Health Politics Policy and Law Paper Instructions and assigned reading is attached below. If you have any questions please feel free to ask. Thank you! Instructions: This assignment must be done in APA format. It is broken
down into 4 questions. A minimum of 1700 words (references is not
included) for the overall assignment is required. The minimum reference
count is 4 (including in-text citations) for the overall assignment. Also,
even though this assignment is done in APA, it must keep the question,
answer, and reference format. Please see example below.
Format: Question: XYZ
Articles for questions: https://www.ahajournals.org/doi/full/10.1161/01.cir.101.16.2015
1. The United States government is based on a balance of power between 3
branches, which are the Executive, Legislative and Judicial. These 3
branches are heavily immersed in the debate over a national health care
system, without a specified model. This debate has raged on since the
Presidency of Teddy Roosevelt and culminated with the passage of the
Affordable Care Act. In a narrative format, discuss the political process
involved in the initial passage of the Affordable Care Act.
2. Define the legal hurdles impacting a nationalized health system.
3. What process might be more effective in proposing and passing a
nationalized health system for the US.
4. Describe the underlying issues that resulted in a divided nation over the
passage of a nationalized healthcare system.
Part Two: This part of the assignment is simple. The minimum word count for
this assignment is 250 words (per response); with one reference each.
Note: Write as if you’re actually talking to the person.
1. The Affordable Care Act was put into motion in 2010 after many decades
of failed attempts of adopting a form of universal healthcare by the
legislative branch (Morone, Litman & Robins, 2009). The issue with the
United States’ form of democracy is the separation of power within the
Congress and with two parties having opposing ideas. When an idea gets
brought up by one party, it gets shot down by the other. Finding a balance
and a win-win for all is the ultimate goal and the major setback of our
healthcare not being where it should be.
The Affordable Care Act was the first big step towards a change in our
healthcare industry that was implemented by the Democratic party. Now
with a Republican in office, there are talks and proposals to stop the ACA.
This proposal would be a “repeal and delay”, which would remove funding
towards this program and delay it for a few years (Wilensky, 2017). The
Republican party would prefer more of an insurance regulation and
changing the MMS budgeting structure. Another aim would be towards
the Veterans Affairs program and increasing the quality and services that
are currently provided. Prescription drug prices are also on the rise and
the Trump Administration is focused on reducing these unwarranted
costs, although they would most likely not focus on CMS drug
The Republicans certainly have changed some aspects of the ACA, 24
times in the first six years, and the Democratic party is looking to retain
most of the original ACA (Mcdonough, 2016). The Democratic party’s main
focus in 2016 was the affordability of the ACA’s tax credits, improving
states’ participation in Medicaid programs, monitoring premiums and not
allowing premiums to grow faster than household price index, and
eliminating a glitch that affects households who do not qualify for
assistance but need it. Clinton wanted to allot $500 million for enrollment
It is clear that both parties have a lot of differences towards the ACA. The
Republican party is geared towards amending and potentially eliminating
the ACA and forming their own healthcare structure, whereas the
Democrats are willing to spend millions of dollars towards improving and
trying to get more people enrolled into the program. The Republicans are
trying to fix aspects of healthcare that need attention and are getting out
of control such as increases of prescriptions and VA programs. The
Democrats, on the other hand, are trying to group most, if not all
individuals that are struggling with prescription medications and poor
quality, such as Veterans, within the ACA. Although there are huge
conflicting feelings from both parties, the goal between both are that they
want to improve not only the quality of healthcare but also making it
affordable for individuals and families.
2. A lot of things have changed since the Affordable care act passed in 2010.
Currently Democrats and Republicans are at opposition on trying to repeal
the ACA. Democrats support “insurance for all” and believe people should
have health coverage regardless of pre-existing conditions, Republicans
wants insurance to be provided privately in the market but also want
companies to cover expenses related to pre-existing conditions. The
conflicting part of that is having both of those things without having an
individual mandate.There would be no incentive for a person to sign up
for insurance and pay all the premiums until they were to come down
with something costing a lot of money. Republicans hate the Affordable
care act but they like certain parts of it, like coverage of pre-existing
conditions and choice of private insurers, which is a disaster of mandates,
regulation and subsidies.
Out of thirty states with Republican governors in 2013, only four launched
their own exchange(Jones,Bradley & Oberlander,2014).”States could
maximize control over decision making and avoid federal intervention by
establishing their own health insurance exchanges.Yet GOP leaders feared
that creating exchanges would entrench a law they intensely opposed and
undermine legal challenges to the ACA. Republicans’ calculations were
further complicated by uncertainty over the Supreme Court’s ruling on the
ACA’s constitutionality”(Jones,Bradley & Oberlander,2014).
Administration is trying to create an alternative individual health coverage
market independent of the ACA. Currently there are three alternatives.
