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Cost-Benefit Analysis and The Affordable Care Act

Cost-Benefit Analysis and The Affordable Care Act

Discussion Response 1


Thank you for your post. I agree with your analysis of how the cost-benefit analysis influences legislators’ decisions regarding the Affordable Care Act (ACA) and how voter views impact national policy decisions. You have highlighted the delicate balance lawmakers must strike between their re-election prospects and the potential consequences of their policy choices on their constituents. However, I would like to expand on your points and offer an example to illustrate these dynamics further.

In the case of the ACA, the cost-benefit analysis was crucial for legislators. Repealing or replacing the ACA was a contentious issue, and legislators had to weigh the potential benefits of fulfilling their campaign promises and appealing to their party’s base against the potential costs of losing support from constituents who relied on the ACA for their healthcare coverage (Adamson et al., 2019). For instance, in 2017, Senate Republicans attempted to repeal the ACA, and the Congressional Budget Office (CBO) estimated that such a move could lead to over 20 million people losing their health insurance. Lawmakers had to consider the backlash they might face from these millions of Americans who could lose coverage and how that would impact their re-election prospects (Adamson et al., 2019).

Moreover, your point about analyzing voters’ views is vital. Legislators often commission polls and surveys to gauge public opinion on crucial issues like healthcare. For instance, during the ACA repeal efforts, polling consistently showed that most Americans opposed the repeal, and many were concerned about losing pre-existing condition protections (Milstead & Short, 2019). Legislative leaders who considered these findings were more likely to align their positions with public sentiment, knowing that opposing the popular opinion on such a significant issue could harm their re-election chances.

However, it’s worth noting that voter views can be complex and may vary based on party lines. For example, while most Americans might support a policy like the ACA, opinions within each party can differ significantly. Some conservative voters may strongly oppose it, while some liberal voters might believe it doesn’t go far enough (Milstead & Short, 2019). This makes it challenging for legislators to please all their constituents, especially in highly polarized environments.


Adamson, B. J., Cohen, A. B., Estevez, M., Magee, K., Williams, E., Gross, C. P., … & Davidoff, A. J. (2019). Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.

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

Discussion Response 2


This is an amazing post. Your analysis of the impact of cost-benefit analysis and voter views on the ACA repeal/replace efforts and Medicare/Medicaid reforms is insightful and well-structured. I want to expand on your points and offer an example to illustrate the complexity of these dynamics.

You rightly emphasize the role of legislators’ re-election concerns in shaping their decisions on healthcare policies. The ACA repeal/replace efforts during Trump’s presidency indeed highlighted the internal divisions within the Republican Party. Moderate Republicans, particularly those in swing states, were concerned about how supporting such a controversial move could affect their re-election prospects (Zhao et al., 2020). This division was exemplified during the Senate vote on the “Skinny Repeal” of the ACA in 2017, which ultimately failed due to the defection of several moderate Republican senators, who were influenced by the potential backlash from their constituents.

The cost-benefit analysis you mentioned is indeed multifaceted. Removing the ACA might have pleased some voters who viewed it as government overreach and unsustainable. Still, it also risked alienating those relying on its provisions, especially for coverage of pre-existing conditions (Milstead & Short, 2019). This trade-off between appealing to the party base and ensuring constituents’ welfare underscores the complexity of healthcare policy decisions.

To add an example, consider the 2018 midterm elections. Many Democrats campaigned to protect the ACA and its popular provisions, particularly those related to pre-existing conditions (Zhao et al., 2020). They analyzed voter views and realized that healthcare was a top concern for many Americans. As a result, the Democrats won a majority in the House of Representatives. This demonstrates how public opinion on healthcare can directly impact election outcomes and influence legislative priorities.

Furthermore, your point about the popularity of Medicare among older Americans is crucial. Elected officials must tread carefully when considering changes to Medicare, as it directly affects a demographic known for its high voter turnout. In 2012, during his campaign for re-election, President Obama faced criticism from Republicans for alleged cuts to Medicare in the ACA. However, he successfully countered these claims by emphasizing the ACA’s benefits to seniors, such as closing the “donut hole” in prescription drug coverage. This strategic move helped him secure a significant portion of the senior vote.


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

Zhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: a review at 10 years. CA: a cancer journal for clinicians70(3), 165-181.


