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One of the things that keeps the U.S. from dissolving into an anarchy, is the system of government that was created for the young nation back in 1787. In order to effectively run and keep order on a large democracy such as the United States, there is a need for an organized system of government such as the three branches system that we have currently. The branches of the American government system are the judicial, executive, and legislative branches which each serve their own distinct purpose in trying to maintain the power of the government under balance. When all three groups execute their individual roles then it allows a manner for efficiency and progress to be made in the U.S. One such example of what can be accomplished when all three groups work together is the creation of legislation that is ideally supposed to fix a current issue in the country and provide a solution to better the lives of the American people. One example of a piece of legislation that was supposed to better the issue of healthcare in the Unites States is the Patient and Protection and Affordable Care Act. In order to truly understand the importance that the Affordable Care Act has on America is evaluating its impact on the American government and society.
The Patient Protection and Affordable Care Act (PPACA) was enacted on March 23, 2010 after much debate in Congress. At the time of the act’s creation according to Coffin and Rak there were 49.9 million uninsured residents in the United States, even though the U.S. “spent more money on healthcare as a percentage of GDP than any other nation in 2008 and had the fourth-highest government healthcare spending per capita”. The act was created to address the rate of uninsured people and was pitched as “healthcare is a right not a privilege”. The goal of the Act was to attain a 94% rate of Americans covered by health insurance which was to be done in 10 years keeping under the $900 billion limit set by President Barack Obama. Coffin and Rak talk about there were many benefits that were a part of the legislation such as extending the dependent coverage to 26, elimination of lifetime limits on insurance coverage, the prohibition of denying children with pre-existing conditions insurance coverage, mandates that employers provide insurance coverage and it provides coverage for those uninsured without increasing the cost of healthcare. Besides the patient advantages there are benefits for physicians as well such as “having more control over treatment decisions due to the elimination of coverage exclusions for preexisting conditions and patient access to preventative services”, less insurance bureaucratic paperwork, a standardization of the rules for the confidential exchange of health information, and also financial security to practices that follow the Act (Coffin and Rak).
How it works
The point of the Affordable Care Act according to Davis et.al is placing greater value the primary care aspect to healthcare so that there can be a reduction on the reliance on specialty care, which is usually the drive for the high costs for insurance costs. The idea is that by increasing the access to healthcare services it will allow for more preventive care which will allow for the “better management for chronic conditions”, therefore allowing for a reduction in costs for care without sacrificing the quality of it. There also is an incentive for states to adopt this policy as Davis et.al mention as it offers states the “flexibility to design payment methodology that works for them” (Davis et.al). Regardless of all the benefits that were proposed in the bill, the only way those benefits are able to be given to the American people is through the passing of the bill in Congress, the enactment and enforcement of the law by the President, and the validation of legitimacy in the Constitution by the Supreme Court.
One of the main responsibilities of the legislative branch of the U.S. government is its creation of bills and enactment of them into law. According to John Cannan, health care legislation has proven to be “a model to show how legislative procedures shape legislative history” and can be seen in the example of the Affordable Care Act passed in 2010. He begins by speaking on how the legislation process seems so simple based off what is shown in Schoolhouse Rock’s “I’m Just a Bill”, but in reality that is a much traditional approach to the process and because of the “hyper-partisanship” that is found today in politics the processes have become much more dramatic due to the “demands of campaign finance, 24hr news cycles, deficit, and social media” the process has become “less systematic and more ‘ad hoc’”. Cannan says that the Affordable Care Act is a great example of how this “ad hoc legislation” works as the debate over health care and providing it to all Americans was highly challenged and critiqued from its inception into Congress and to enact it, it required many ad hoc procedures (Cannan).
Truly defining the modern process of legislation enactment in Congress, the ACA bill was delegated by President Obama to the Senate and House, as Cannan mentions was probably a way to avoid the failure by President Clinton to craft it in the executive office which happened 15 years earlier. From there it was overtaken by the leading committees in the House who had jurisdiction over the health care sphere. Several hearings and markups later, the minority party at the time, being the Republican party, were still “unwilling to provide any positive input and are relegated to advancing the futile amendments to further embarrass the majority” so they were left out of the extra committee consultations, thus changing how committee discussion over legislation occurs by not allowing intense discussion that is unproductive. There also happened to be backlash from the “fiscally conservative ’Blue Dog’ Democrats” who withheld their vote in order to reduce the costs and placing limitations on the plan so that private insurance companies could compete with it.
When it was passed to the Senate, it caused more issues in its passing as the Senate has less rules or limits on debate and to pass a bill there is a need for cloture to close debate and also cloture in order to vote on it. Besides the constant “ping-ponging” between the houses, the bigger feat then became for the Democrats to try and break the united front that was upheld by the majority of the Republicans and unite all of the democratic and independent seats in order to pass the bill. In the end, after many revisions the bill got passed by both the House and Senate in the end December of 2010. What remains to be notable about the act is that after it had been passed, the next step in the traditional processes of legislation passing would call for a conference committee which reevaluates the additions, removals and overall opinions that were worked on throughout the entire process. However, in the Affordable Care Act that option was not considered, as it would have given opposers to further impede the enactment of the bill. So, there was a sort of makeup conference committee made by the Democratic Congressional leaders and White House officials all behind closed doors, which led to further dissatisfaction to the opposition with the passing and completion of the bill. Regardless of the still lingering opinions of the matter, the fact that the Affordable Care Act was able to change the manner in which legislation is passed speaks to its modern impact as it has become the “rule now, not just the exception” (Cannan).