The American Health Care Act,which produces penalties for those without
coverage, and repeals ACA mandates and other subsidies, The CARE act,
repeals ACA mandates and cost sharing subsidies, produces no changes to
Medicare, loosens regulations on insurers and eliminates taxes and fees
from the ACA. And replacing the ACA with a single payer plan, it
proposes that a comprehensive single-payer plan would provide all 311
million legal residents of the United States with coverage in 2017. The
only uninsured would be 11 million undocumented
For many generations Democrats have fought for Universal healthcare in
2010 the ACA was finally passed and sparked outrage among Republicans.
More recently and in hopes of pushing agendas Democrats are for
“Medicare for all”, a government funded health care
system(Seidman,2015).This would expand beyond what is already offered
in the ACA. Vermont Sen. Bernie Sanders is the one that first introduced
the Medicare for all proposal and says it is one step closer toward
achieving Universal health care. One huge issue with the Republican party
is the cost. Several studies have been done and healthcare spending
would drastically increase, the estimated cost is around $30 trillion.
Democrats argue that is “grossly misleading and biased”(Seidman,2015).
Mark A. Peterson
We cannot understand health politics and policy without understanding
Congress. In this chapter, Mark Peterson explores the logic of our legislature,
shows how it is unique, and explains why it matters.
Congress has been both friend and foe of health policy. What
I all reit enacts, what it ignores, and what it actively defeats
veal a good deal about the legislative process in theCUnited
States and echo the changes that, over time, remake American
lawmaking. As reflected in the landmark displays of congresU the
sional action, stalemate, and obstreperousness during
Obama administration, it is national politics writ large played
out in the most important crucible of policymaking.
The cumulative effects of what Congress has enacted are
substantial by any measure. Since the 1930s, as a 1
legislative attention to hospital construction, biomedical re1
search, medical manpower training, drug safety, public health,
and workplace safety, as well as direct provision of
health insurance and tax subsidies for private coverage, Con5
gress has constructed a far-reaching national health-policy
domain with enormous financial consequences. JustTin monetary terms, a comprehensive analysis of all federal S
expenditures and tax benefits in 1999 estimated that federal dollars
represent 40.8% of the nation’s overall health care spending.
Throw in state funding for the federally established Medicaid
program and the total hits 47.3%.1
But for all of its engagement with health policy, Capitol
Hill has presented a nearly insurmountable hurdle for particular kinds of policies. Except for legislation that cuts
projected spending for public programs like Medicare and
Medicaid, Congress has consistently rejected proposals
designed to contain health care costs systemwide, even
when overall health care expenditures have increased at
more than two or three times the overall rate of inflation,
far faster than economic growth, and well beyond the demographic pressures of an aging society. It forthrightly
rejected, for example, President Carter’s initiative for hospital cost containment. 2 Moreover, until the enactment
of the Patient Protection and Affordable Care Act of 2010
(generally referred to as the ACA), for nearly 65 years the
legislative branch refused, time and again, all attempts to
establish a system that moves toward universal health insurance coverage. As every other advanced democracy
in the world achieved, each in its own way, the “international standard” that combines effective cost containment
and universal coverage, Congress has rejected comparable
efforts in the United States. 3 As we will see later in this
9781305172005, Health Politics and Policy, Fifth Edition, Morone/Ehlke – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.
CHAPTER 3 • Congress
chapter, even the enactment of the ACA, with all of its
substantive shortcomings, required extraordinary political
How are we to understand these dynamics of the American
legislative process, with its emphasis on distributive policymaking, bursts of regulation, episodic focus on particular
populations and constituencies, and enormous resistance
to broad-scale strategies to discipline health care spending
and provide universal insurance coverage? What does one
need to know about Congress to explain this mix of activism, struggle, and denial, to ascertain “the logic of congresH
sional action” and inaction in health policymaking?4 In this
chapter, I describe the core features that define Congress
an institution and as a collection of individual legislators.
also consider how unusual election results as well as changes
in the structure of Congress alter the internal politics of lawmaking, on occasion permitting dramatic policymaking. S
these fundamentals of the legislative branch in hand, I turn
to the issue that is often of paramount interest to students of
health politics and policy, offering a fairly detailed analysis of
the repeated failures of comprehensive health care reform
the legislative arena and the sources of the relative success
in 2010. Finally, I assess the rise of extreme partisanshipHand
ideological division in Congress and consider its implications
for the future of health policymaking.
