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Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050

Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050

The U.S. Federal Government is made up of three branches: legislative, executive, and judicial. To ensure the government is effective and citizen’s rights are protected, each branch has its powers and responsibilities, including working with the other branches. The legislative branch is made up of the House and Senate, known collectively as the Congress. Among other powers, the legislative branch makes all laws, declares war, regulates interstate and foreign commerce, and controls taxing and spending policies. (United States House of Representatives, n.d.).

The members of the house are elected every two years. In general, the elected officials usually have much passion and want to make good policy during their terms. Many come to their respective legislative bodies because they want to make a difference and be part of good government (National Council for the Social Studies, n.d.).

One of the most essential policies enacted by the legislators is the ACA (Affordable Care Act), famously known as Obamacare, a comprehensive care reform law enacted in March 2010. The three main goals of the ACA (Affordable Care Act) are: to make affordable health insurance available to more people, enhance Medicaid programs, and support innovative medical care delivery methods designed to lower the costs of health care (Health Care, n.d.). However, some conservatives objected to the policy. It is because of the increase and high insurance premiums that we need to pay for Obamacare. They also think that it may have adverse effects on the quality of care. According to Laureate (2018), the ACA (Affordable Care Act) passed without Republicans’ signatures. After it was passed and implemented, half of the states, led by either Republican governors or legislatures, are actively challenging or ignoring the law. So it is clear that obviously, politics is playing a significant role in both the design at the outset and now the implementation of the ACA (Affordable Care Act). During Trump’s administration, the republicans tried to replace the ACA (Affordable Care Act) with AHCA (American Health Care Act). The AHCA (American Health Care Act) ensures more affordable health by not requiring everyone to buy the insurance and not paying penalties if they decide to buy later. However, the AHCA (American Health Care Act) has not to get the majority of the vote and has not become a law. According to a national poll done by Quinnipiac University, 56% of American voters disapproved of the AHCA, and 46% of voters said they would be less likely to vote for their representative if they supported the AHCA. If doing the right thing wasn’t enough to get Republican representatives to oppose the bill, knowing that they could lose their seats in the next election sure was (Iyamah J., 2017).

The number one job of a legislator is to be re-elected. Legislators want to remain in office or at least leave on their terms. In order to find the support to be re-elected continually, legislators must be aware of not only the political climate but also how specific votes will affect their ability to stay in office. They must consider the will of their constituents, the needs of their state, and the desire of their party (National Council for the Social Studies, n.d.). Once legislators win a seat, they are expected to make good decisions on whom they support and what advocacy they champion. In a cost-benefit analysis, the making of policy and law should pass a stringent process. They need to influence other legislators with their arguments. Sufficient data and research should support a bill to pass a debate and move to the Senate. The bill needs the majority of the votes in order for it to be a policy. If a legislator did not re-elect, the policy they make or amends could be dismantled. In order for a bill to be a policy, a legislator needs support from the officials. The policy should cover the greater good of the population. The re-election of a legislator means continuity of the policy they started or a chance to repeal a current policy.


Health Care.gov (n.d.). Affordable Care Act (ACA). Retrieved from https://healthcare.gov/glossary/affordable-care-act/

Imayah, J. (2017). Why did the American Health Care Act Fail?. Friends Committee on National Legislation. Retrieved from https://fcnl.org/updates/2017-04/why-did-american-health-care-act-fail

Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel Teitelbaum (Video file). Baltimore, MD: Author.

National Council for the Social Studies. (n.d.). How Legislators Make Decisions. Retrieved from https://socialstudies.org/advocacy/how-legislators-make-decisions

The White House. (n.d.). The Legislative Branch. Retrieved from https://whitehouse.gov/about-the-white-house/our-government/thr-legislative-branch/

United States House of Representative. (n.d.). Retrieved September 20, 2018, from https://www.house.gov/

Unites States Senate. (n.d.). Senate organization chart for the 115th Congress. Retrieved September 20, 2018, from https://www.senate.gov/reference/org_chart.htm

Individuals, regardless of political affiliation, are frequently concerned when they consider perceived competing government interests and their impact on topics of interest to them. The healthcare industry is no exception. Some people believe that local, state, and federal policies and legislation can be aided or hampered by interests other than societal benefit as stated in Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050.

Consider that the most important job of a legislator is to be re-elected. Cost can be

Discussion Politics and the Patient Protection and Affordable Care Act NURS 6050

Discussion Politics and the Patient Protection and Affordable Care Act NURS 6050

expressed in both votes and dollars. As a result, it is critical to consider the legislator’s perspective on whether or not to promote a particular initiative in the political landscape as discussed in Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050.

