Requirements You have been given the opportunity to present your

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Business Finance: Management Week 3 Assignment

Historical Perspective: The Affordable Care Act; Barack Obama vs Donald Trump

Administrations

Gabrielle McNeely

Professor Timothy Smith

Strayer University

PAD 510

1/21/2024

2

Historical Perspective: The Affordable Care Act; Barack Obama vs Donald Trump

Administrations

The Affordable Care Act (ACA), also known as the Patient Protection and Affordable

Care Act (PPACA), is a health insurance reform policy signed into law by President Obama on

March 23rd, 2010 (Vankar, 1). Passed by the 111th Congress, ACA was America's most

expansive regulatory overhaul of health insurance coverage since the adoption of Medicare and

Medicaid. Particularly, the new law ushered in reforms by expanding access to health coverage

by making it more affordable and protecting consumers from exploitative health insurance

companies (Vankar, 1). Previously, health insurance firms would deny coverage to people with

chronic conditions such as heart disease, asthma, etc., or limit the compensation they would offer

those patients. Notably, before the introduction of the Affordable Care Act, more than 50 million

Americans lacked health insurance, one of the lowest performances among developed nations in

health coverage (Vankar, 1). The policy aimed to increase universal health coverage and improve

health insurance quality, affordability, and fairness. Despite this policy's anticipated benefits, the

ACA became one of America's most contested public health policies. This analysis focuses on

the Affordable Care Act during President Obama's and Donald Trump's eras. While President

Obama championed the passage and full adoption of the ACA, President Trump sought to repeal

the bill and reverse most of the gains made in health insurance coverage.

Historical Perspective of the ACA: Social, Economic, and Political Environments during

President Obama's Era

The Affordable Care Act came at the right time, socially, economically, and politically,

since the transformation of the country's health coverage system was long overdue. Socially,

Americans had been subjected to discrimination in accessing health coverage, where people with

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chronic health conditions would not access coverage or would have the amounts of

compensation capped at a particular figure (Gusmano, 3). Such a discriminative policy led to the

creation of social classes, where the rich would afford expensive health coverage while those

with no income locked out of such programs (Campbell and Shore-Sheppard, 4). Therefore, such

a move had divided society between the rich and the poor, where the rich would afford health

insurance.

Economically, during the passage of the ACA, the US economy was barely recovering

from the 2008 global financial crisis. Although the financial crisis ended in June 2009, the US

economy had barely recovered from the recession by March 2010, when the ACA was passed.

Notably, the US economy averaged an annual growth of 2 percent in the first four years after the

recession. In addition, 5.05 million Americans lost jobs in 2009, during President Obama's first

year in office (Jones, 5). The loss of jobs affected health insurance coverage since those affected

could no longer pay insurance premiums and hence lost their coverage. Similarly, in 2010, the

country experienced one of the highest unemployment rates at 9.6 percent (Jones, 5). Based on

the country's tough economic situation, the passage of the ACA in 2010 offered a major relief to

citizens by reducing the overall cost of health insurance. Therefore, such a policy came at the

right time.

Politically, the ACA policy, also known as Obamacare, was highly anticipated since

Obama promised to insure the uninsured during the campaign period. However, the nation was

divided politically on the matter of ACA. In 2010, only 46 percent of the US adult population

supported Aca. While Democrats favored the bill, Republicans opposed it.

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Historical Perspective of the ACA: Social, Economic, and Political Environments during

President Trump's Era

Since the bill's passage in 2010, Republicans have strived to repeal it and reverse most of

the gains achieved. Republican's primary argument is that the bill would distort America's

healthcare system by making private insurance more expensive and also undermine Medicare for

seniors. Trump's victory in the 2016 elections renewed Republican's efforts to repeal the ACA

law. According to Gusmano et al. (3), President Trump's health policy agenda revolved around

repealing ACA, which he termed a 'disaster.' Socially, the ACA, as of 2016, had narrowed down

the social gap in terms of access to healthcare. By 2016, the number of uninsured Americans had

dropped to 26.7 million from 46.5 million in 2010 (Tolbert and Drake, 6). As a result, ACA

reduced the social gap between the poor and the rich regarding the ability to afford health

coverage.

Economically, President Trump's reign, before the COVID-19 pandemic, enjoyed better

economic prospects than Obama's tenure in 2010, when the economy was recovering from the

2008 financial crisis. As a result, the people were better placed to afford healthcare coverage. As

highlighted, less than 27 million Americans did not have health insurance cover in 2016,

compared to over 46 million in 2010 (Tolbert and Drake, 6). However, despite the positive

progress in regard to health insurance as a result of the ACA, Trump's administration sought to

abolish it.