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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.

Cost-Benefit Analysis and The Affordable Care Act

Cost-Benefit Analysis and The Affordable Care Act

Classmate Post 1

“When it comes to controversial policy decisions that could affect their chances of getting re-elected, legislators are frequently required to consider the costs and advantages of their judgments, which plays an essential role in getting them re-elected (Milstead et al., 2019). Also, in the book Health Policy and Politics, Ch 3 states and compares several times how the law-making process is like that of a game. The Affordable Care Act (ACA) replacement and repeal case shows how the cost-benefit analysis influenced lawmakers’ attempts to change this legislation.

ACA became law on March 23, 2010, but full implementation took place on January 1, 2014, when employer accountability and individual responsibility went into effect along with Medicaid expansions (Rosenbaum, 2011). Since its full implementation, ACA has been one of the most controversial political topics and has yet to have a clear solution. More importantly, healthcare is integral in societies worldwide and is crucial to individual well-being, longevity, and socioeconomic development (NIH, 2021).

When politicians need to make complex or controversial choices about public policy, such as the attempted repeal and replacement of the Affordable Care Act, the cost-benefit analysis becomes especially important. Legislators who are up for reelection must evaluate the likely response from the voters they represent and the general public attitude when considering the potential costs of acting against the perceived advantages of their actions.

Legislators have to keep in mind that repealing the ACA would also mean that over 40 million people’s health insurance coverage would be at risk. All those Americans would eventually lose their coverage, and access to healthcare would become unpredictable (The United States Government, 2023). Also, legislators who voted for repeal would be expected to see severe blowback from voters, lowering their chances of re-election since most of the American people support ACA and possibly igniting worries about reduced healthcare access or rising costs, especially for disadvantaged populations.

Analyses of voters’ views affect legislative leaders in the way that when supporting or advocating national policies, legislative leaders consider peoples’ opinions on healthcare and other important policy topics. By doing this, they ensure that their stand is in line with public opinion and raise their own and their party’s prospects of winning elections.

Classmate Post 2

Politics and the Affordable Care Act

The efforts to repeal/replace the Affordable Care Act (ACA) and the reforms to Medicare and Medicaid programs were the subject of heated discussion and political debates for years. The idea to abolish Obamacare and make changes to the long-running programs within a year of Trump’s presidency alarmed moderate Republicans who expressed their concern with how these changes would affect their chances of being reelected rather than how real people would be affected by it (Milstead & Short, 2019). To strengthen their party base and attain fiscal stability, Republicans advocate for repealing the Affordable Care Act (ACA). Critics assert that the ACA is financially burdensome and unstable, and its replacement could be considered a significant accomplishment.

The cost-benefit analysis of repealing or replacing the Affordable Care Act (ACA) is complex, with advantages and disadvantages. Removing the ACA could win the favor of voters who believe it is an overreach and financially unsustainable while losing others who benefit from coverage. Toussaint (2016) suggests that the ACA should be improved, as it has expanded insurance coverage and provided competition and rewards to care providers, leading to better quality care. Repealing the ACA could impact healthcare delivery systems, particularly in treating Opioid Use Disorder (OUD), as it would eliminate the need for marketplace plans to cover essential health benefits. Legislation involving complex and lengthy negotiations could alienate certain constituents and legislators who push for repeal without a suitable replacement risk negative public opinion. They should convince the public that their new proposal is better than the ACA.

Legislators are often swayed by public opinion, as their primary job is to be reelected. Therefore, analyzing the voter views is essential in determining their recommendations or positions in specific policies. For example, removing the funds to Medicare could be politically dangerous due to its popularity among older Americans, a demographic known for high voter turnout (Blendon & Benson, 2018). Some politicians managed to win elections by effectively harnessing public opinion. For example, former President Barack Obama successfully promoted ACA during his campaign. This strategy worked in various respects, enabling him to successfully fend off Republican attempts to repeal the ACA (Mariner, 2020). Another example is Joe Biden, who advocated expanding the ACA and adding a public option in 2020 and has since campaigned for measures to improve its availability and affordability (Kirzinger et al., 2022).

In conclusion, the legislators should primarily consider the costs and benefits of repealing or replacing the ACA. Legislators must weigh their party expectations, constituent needs, commitments, and dynamic and differing public opinion.

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