Politics and the Patient Protection and Affordable Care Act
Politics and the Patient Protection and Affordable Care ActRegardless 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.BELOW IS THE QUESTION——————-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.BELOW IS THE REQUIRED READING——————–Required ReadingsMilstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.Chapter 3, “Government Response: Legislation” (pp. 37-56)Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 180-183 only)Congress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook, 65(2), 346-350. doi:10.1016/j.outlook.2017.05.003.United States House of Representatives. (n.d.). Retrieved September 20, 2018, from https://www.house.gov/United States Senate. (n.d.). Retrieved September 20, 2018, from https://www.senate.gov/United States Senate. (n.d.). Senate organization chart for the 115th Congress. Retrieved September 20, 2018, from https://www.senate.gov/reference/org_chart.htm.Please use APA 7th edition format with 4 referencies not more than 5 years old.Please go through the grading rubic CORE SKILL: analyzing a major policy as the product of COMPETING INTERESTS and CONSTRAINTS — explaining why it took the shape it did rather than merely describing its provisions or judging it.
THE STRUCTURE OF THE ACA — know the three-legged stool, because its provisions are INTERDEPENDENT and this interdependence is the key to the whole analysis: (1) GUARANTEED ISSUE and COMMUNITY RATING — insurers cannot deny coverage or charge more for pre-existing conditions; (2) the INDIVIDUAL MANDATE — everyone must buy insurance or pay a penalty; (3) SUBSIDIES — to make that purchase affordable. WHY ALL THREE ARE NECESSARY: guaranteed issue alone produces an ADVERSE SELECTION DEATH SPIRAL — if you can buy insurance after you get sick, healthy people wait, the risk pool deteriorates, premiums rise, more healthy people leave, and the market collapses. The mandate exists to prevent that; the subsidies exist to make the mandate tolerable. UNDERSTANDING THIS INTERDEPENDENCE IS THE SINGLE MOST IMPORTANT ANALYTICAL POINT IN THE TOPIC — and it explains why the effective elimination of the mandate penalty in 2017 was consequential, and why the market did not collapse as some predicted (subsidies insulated most marketplace buyers from premium increases, which is itself an interesting policy lesson about how partial dismantling produces unpredictable results).
OTHER MAJOR PROVISIONS: MEDICAID EXPANSION; dependent coverage to age 26; essential health benefits; elimination of annual and lifetime limits; the medical loss ratio requirement; preventive services without cost-sharing; the employer mandate; ACOs and value-based payment reforms.
THE LEGAL HISTORY — cite it: NFIB v. SEBELIUS (2012) upheld the individual mandate as a valid exercise of the TAXING power (not the Commerce Clause) BUT made MEDICAID EXPANSION EFFECTIVELY OPTIONAL for states — which created the “COVERAGE GAP”: in non-expansion states, people too poor for marketplace subsidies but ineligible for existing Medicaid have NO affordable option. THIS IS THE PUREST EXAMPLE OF AN UNINTENDED CONSEQUENCE IN MODERN US HEALTH POLICY — a decision meant to protect state sovereignty left the poorest people in non-expansion states worse off than those slightly above them. Also: King v. Burwell (2015) and California v. Texas (2021).
THE POLITICS: the ACA was built on a MARKET-BASED architecture with Republican intellectual origins (the Heritage Foundation’s individual mandate proposal; Massachusetts’ Romneycare) — which is why the intensity of partisan opposition is a genuinely interesting political puzzle rather than a simple ideological story. Interest groups shaped it decisively: hospitals accepted payment cuts in exchange for expanded coverage; PhRMA secured concessions; insurers gained a mandated customer base. Explaining these bargains is exactly the “competing interests” analysis the assignment asks for.
EVALUATE ON EVIDENCE: the uninsured rate fell substantially; coverage gains were largest in expansion states; the Medicaid expansion literature finds improvements in access, financial security, and some health outcomes. Costs and premiums remain contested. BE EVENHANDED — present the strongest version of both critiques (cost, narrow networks, deductibles, market concentration) and both defenses. A paper that reads as advocacy loses marks.
NURSING RELEVANCE: expanded coverage, prevention and wellness funding, workforce provisions, nurse-managed health clinics, and the Prevention and Public Health Fund.
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