To Prepare for Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050:

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.

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Politics and the Patient Protection and Affordable Care Act NURS 6050

RE: Discussion – Week 3

               It is to no avail that health care is one of the most important topics when it comes to the legislators and the public. The Affordable Care Act (ACA) is the most controversial yet needed health care plans that has been established. The ACA which was introduced in 2010 during former President Obama’s term provides health care to millions of people young and old that would not previously have health care. The ACA’s purpose was to expand the Medicaid program, and support innovative medical care delivery methods designed to lower the costs of health care generally (Healthcare.gov, n.d.). The Affordable Care Act has met much debate as it has not been as affordable as it was deemed to be. Also, it created a liability for the American people to have insurance such as penalizing anyone who did not have insurance. One unsettling aspect was the cuts that had to be put forward to make the ACA and expansion happen. These have been the cons of ACA that have made for huge political viewpoints. This has been the mark for many politicians in terms of putting forth their stance to get re-elected. Rather than caring about the actual future of health care accessibility and out of pocket expenses that people face, the ACA is being used during this time as a re-election tool. As President Trump wants to see the ACA depleted while others would like to see it built up, it seems legislators are either for it or against it. The goal for their viewpoint on the matter is for support and re-election purposes. “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, p. 51). “The legislators cost-benefit calculations are not the cost-benefit to society of enacting particular legislation, but the benefits are the additional political support the legislator would receive from supporting legislation and lost political support they would incur as a result of their action” (Milstead & Short, 2019, p55). Politicians and legislators look for what they think will bring them success, such as staying in office for re-election. The decisions of legislative leaders are affected through the voter’s views. According to National Council for the Social Studies, legislators consider the Triangle Test when deciding how to vote. They think, do my constituents care about this issue? Is this good policy for the Nation and does this make sense? Is this press worthy? (n.d.).

A legislator whose goal is to be re-elected would be smart to go with the popular vote.


Healthcare.gov. (n.d.). Affordable Care Act (ACA)-HealthCare.gov Glossary. Retrieved September 17,

2020. from https://www.healthcare.gov/gossary/affordable-care-act/

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. (p.51, 55). Burlington,

MA: Jones & Bartlett Learning

National Council for the Social Studies. (n.d.). How Legislators Make Decisions. Retrieved September

17, 2020, Retrieved https://www.socialstudies.org/advocacy/how-legislators-make-decisions

By Day 3 of Week 3

Post an explanation of how you believe the cost-benefit analysis of legislators’ reelection affected efforts to repeal/replace the ACA.
Then, explain how analyses of voters’ views may influence legislative leaders’ decisions in recommending or positioning national policies (for example, decisions by Congress affecting Medicare or Medicaid).
Remember that the most important job of a legislator is to be re-elected.
Please review your discussion grading rubric to ensure that your responses meet the requirements.

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days by expanding on their explanation and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:

Week 3 Discussion

Politics and the Patient Protection and Affordable Care Act

In the political system, the main aim of any political leader is to get reelected. The Trump administration and the legislators allied to the ruling have tried to repeal the Patient Protection and Affordable Care Act (ACA) three times since 2016 and they have not been successful. What Americans presumable need as it concerns universal healthcare, involves slight changes to the ACA as opposed to repealing it (Milstead & Shortm, 2019).  As such, in their quest for reelection, the legislators may engage in cost- benefit analysis in repealing the ACA.

Owing to the fact that Americans have shown openly that they are not for repealing the ACA, exercising patience may be of great significance in ensuring that the legislators attain reelection. However, insisting on repealing the policy could be costly to the legislators. According to Milstead and Shortm (2019), legislators who take an angle of making changes to the policy could have a significant benefit that could positively affect their re-election since it has been evident that this is what the American voters want.

As such, analysis of the views of voters could have significant effects on the decisions by legislators as it concerns recommendation of such national policies as impacting changes on the Center of Medicare and Medicaid Services, which has been a hot bone of contention over the years (Taylor et al., 2017). As much as the ACA failed to take Americans to the promised land of universal health care, the views of voters are not for repealing but for making specific changes that would ensure that the policy ensures universal health coverage. Therefore, in their quest for reelection, legislators could decide on making policy recommendations that align with the views of the voters (United States House of Representatives, n.d).


Milstead, J.A., & Shortm, N.M. (2019). Health Policy and Politics: A nurse’s guide (6thEd.) Burlington, MA: Jones & Bartlett learning.

Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, VC.,Safriet, B. J., & Hagan, T. (2017). Corrigedum 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 from https://www

RE: Discussion – Week 3

     I agree with you that legislators should agree on making policy changes or recommendations that align with the views of the voter. Voters desire the expansion of universal health coverage; however they oppose some of the regulations that the Affordable Care Act proposed along with it. Enacting penalties to individuals who were not covered under a health plan did not set well with the public. In efforts of repeal the ACA, the Graham-Cassidy Bill, the American Healthcare Act, and the Better Care Reconciliation Act all attempted to lessen or remove the penalties to individuals who were without healthcare coverage and to remove the penalties enacted upon businesses that failed to meet the coverage requirements (Nadash, 2018). Republicans saw the repeal as an opportunity to gain votes due to the unpopular mandates (Nadash, 2018).

Politics has never been something I have been interested in. In my opinion, there is a lot of scheming, finger pointing and truth stretching. However, I know that politics must go on. Milstead and Short (2019) state, “Many nurses and other healthcare professionals see “politics” as a negative term and perceive “playing politics” as a reason for not getting involved in political advocacy.” As I have advanced in my nursing career, I have gained knowledge and can see how political advocacy can help shape health policy. This does not mean that I agree with how politics works, but that if I am involved in informing politicians on healthcare issues, I may be able to make a difference in our populations health.


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

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. https://doi-            org.ezp.waldenulibrary.org/10.1080/08959420.2018.1462683

RE: Discussion – Week 3

Week 3 Discussion

Main Response

The Affordable Care Act of 2010 was put in place by President Obama and supported mainly by the Democratic Party. The act offers affordable insurance to all Americans and is a step in the direction of healthcare as a human right (Laureate Education, 2018). The ACA has expanded Medicaid, made it illegal to charge extra or give less coverage to the elderly, infirm, or disabled, and mandated that companies employing more than 50 people offer quality health insurance. These fit the Democrat agenda. Democrats are known to fight against social inequality and embrace civil rights. The Republican agenda under Trump, leans towards cutting back on Federal Funding of healthcare and even seems to be racially biased. Attempts to repeal the ACA have been met with outrage from the groups that benefit most from affordable insurance, namely the millions of low-income seniors, disabled and infirm (Nadash et al., 2018).

Quality healthcare and preventative care for high risk groups is offered under the ACA, with the justification that this will lead to better outcomes and less spent in the long run. Republicans would like to overturn the ACA and allow individual insurance companies high-risk pools, where insurance companies balance out the cost of covering high utilization customers with a higher number of younger, healthier low utilization customers. The ACA outlawed this. They would also like to cut back on Medicare and Medicaid. Knowing that they are coming up on an election year, the Republicans do not want to lose votes. They have backed off on the repeal, which is unpopular with their constituents and special interest groups.

Legislators cannot go too far astray from the agenda of their political party. Politics is a game of making deals. At times legislator’s votes may be based on a strategy to be re-elected. Sometimes there will be an agreed-upon trade of votes, quid pro quo. While the timing and the current state of political affairs affect a legislator’s vote, it is always essential for a legislator to be open-minded and willing to bend (Milstead & Short, 2019). Keeping in the good graces of colleagues and constituents is the best bet of being re-elected. Voting to cut Medicare and repeal the ACA would not be in the best interest of legislators trying to be re-elected in the current political climate regardless of their political affiliation.


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

Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel Teitelbaum [Video file]. Baltimore, MD: Author.

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. https://doi-org.ezp.waldenulibrary.org/10.1080/08959420.2018.1462683

RE: Discussion – Week 3

Cost-Benefit Analysis and Legislator’s Reelection

The cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the Affordable Care Act in numerous ways. Many variables affect legislative decisions: legislators, constituents, special interest groups, lobbyists, committees, chief executives, legislative aids, and many more (Milstead, 2019). Another complication to the process is if an interest group has enough money to support a legislator to be reelected. In return, that legislator could put the interest group’s views before their views on policy decisions. (Milstead, 2019). Therefore the cost-benefit analysis can be misconstrued by the reelection supporter views (wealthy people or special interest groups) being the main goal is to be reelected (Milstead, 2019).

Nurses bring a valued insight into the healthcare system, allowing them to present what is improving the health of their patients (American Nurses Association, n.d.). A rational nurse can stand behind “the ultimate point in participating in policymaking is to improve patient outcomes.” (Milstead, 2019, p. 39) This conflicts “the realization that policymakers are not necessarily focused on how real people will be affected by the changes to Obamacare or Medicare and Medicaid but rather on how the changes will affect their reelections chances.” (Milstead, 2019, p. 40) Nurses who are passionate about something they would like on the agenda could be overridden by a particular interest group with the funds to support the legislator. The reelection supporter may think in the opposite way of the legislator but will have a voice in the policymaking decision because of their money. It is understandable how nurses are overwhelmed with the policy process being there are many complexities to the equation.

