep an
eye on the political atmosphere and how their votes on certain issues affect their chances of remaining in
office (Brodie et al., 2020). This means they need to think about the needs of the country as well as the
desires of the party. Legislative leaders are chosen by the people at large and must run for office. As a
result, voters’ opinions matter in determining the outcomes of contentious policy debates like the
Affordable Care Act (ACA) and the American Health Care Act (AHCA). The Affordable Care Act
(ACA) repeal, for instance, was passed without a single Republican’s signature; it is now being

In conclusion, legislative leaders’ actions are heavily influenced by the views of the electorate. As a
result, legislators should make judgments based on well-thought-out protocols and keep an eye on how
their choices can influence future votes.


Béland, D., Rocco, P., & Waddan, A. (2019). Policy feedback and the politics of the Affordable Care
Act. Policy Studies Journal, 47(2), 395-422.

Brodie, M., Hamel, E. C., Kirzinger, A., & Altman, D. E. (2020). The Past, Present, And Possible Future
Of Public Opinion On The ACA: A review of 102 nationally representative public opinion polls about the
Affordable Care Act, 2010 through 2019. Health Affairs, 39(3), 462-470.

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.

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

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