The prevailing political situation regarding ACA during Trump's reign was not different

from Obama's. The public's support for ACA barely changed during the two reigns, with 45

percent of US adults supporting the policy, compared to 46 percent in 2010. Politically, President

Trump sought to energize his political base by repealing the ACA. For instance, in 2017, he

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passed the Tax Cuts and the Jobs Act (TCJA), which eliminated ACA's shared responsibility

(Neuman et al., 7). In conclusion, the Obama and Trump administrations had diverse views

regarding the ACA. While Obama's administration pioneered and passed the ACA in 2010, his

successor, President Trump, spent much of his time in 2016 trying to reverse the ACA law. The

political support and opposition to ACA have not changed over the years, with the majority of

Democrats supporting the ACA law while Republicans strive to abolish it.

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Source List

1. Vankar, Preeti. 2023. Affordable Care Act: Statistics and facts. Statista.

https://www.statista.com/topics/3272/obamacare/#topicOverview

2. US Department of Health and Human Services. 2022. About the Affordable Care Act.

https://www.hhs.gov/healthcare/about-the-aca/index.html

3. Gusmano, Michael, K. et al. 2020. Trump v. the ACA. Health Economics and Law, pp.1-

5.

4. Campbell Louise Andrea and Shore-Sheppard Lara. The social, political, and economic

effects of the Affordable Care Act: Introduction to the issue. The Russell Sage

Foundation Journal of the Social Sciences, 6(2), 1-40.

https://www.rsfjournal.org/content/6/2/1#sec-7

5. Jones, Chuck. 2020. Trump's job losses will exceed the Great Recession. Forbes.

https://www.forbes.com/sites/chuckjones/2020/04/04/trumps-job-losses-will-exceed-the-

great-recessions/?sh=43b3dd9f7d37

6. Tolbert Jennifer and Drake Patrick. 2023. Key facts about the uninsured population. KFF.

7. Neuman Tricia. et al. 2020. President Trump's record on healthcare. KFF.

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The Affordable Care Act (ACA)

Gabrielle McNeely

Professor Timothy Smith

Strayer University

PAD 510

2/12/2024

2

Summary of the Policy

The Affordable Care Act (ACA), passed into law in 2010 by President Obama, aimed to solve

critical challenges within the United States' healthcare system. Primarily, the ACA strove to

increase healthcare coverage, improve healthcare quality, and diminish costs. Among its main

facets was the creation of insurance markets where individuals and small businesses could

routinely select and purchase their health plans through subsidies assessed according to income.

The ACA also covered broader low-income individuals to achieve Medicaid eligibility but

reduced coverage denial based on previous conditions. Moreover, it required that everyone be

covered by health insurance coverage or face an 'individual mandate' penalty. However, this fine

was later eliminated. Some of the aspects included in ACA are also aimed at developing

preventative care and reducing spending on health. However, the policy addresses a healthcare

system with millions of uninsured citizens, high costs incurred to receive treatment, and rampant

differences across services. The ACA addressed these issues by improving access to affordable

healthcare coverage, quality of care, and cost-containment measures. The recommendations to

make this policy more effective include the creation of health insurance marketplaces, the

promotion of preventive care programs, and the implementation of reforms in healthcare to

protect consumers. Consumers should have access to platforms to compare and purchase health

insurance plans. The reforms could incorporate enhanced protection for the consumers against

insurance companies abuses, new information about prices, quality measures, and renewed

governance to prevent fraud and ensure patient safety. Investing in preventive care programs is

as vital as saving public health by contributing to better end-results and the eventual decrease of

the overall health bills. These programs may include screenings, vaccination, counseling, and

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other interventions designed to detect and prevent illnesses before they become more severe and

costly for treatment.

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The Affordable Care Act (ACA)

The ACA policy was signed into law on March 23, 2010, during President Obama's

tenure. The primary objective of this policy was to enhance healthcare coverage by making car

services affordable to all Americans. The policy affirms that every U.S. citizen should have

equal access to healthcare as primary security. The policy offers insurance to at least 30 million

uninsured Americans. This insurance is attained through the expansion of Medicaid and the

extension of federal financial assistance to the lower and middle-income populations to ease

purchasing private coverage. Although most Americans perceive the policy positively or

negatively, it impacts every aspect of the American healthcare system differently.

Parties Involved In The ACA Policy

Health Insurance Companies

Insurers' contributions to ACA are of significant importance. Insurers provide

opportunities via health insurance exchanges and Medicaid managed-care plans that offer the

best insurance choices. The ACA brought about new regulations regarding insurance practices in

the form of denial of coverage because of pre-existing conditions, among other essentials such as

necessary health benefits (Brodie et al. 2020). The role and function of health insurance

companies is to influence the awareness about the policy. They must lobby, campaign, and

participate in healthcare industry associations on healthcare coverage and accessibility. The

primary intentions should be preserving their market share and making health insurance coverage

favorable to all Americans.

