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Politics and the Patient Protection and Affordable Care Act

The Affordable Care Act (ACA) is among the comprehensive and sophisticated reforms in the US health system. As argued by Reisman (2015), ACA has been through unprecedented degree of scrutiny particularly by the Republicans. Drawing from the cost and benefit analysis of the politics, the core challenge of repealing and replacing the act has been the millions of Americans that will be left uninsured although the federal deficit is estimated to be reduced by $337 billion over the next decade. This paper examines the politics and the patient protection and ACA.

Overview on Efforts to Repeal and Replace the ACA

The informal release of the draft legislation aimed at repealing and replacing ACA was in 2017, February and the new draft released in March. The American Health Care Act (AHCA) that sought to repeal and replace ACA was passed by the House Committee. The findings by the Congressional Budget Office (CBO) revealed that AHCA would result in 24 million Americans being uninsured. However, the federal deficit would reduce by $ 337 billion in the next decade. The bill was withdrawn from the House floor after the White House and the Republican leadership determined inadequate votes for passing the legislation.

After evaluation of the costs and benefits of the AHCA, the Senate released its overhaul proposal, referred to as the Better Care Reconciliation Act of 2017. Reconciliation in this regard meant legislation consideration in an expedited manner and limiting the elements in the bill, including spending and taxes. Further, the employer and individual penalties were repealed, and there was no continuity of the coverage incentive provisions (Nuzum, Collins, & Abrams, 2017). Other elements covered in the detailed legislative summary were the tax credits, actuarial value of health coverage-metal tier requirements, the essential health benefits, cost-sharing subsidies, and the state waivers or the pre-existing conditions.

Benefits Among the Stakeholders

The politics to repeal and replace the ACA were not about counting votes and political maneuvering. Instead, the impacts on the different stakeholders were unique according to the benefits. To families, the concern was whether they would still benefit from the health coverage and afford prescription medications. The healthcare providers were concerned about the ability to serve all individuals in the society without being overwhelmed by the uncompensated care costs. The states, on the other hand, were concerned about businesses and preserving jobs. Also, they were concerned with having all the required resources to avert the opioid crisis, among other emergencies in the public health sector.

The stakeholders that stand to benefit the most are the insurers and the patients. This is centered on the replacement policy targeting to repeal the taxes, increasing the coverage costs, and maintaining the essential health benefits (Willison & Singer, 2017). Notably, the Senate bill proposes to cancel the ACA taxes apart from the Cadillac tax. Also, the ACA limited the employer or individual’s amount of contribution to the Flexible Savings Account to $2,500. The limitation is repealed under AHCA and the contribution is increased to $6,500 and $13,000 for individual and family respectively per year. This would imply the insurer had more funds and would not suffer losses. The Senate bill further mirrors the AHCA plan to increase funding by $100 million for the Community Health Centre Fund, which would see an increase in quality care. Other provisions that benefit the patients are planned parenthood and the patient and state stability fund.  

Cost-Benefit Analysis in Terms of Re-elected Legislatures

The legislator’s core objective is to be re-elected. Although there are instances that the individual in the elective position may advocate for the people’s welfare, it may be a challenge to please everyone. In President Trump’s decision to renew the war on Obamacare, the lawmakers should consider the reckoning that presents alongside the efforts to repeal and replace the ACA. The main cost of the repeal and replacement of the ACA from the legislator’s perspective was losing their positions in the upcoming election. The benefits to those that argue against the move to repeal and replace ACA include having broad support from the voters, which results in re-election. The legislators understand these aspects, which has a significant influence on the repeal and replacement of the ACA. Both the Republicans and Democrats acknowledge the existence of gaps in the ACA as it is currently constituted. The Republicans that want to be re-elected in 2020 are among those that stopped the repeal of the Obamacare, such as Maine Sen. Susan Collings (Davis, 2019). It is, therefore, apparent that the legislators consider their interests also in their support or rejection of the repeal and replace.

Effect of Voter View on the Legislative Leaders’ Decision

The voters’ views play a vital role in influencing the legislative leaders in establishing and implementing national policies. According to President Trump, the Grand Old Party’s repeal efforts would provide a better alternative and would be termed as the party of healthcare. On the other hand, the GOP legislatures are concerned with their downfall, which is associated with an issue that assisted them in ascending to power (Sullivan, 2018). Listening to the voters’ views is essential in determining the individual’s position on policy issues. For a Bill to be tabled in the House for review and discussion, the legislatures consider the diverse views of the voters. Besides, one of the legislator’s primary goal is re-election. Therefore, the individual must evaluate all the views and consider the majority, which aid in winning the hearts of the people.

            In summary, ACA has attracted wide attention from the people and legislators. The repeal and replacement of the ACA with the AHCA were rejected, and the Senate proposal of the Better Care Reconciliation Act of 2017 presented. The primary beneficiaries of the repeal and replacement of ACA are the insurers and the people. For the legislators, it is apparent that the voters’ view is a significant influence on their decisions.