The analyses of voter’s views impact national policies broadly. If the main goal for a legislator is to be reelected, they have to have the votes. This can make the Affordable Care Act and other health care system solutions so tricky. While half of the population wants to leave the Affordable Care Act in place, 19% wants to repeal and replace the Affordable Care Act, and 24% wants to know the replacement plan before the repeal (Milstead 2019). That makes it difficult on when to make healthcare policy moves and how to make them. With 20% of the United States on Medicaid in 2017 and 55.5 million on Medicare in 2015, the voters’ views will immensely impact Congress’s decisions (Milstead, 2019).

On the positive side, if legislators or other government officials were not voted in, they would not consider what the people want or what they believe is best. In that situation, we would have someone making all of our decisions without thinking twice about what the voters think. The Affordable Care Act did not have any republican signatures when it came into place (Laureate Education, 2018). As a result, half of the states (republican lead states) are going against the law (Laureate Education, 2018). All voters’ views must be under consideration because even if a policy is put into place, the other half of the population may stand up against the policy and make it unsuccessful. This is why President Trump should consider changing parts of the Affordable Care Act instead of getting rid of it completely.


American Nurses Association (n.d.). Health Policy. https://www.nursingworld.org/practice-policy/health-policy/

Laureate Education (Producer). (2018). Contemporary Issues in Public Health Policy with Joel Teitelbaum [Video file]. Baltimore, MD: Author.

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

Working with Legislators Program Transcript

FEMALE SPEAKER: The people who you are talking with in an elective office or their staffs are extremely bright. Having said that, do not assume that they know what you know. That’s what you bring to the table.


These may be individuals that have never been in the hospital except for the day that they were carried out in their mother’s arms. They may not have had ongoing, extensive exposure to the challenges of the populations you’re serving. So you’re the voice to that. So bright people, but do not underestimate what you bring to that conversation.

FEMALE SPEAKER: I’ve always told students, if you ever go into a legislator’s office and heart conditions are your thing, don’t ever talk about all the CABGs that have been done. That’s a coronary artery bypass graft. They don’t know what a CABG is. They think a CABG is something that looks kind of like a lettuce, only it’s tougher.

We know not to use that kind of terminology with patients. We know not to use it with legislators, even though they may be lawyers and attorneys. They don’t understand medical terminology.

FEMALE SPEAKER: So it’s really important for people that you’re talking to know your background, to know that you’re a registered nurse, that you have a master’s degree, and your specialty is in a particular area. So you’re talking about the population you work for and maybe even where you work. That’s information that they need to know about you, because how they process the rest of what you tell them will be informed and influenced by their knowledge of your background.

So be sure that that’s the first thing you say to them. This is my name. This is what I am. And here’s where I’m from.

It’s really important to have your facts down, and that if there’s a question you’re asked and you don’t know the answer to it, to know that that’s OK, that you do the follow up coming back to them and letting them know, I don’t know the answer to that question. But I’ll be sure to get it for you. And then do it, and do it quickly.

We also should never stretch the truth, deviate from fact. If what we’re sharing is an opinion, we ought to let them know it’s an opinion. Now, I would say it’s an expert opinion, probably, on health care, because of our background. But be able to distinguish, my opinion is this, or based on my experience, this is what I see.

Additionally, it’s so important for us to be members of professional nursing organizations. It’s important, because it’s so challenging these days to stay abreast of the issues, challenges, problems, policies that are resonating at state and federal levels. So I stay in close touch through email communication that I get from the professional associations of which I’m a member. And when they ask me to do something, I act on it.

It doesn’t mean you have to be full-time in health policy to do this. It does mean that on occasion, spending five minutes to read up on an issue and then sending an email consistent with what my professional association is asking me to do, that might be at least as important as what you do for a patient or for family or for a community that day, because engaging there might actually be part of the trigger to get a policymaker to do something different than they may or may not have done otherwise.

FEMALE SPEAKER: It’s fine to disagree. But let’s work on what is going– that we can get done successfully together, though. And that’s been my whole thing with policy, collaboration across parties, working together to get things done.

When we have a disagreement, we disagree without hostility, but we certainly disagree clearly and reinforce our positio