Government Entities

The federal government, through Congress, enacts healthcare policies. These policies are

then carried out and enforced by the Executive arm of the government, including federal

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agencies like the Department of Health and Human Services. The role and function of

government entities should be to implement some aspects of the policy. For instance, State

governments implement the policy provisions, such as increasing Medicaid coverage and

establishing health insurance exchanges.

Employers

The ACA has business stakeholders, mainly small and medium-sized enterprises, due to

their employer role that directs some employers to offer health insurance for workers or pay

penalties. The ACA additionally brought in rules on employer-backed protection that led, for

instance, to the coverage of reliant until they are 26 years old. In aiding the effectiveness of the

policy, Lester et al. (2021) show that employers should promote the employer's “shared

responsibility” by offering adequate and affordable health coverage to certain workers.

Patients and Advocacy Groups

Patients and families searching for healthcare services coverage also need more of the policy.

However, the implementation of the policy implies patients have access to broader coverage and

consumer protection and preventive care services as stipulated by the policy. The role and

function of patients is to use marketplaces to find and apply for health coverage that matches

their budgets and specific healthcare needs. Organizations like the American Cancer Society and

the American Heart Association should aid the policy by supporting patient rights, healthcare

accessibility, and affordability.

Healthcare Providers

This stakeholder includes hospitals, physician group practices, clinics, pharmacies, and

other providers that deliver patient care. The parties are interested in the effects of patients,

reimbursement rates, quality metrics, and volume on ACA. The role and function of healthcare

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providers in the policy is lobbying for campaign contributions, and professional organizations

provide them with significant political power (Oberlander, 2020). However, the intentions should

focus on securing adequate reimbursement rates, decreasing workloads resulting from

administered appearance, and medical authority. Therefore, the care providers can push for the

policy to facilitate increased reimbursement scales to attain more comprehensive healthcare

coverage. The healthcare provider's effect on ACA is spearheaded through quality metrics,

payment reforms, and electronic HSR implementation.

Political Influence Analysis

Health Insurance Companies

The motives of insurance companies regarding the ACA are multi-faceted. On the other

hand, they are advantaged by the growing coverage, which means they have more clients.

However, they are subject to such constraints as compulsion to cover preexisting conditions and

profitability restrictions. Instances may arise whereby insurers will desire to make as much profit

from people as possible while policymakers want insurance practice regulated for the interest of

consumers (Keisler-Starkey & Bunch, 2020). Conflicts usually occur between insurance firms

and other stakeholders on premium pricing, coverage mandates, and network adequacy issues.

Insurance firms constantly lobby Congress and partner with other stakeholders to mold rules and

policies in their favor. Their political power has led to revisions of some ACA sections—for

instance, the modifications of the risk corridors and the cost-sharing reduction payments.

Patient Advocacy Organizations

The main driving force of patient advocacy groups is to guarantee affordable and quality

healthcare access to their followers. They advocate for coverage enhancement, patient rights

protection, and healthcare outcomes improving policies. Although their interest tends to coincide

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with those of patients, there are conflicts with other stakeholders like insurance companies or

policymakers concerning the specifics of coverage requirements, reimbursement rates, or the

extent of government involvement in health care (Warner et al. 2020). These associations

typically work with legislators, governmental bodies, and other advocacy groups to effect

healthcare policy through lobbying, grassroots activities, and public education initiatives. Their

political power has been critical in forming some ACA provisions, notably essential health

benefits and preventive care services without cost-sharing requirements. Furthermore, they

support the retention and growth of Medicaid, a necessary part of the ACA’s coverage expansion

initiatives.

In conclusion, ACA has affected United States healthcare, making it greatly obligated not

only to develop a fuller measure of inclusion but also to enhance quality and control

expenditures. From the myriad of stakeholders, involving governmental institutions, health care

establishments, insurer entities related to the Health insurance sector, and lastly, patients people

or, in other words, the employer has some determinant control of politics at accounting policy

making. Knowledge of why these groups want what they do is essential to understanding the

politics surrounding U.S. healthcare policy because in that context, especially whenever non-

medical issues may be contemplated, a group's motivations are where conflicts and

interrelationships among stakeholders can best be understood by those who create policies for all

Americans which comport with federal constitutional law on no matter whatever might.

