Question

Explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).

Answer 1

Politics and the Patient Protection and Affordable Care Act

Regardless 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.

The suppliers of legislative benefits are legislators, and their primary goal is to be re-elected. Thus, legislators need to maximize their chances for re-election, which requires political support. Legislators are assumed to be rational and to make cost-benefit calculations when faced with demands for legislation. However, the legislator's cost-benefit calculations are not the cost-benefits to society of enacting particular legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur as a result of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support the legislation. (page 27)

Source: Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Chicago, IL: Health Administration Press.

For many Americans, the debate over repealing and replacing the Affordable Care Act (ACA) isn’t about political maneuvering or vote counting. For families, it’s about whether they will still have health coverage after the dust settles, and whether they will still be able to afford their prescription medications. For health care providers, it’s about being able to serve all the patients in their community without being overwhelmed by the costs of uncompensated care. For states, it’s also about preserving jobs and businesses, as well as having the resources needed to address the opioid crisis and other public health emergencies.

For nearly a century, The Commonwealth Fund has been evaluating policies and proposals with an eye toward whether or not they make it easier for more Americans to get high-quality health care.

Through work we’ve supported, we can project the impact that proposed changes, such as those in the American Health Care Act (the House bill) and the Better Care Reconciliation Act (the Senate bill) may have on people’s health care and on state economies. While any policy’s precise impact will vary greatly from state to state, the data on these two bills’ effects are pretty compelling. Click a state below to view a fact sheet with more information.

*Repealing the ACA and Replacing it with BCRA Would Increase the Number of Uninsured :

In particular, the projected impact of ACA repeal on state budgets and the overall job market highlight just how critical the health care sector is to the nation’s economy. The evidence reminds us to examine any changes under consideration for unintended consequences.

Other Commonwealth Fund research, including our long-running biennial health insurance survey, shows that people with Medicaid coverage are less likely to have cost-related problems accessing health care and enjoy more financial protections than are many Americans with private insurance.

From covering the majority of births to covering the bulk of long-term care provided at the end of life, Medicaid is inextricably woven into the fabric of the U.S. health care system.

*Medicaid and the Children's Health Insurance Program Bring Coverage to States:

All this research underlines the critical importance of grounding any plan to restructure U.S. health care in objective evidence. And it shows why proposed changes must be designed from the start to make the U.S. health care system work better for everyone.