While the executive branch has many roles and responsibilities, one of the jobs that is most relevant is the ability of the president to sign a bill into law. What is interesting about the Affordable Care Act in the executive branch context, is how it was a bill that added to the elevation of the administrative presidency under the “fractious federalism” as Thompson and Gusmano assert, all done under the popular nickname “Obamacare”. Unlike most bills, many of the provisions of the bill were interpreted and worked on upon by the federal and state administrators to shape and form the bill itself. All done outside the norm of formal rulemaking, by late 2013 the Obama administration “had published more than seventy final rules and issued scores of interpretive guidelines”. This helps exemplify the point that Thompson and Gusmano make being that the ACA was the “poster child” for the growing trend of partisan polarization that the U.S. had been undergoing for the past several decades.
The Affordable Care Act was able to pass through Congress “without a single Republican vote” demonstrating the utter power that the Democratic party had in Congress but also executive office in being able to defend every “intense ideological attacks by congressional Republicans” who consistently attempted to impede the progress of the bill. Thompson and Gusmano say that it is due to the intense political polarization that there was this cause for “fractious federalism”. The way they define this concept revolved around the ACA as: 1) there was intense opposition from the state policymakers who were “rooted in their partisan, ideological” ways, 2) the opposing state legislators to weaken the new law through court action and lobbying, and 3) reluctance by these partisans to implement the ACA. The fractious quality that the authors write about is meant to depict the constant efforts by “key party elites and supporters to promote a vertical partisan coalition” (Thompson and Gusmano). Thus, causing the Obama administration to have to convince states who were strongly opposed to the bill to participate using a variety of strategies. This allowed for the administrative presidency to be able to take on the power needed to deal with the defining partisan issue that ACA defined to work out solutions to get the states on board to implement the new policy. In other words, the Act was able to redefine the manner in which the administration of the president could be perceived and their ability to gain support of the population to institute the new policy of Obamacare.
As the Supreme Court of the United States one of their major responsibilities is to uphold the highest law of the U.S., that being the Constitution but also assuring that the laws passed by Congress are in line with the statues established within the Constitution. According to Jones the Affordable Care Act is considered to be “the most important legislation passed by the US Congress since the creation of Medicare and Medicaid in 1965.” As already previously discussed, there was much dispute and concern over the ACA itself that came from both political parties. Some of those concerns became “legal questions regarding constitutionality” so the Supreme Court took up the case. Some of the concerns revolved around the idea of forcing Americans to pay for health insurance or if not paying a penalty fee. Another general concern was with the funding of the initiative through the federal purse.
The Supreme Court determined that the ACA was constitutional in a 5-4 decision as the “penalty was treated as a tax” and “Congress has a right to impose taxes” as its being done through the IRS (Jones). The mandate included in the implications of the SCOTUS decision established that citizens must buy health insurance or pay the penalty tax. According to Haus this was done to lessen the burden of the taxpayers to pay for the care of freeloaders or those who have not chosen to pay for health insurance. However, Haas discusses how the responses to the decision of the SCOTUS reflects the “ideological and political divides in the US”. There is still very much a debate on whether healthcare is a right or a privilege. The debate also becomes more contentious as Americans are being told that the “big government should be kept out of health care” and there should be an allowance for the “free market to work to control the costs of health care”. However, through the provisions of the bill there is an opportunity for states alongside the insurance companies to design the insurance exchanges to work in their favor. This is something the states have to do as it is under this law to “establish health insurance exchanges” (Haas). Even though the law has been passed, signed and validated for its constitutionality and cannot be technically be ignored since it has been enacted into law, there still remains high tension and disagreement over the ACA regardless of the validity of it in the eyes of judicial law.
II. The Conclusion of the Impact of the Act on the American Government
Regardless of one’s opinion on the Patient Protection and Affordable Care Act, it is indisputably a significant piece of legislation that has changed the way that health care has been perceived in the U.S. Not only did it change the manner in which policy relates to health care, but it also transformed the processes for how legislation gets created by modernizing the procedures and course of action taken to pass a law. Through the enacting of this law it allowed for the majority party to use “unconventional” methods to bypass the intense opposition received by the minority party and get it passed by both the House and the Senate. Therefore, changing the future of passing legislation through Congress for all future bills. The ACA was also able to reinforce the power that one presidential administration can have over the creation and support of the laws, as the Obama administration heavily influence the provisions of the bill when it was still being passed through Congress. Not only that but the main nickname that was most commonly referred by the American people in speaking about this law was Obamacare, demonstrating the explicit association of the policy with the former president. This then was able to further establish the power of the administration to sway the opinion of the public, whether that be a positive or negative influence. While at the same time furthering the political partisanship divide that only caused more and more problems with convincing both sides to agree to enforce the law on the federal and state level. Since the law suffered from so much discrimination, it was eventually brought up to the Supreme Court, where even despite the claims that it seemed unconstitutional to force someone to pay a penalty tax by not getting health coverage, it was deemed to be legal. This then allowed for the further polarization of the branches, now in the judicial branch as there happened to be a democratic majority in the SCOTUS. Now, the Affordable Care Act is not perfect to any means and does need revisions so as to truly satisfy the majority of people, but it should be in the high priority of the United States to be able to secure health care for its citizens. As truly one of the biggest issues that needs to be solved in the health care field is the fact that the United States pays more for health care then most countries in the world and still about half of the population of the US is not covered by health insurance. While Obama started the movement in starting to find a solution for the health care issues of the United States, currently the US is left in the hands of the current presidential administration and other branches of government to do good by its people and hopefully come up with a solution to the seemingly never-ending debate of health care provisions in the United States.
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