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References

Brodie, M., Hamel, E. C., Kirzinger, A., & Altman, D. E. (2020). The Past, Present, And

Possible Future Of Public Opinion On The ACA: A review of 102 nationally

representative public opinion polls about the Affordable Care Act, 2010 through 2019.

Health Affairs, 39(3), 462-470.

Keisler-Starkey, K., & Bunch, L. N. (2020). Health insurance coverage in the United States:

2019. Washington, DC: US Census Bureau.

Lester, G. V., Brock Baskin, M. E., & Clinton, M. S. (2021). Employer-sponsored benefits in the

United States: The past, present, and future. Compensation & Benefits Review, 53(1), 24-

42.

Oberlander, J. (2020). The Ten Years’ War: Politics, Partisanship, And The ACA: An

exploration of why the Affordable Care Act has been so divisive despite the law’s

considerable accomplishments. Health Affairs, 39(3), 471-478.

Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C., … &

American Heart Association Advocacy Coordinating Committee. (2020). Advancing

healthcare reform: the American Heart Association’s 2020 statement of principles for

adequate, accessible, and affordable health care: a presidential advisory from the

American Heart Association. Circulation, 141(10), e601-e614.

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ACA

Gabrielle McNeely

Professor Timothy Smith

Strayer University

PAD 510

2

Argument In Favour of The Affordable Care Act

The Affordable Care Act (ACA) is one of the significant healthcare policies that have

revolutionized the healthcare landscape in the United States. Adopting a normative approach,

the ACA acts in in line with the principle that the access to healthcare is a fundamental

human right and rather not just a right for the well-off in the society. The ACA has, through

ways such as the expansion of Medicaid and other subsidies to low-income and middle-

income families, increased accessibility and the affordability of healthcare services. Further,

this satisfies the moral imperative of the need for everyone, regardless of which

socioeconomic status, to lead a healthy life.

Viewing the issue from a positive point of view, the act has become a game-changer

not only for the American public but also for the healthcare system. Bringing in more

Americans who have not been insured to being able to afford the healthcare system leads to a

reduced burden on the public healthcare system. Improvement of preventive care in areas

where it was not previously available allows for reduced cases of ill health, which is a plus

for the country at large. Guth et al. (2020) indicate that ACA implementation has brought

about significant gains in healthcare, for instance in, improved access to care, increased

utilization of services, and more affordability and financial security for many Americans. As

such, ACA has been a game-changer in not only bringing about improvement in access to

care but also affecting the health system in terms of reducing pressure on it due to the

immense support effects that come with increased preventive care (Ercia,2021). These issues

have led to more equity in the access to care and laid a more solid ground from which to

adopt inclusive and sustainability in the approach to healthcare.

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Position Against the Affordable Care Act (ACA)

Even though the Affordable Health Care Act has been well-intentioned, it has failed

to live up to the promise of improving the healthcare of American citizens. From a normative

point of view, the ACA, rather than bringing about relief to American families, has brought

more problems. Baicker et al. (2023) have shown that the ACA framework itself needed more

other recent amendments to ensure that it works out. The model has come with it a very

complex framework, which has made it difficult for competition to reign in the market. More

importantly, it is obvious from a normative approach that the burden of sustaining the various

subsidies under the approach has brought about a burden to the taxpayer. For those

individuals who believe in limited government intervention in businesses, the taxes become a

great burden to them since they believe in little or no taxes. Another is the infringement on

individual freedoms. In particular, the ACA individual mandate brings on a requirement that

either Americans have insurance coverage or they will face a penalty. As such, mandating the

purchase of health insurance is an infringement on individual freedoms and personal

autonomy. The Bill of Rights provides that individuals have the right to choose whether to

purchase or not to purchase insurance covers, but it is not for the government to compel

individuals to buying insurance against their wishes. In addition to this, the ACA has also

been viewed along the lines of it being coercive since it limits the individual autonomy and

the right to choose. Having in place the mandate for the citizens to purchase insurance covers

makes it difficult for them to make choices on the type of insurance coverage they can have.

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Response to the Argument in Favor of the Affordable Care Act (ACA)

Even though opponents have asserted that ACA is a game-changer policy as far as its

benefits are concerned, the shortcomings that come with this policy cannot be overlooked.

Adopting a normative approach, the access to healthcare is a fundamental human right.

Therefore, the policy falls short of the expectation of human rights by mandating coverage

and being coercive towards American citizens as it concerns their enrolment in the policy

initiative. As such, to achieve the right to healthcare among the population by using these

punitive practices is a very bad idea that needs to be corrected.

In addition, viewing the issue from a positive perspective, it could be seen that the

ACA has had a mixed effect on the quality and the costs of care. On one hand, some

individuals may