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Posted: June 7th, 2024
Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA.
POLITICS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
Title: The Impact of Re-election Considerations on Congressional Efforts to Repeal and Replace the Affordable Care Act
The debate surrounding the repeal and replacement of the Patient Protection and Affordable Care Act (ACA) has been a central focus of American politics since the law’s enactment in 2010. While Republicans have long campaigned on promises to undo the ACA, efforts to repeal and replace the law since gaining control of both Congress and the White House in 2017 have faced significant challenges (Béland et al., 2018). A key factor shaping the political calculus surrounding ACA repeal efforts has been the re-election considerations of legislators.
Members of Congress are fundamentally motivated by the desire to remain in office (Mayhew, 2004). As a result, legislators carefully weigh the perceived costs and benefits that key votes and policy stances will have on their re-election prospects. In the case of repealing and replacing the ACA, Republicans have had to balance the benefits of fulfilling a long-standing campaign promise with the potential electoral costs of undoing a law that has provided health coverage to millions of Americans.
Public opinion polling has consistently shown that while the ACA as a whole remains controversial, key provisions of the law such as protections for pre-existing conditions are extremely popular with voters of both parties (Kirzinger et al., 2020). Efforts to repeal the ACA would necessarily eliminate these popular provisions, creating a significant political risk for legislators. Additionally, the Congressional Budget Office has projected that ACA repeal would result in millions of Americans losing health coverage (Congressional Budget Office, 2017), an outcome that could prove electorally damaging for incumbents.
Consequently, congressional Republicans have struggled to coalesce around a viable replacement for the ACA (Rocco & Haeder, 2018). Intra-party disagreements over the appropriate scope and structure of a replacement bill reflect divisions between legislators primarily concerned with delivering on campaign promises to repeal the ACA and those worried about the electoral fallout of disrupting the health care system. This dynamic was evident in the ultimate failure of Senate Republicans’ 2017 ACA repeal effort, where concerns about the bill’s impact on coverage levels and Medicaid funding helped derail its passage (Jacobs & Mettler, 2018).
The specter of re-election has thus acted as a significant constraint on Republican efforts to repeal and replace the ACA. While legislators have strong incentives to fulfill their campaign pledges, the potential electoral costs of undoing popular provisions of the law and increasing the uninsured population have made many wary of supporting repeal without a credible replacement. As long as public opinion remains supportive of key aspects of the ACA, re-election considerations will likely continue to complicate any future efforts to dismantle the law.
References:
Béland, D., Rocco, P., & Waddan, A. (2018). Obamacare in the Trump Era: Where are we now, and where are we going? Political Quarterly, 89(4), 687-694. https://doi.org/10.1111/1467-923X.12527
Congressional Budget Office. (2017). H.R. 1628, American Health Care Act of 2017. https://www.cbo.gov/publication/52752
Jacobs, L. R., & Mettler, S. (2018). When and how new policy creates new politics: Examining the feedback effects of the Affordable Care Act on public opinion. Perspectives on Politics, 16(2), 345-363. https://doi.org/10.1017/S1537592717004182
Kirzinger, A., Muñana, C., & Brodie, M. (2020). KFF Health Tracking Poll – February 2020: Health Care in the 2020 Election. Kaiser Family Foundation. https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-february-2020/
Rocco, P., & Haeder, S. F. (2018). How intense policy demanders shape postreform politics: Evidence from the Affordable Care Act. Journal of Health Politics, Policy and Law, 43(2), 271-304. https://doi.org/10.1215/03616878-4303498
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