The Baseline Congress
One fact about Congress stands above all others: “Among
the national legislatures of major countries, Congress isQthe
only one that still plays a powerful independent role in public
policymaking. . . . Only Congress initiates legislation, makes
decisions on major provisions, and says ‘no’ to executiveApro-
posals.”5 Consider the stark difference between the United
States and the United Kingdom. Three major empirical studies
reveal that Congress in the postwar period adopted, typically
only in part, just 6 in 10 presidential initiatives. Some presi1
dents fared especially poorly—Gerald Ford and Jimmy Carter
could get Capitol Hill to accept only about a third of their leg6
islative agendas. In contrast, British Prime Minister Tony5Blair
was in office for more than eight years before the parliament
defeated—for the first time—one of his major legislative pro7
posals. Congress not only frequently exercises its authority
to block or substantially alter initiatives from the executive,
it often plays a critical leadership role in the formative stages
of policymaking. Policy ideas “proposed” by presidents often
begin as bills drafted much earlier by members of Congress.8
Based on his detailed historical analysis of 28 major statutes
enacted from 1947 to 1990, Charles O. Jones determined that
the impact of the legislature was “preponderant” for a quarter
of the laws, and in more than half the cases Congress shared
roughly equal influence with the president.9
What permits Congress to be so different from other national legislatures and therefore of such unique consequence
to health policymaking is the “separation of powers” and
attendant checks and balances established by the US Constitution. This system of independent legislative, executive, and
judicial branches of government, each with a formal claim
over some aspect of lawmaking and implementation—more
accurately captured by Richard Neustadt’s phrase, “separated institutions sharing powers”—ensures that Congress
is a central player in national policymaking.10 It also fosters
decision-making complexity by injecting multiple perspectives into the legislative process. Both the Constitution and
institutional arrangements that developed later (through law,
rules, and interpretation) make enacting statutes difficult.
Successful legislation requires assembling a daunting series
of like-minded coalitions in numerous venues—committees
and subcommittees within the House and Senate, while
also garnering the support of the president (or sufficiently
large majorities in both the House and Senate to override a
presidential veto). Just about everything engineered by the
Constitution makes that tricky to do, such as the separate
constituencies and election timetables for the president, the
House, and the Senate.
Elaborating on the comparative context illustrates the
point. Arend Lijphart identified two “ideal types” of democratic constitutional design: “majoritarian” and “consensus.”11 Majoritarian systems simplify the burdens of decision
making by concentrating power in the hands of the leadership
of the political party that won the most recent election. They
dramatically limit the opportunities for independent action by
legislatures. Such systems have a prime minister as the single executive leader. The prime minister and the cabinet (together forming “the government”) are generally members of
parliament, thus fusing the executive and legislative authority. The legislature has only one body with policy-making
power. In addition, only two parties compete meaningfully in
elections and on issues that clearly differentiate the parties.
In those elections, a legislative district is represented by the
candidate who won a plurality of the vote. Lower-level governments are under the authority of the national government.
9781305172005, Health Politics and Policy, Fifth Edition, Morone/Ehlke – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.
PART II • National Political Institutions
The constitution is unwritten, interpreted largely by the parliament itself instead of an independent judicial branch of government. Majority party members in parliament are expected
to follow the lead of their prime minister and cabinet. New
Zealand’s political system fits this image nearly perfectly.12
The United Kingdom and Canada come close to this model.
Alternatively, nations that comport with “consensus”
a rrangements have governing systems in which taking
action requires the nurturing of pervasive agreement among
myriad policy makers located in multiple institutional settings. Everything about these systems fragments power
majoritarian systems concentrate it. As a result, consensus
I in any
systems invite any interest group with a large stake
policy question to work the institutional crevices of dispersed
policymaking in order to shape laws more to their liking or to
“veto” provisions with which it disagrees.13
S atThe United States possesses a number of majoritarian
tributes (executive power concentrated in a single president,
a two-party system, single-member legislative districts, and
“first-past-the-post” plurality elections for Congress and the
president). However, because of the separation ofSpowers
and the equal authority granted the two chambers of ConH
gress, each with distinctive constituencies; federalism that
protects the autonomy of the states (further reflectedAback in
the Senate and tensions between the House and Senate); and
a written constitution with the independent judiciary as the
I of the
final interpreter, this system tilts heavily in the direction
consensus model. In addition, the United States has
the other social institutions—such as muscular political parties, a tradition of a strong administrative state, and Q
organized and influential labor movement—that bridge
U institutional divides in other countries.14
Knowing that Congress matters more than most national
legislatures as a policy-making body, and that legislating is
a complicated endeavor, does not yet tell us how and
Congress acts, or fails to act, in response to particular policy
issues. For insights on these issues, we must first examine
role and orientation of legislators in the American context
the effects of specific features of Congress as an institution on
legislative decision making.
Congress is ultimately an aggregation of its members, even
during periods of heightened partisanship and intraparty
unity. Its actions reflect the motivations, preferences, and
choices of the individuals elected to serve as representatives
and senators. One starting assumption is that members of
Congress are “single-minded seekers of re-election.” 15 That
proposition may be too analytically narrow and politically
cynical, but even when members are primarily intent on
wielding power or pursuing the public interest through good
public policy, reelection is the necessary predicate and thus
an inescapable objective.16 However, that goal creates different behavioral incentives in different systems. In many parliamentary systems, the political parties maintain close control
over the slates of legislative candidates not only determining
who will run (or “stand”) for election and reelection but even
what districts or constituencies they will represent. Electoral
success in such settings, therefore, hinges first on satisfying
the party’s needs, including supporting the expressed policy
positions of the party once in office.
Although there have been times in American history when
the major political parties have played a significant role in
candidate selection and promotion, congressional candidates
and incumbents running for reelection are usually independent agents who promote their individual political interests
(including pressuring their party to adopt greater ideological
purity). In some instances, party figures ranging from local
leaders to the president try to entice particular i…
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