The role of the government is to protect the citizens, enhance the living conditions and contribute to the best possible social and economic standards. However, governments built on a capitalist foundation such as the U.S. tend to be skeptical about investing in social upgrade due to the individualistic ideologies employed by capitalists. Communist governments tend to focus on the social issues but even in capitalist nations, the governments must suppress the individualism prominent in the mentality of the people to improve the lives of the people unable to earn enough income. The controversy surrounding social issues in the United States makes it difficult for leaders to change the existing social policies (Blendon & Benson, 2017). The complexity of imposing these policies increases due to the constitutional foundation that divides the countries administration into federal and states government.
The major step undertaken by Obama to fulfill his promise and idea of the U.S. realizing a nationwide universal coverage to enhance the access to quality healthcare for everyone. The bold move to embark on the formulation and passing of the Patient Protection and Affordable Care Act (ACA) nicknamed, as the Obamacare was magnificent. President Obama signing of the bill into law on March 23, 2010, was a move that many Americans thought as impossible. The essence that many leaders had tried and failed to change Medicare among other social policies since President Roosevelt in the 1930s to have a social policy and the National Health Insurance bills enacted into law. However, the continued debates and controversies surrounding the ACA calls intensive research to understand its formulation and implementations. Therefore, the purpose of this paper is to analyze the ACA’s constitution issues, the success, failures, and the role of media.
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Historical and Constitutional Background
The founding fathers believed that civilization led to the advancement of the public economic and social standards hence the constitutional setting to enhance the rights and the governance that was beneficial to the public. The separation of power into the federal and states governments was important in limiting the presidential power in the bid to protect the public from dictatorial federal governance. The state's government, on the hand, had direct contact with the citizens at the local level thus enabling their administrations to implement policies that solved the issues that affect their public (Sparer, 2011). The embracement bases of the republic governance model meant that the federal law would only make policies to help the state's government implement their bylaws without diminishing the rights and privileges afforded by the Constitution. The division of the federal government into three branches also allowed the legislature to formulate policies, the judiciary to interpret the laws and the executive to implement these laws. The system of governance enabled the continued check and balances and limiting dubious laws into establishing and forcing policies to the states by the federal government.
Volden (2017) argues that the strategy employed by Obama and the Democrats to pass the bill. However, he is clear that the extended learning and involvement of the states in the formulation of the ACA. According to his study, the health insurance experiments in Oregon and Massachusetts helped the learning and implementation process during the planning stages and demonstrating that the policy would not make major changes. The study portrays that states tend to imitate success policies and systems from other states. Therefore, the strategy depicted that regulations to lower health insurance reduced Medicare and Medicaid dependency by increasing the enrollment in health insurance for low-income workers (Volden, 2017). The Obama administration understood the challenges of navigating the bill through the two houses and ensuring the support from the public and interest groups. The lobbying parties toughened the fierce resistance from the Republicans on the attractive Medicaid expansion. The support from the public, interest groups, and government or private sectors among health professionals led to the passage of the bill into law and through coercion, learning, and imitation to expand the implementation of the ACA.
Checks and Balances
The constitutional provisions established to limit federal government into forcing policies to the states is one of the main problems that face the formation of nationwide social policies such as the ACA. The constitutional requirements of passing a bill in the Congress and Senate houses makes it difficult for social policies due to the political divide in the country. Since the passing and signing of the Medicare and Medicaid under the Social Security Act by President Johnson in 1965, different presidents such as Truman, Nixon, and Bill Clinton have tried and failed to make changes other than expanding the existing laws. The various presidents were unable to negotiate their bills through the Congress and the Senate due to the political divide between the Republicans and Democrats in the national scenes (Sparer, 2011 and Blendon & Benson, 2017). The Democrats over the years tend to call for expansion and social investments through whereas the Republicans oppose such moves to ensure expanded social investments. The political issues are not the only hindrance that the leaders faced, as they had to ensure that they respect the separation of power. Due to the ability to negotiate and win political battles, the main concern ACA among other nationwide laws face is based on constitutionality issues.
According to Sparer (2011), the ACA formation and the role played by President Obama to delegate to Congress in its development the actual plan raised alarms on its constitutional violations. The essence that American governance and constitution tried to find a middle ground of Alexander Hamilton and Thomas Jefferson argument to ensure the separation of power led to claims that the move by Obama was a violation of the constitution as he had proposed the ACA bill. The Medicare and Medicaid under the Social Security Act had embraced Jefferson’s ideologies which argued that the states or local authorities were the most suited to provide local responsibilities as they understand the issues facing the people at the local level. However, the move by Roosevelt in 1935, to support these settings as the bases of the federal government embracing a nationwide partnership with the states by creating a federal social welfare legislation result in passing of his bill by the Congress (Jost, 2011). President Obama would have used a similar strategy but the essence that the ACA was contradictory to the existing states policies and systems complicate the matter.
The passing of the bill was made possible by the willingness to enhance the intergovernmental and extended lobbying actions to involve different organizations, interest groups, and professions to support the bill and sway Congress to pass the bill (Sparer, 2011). The nation’s health insurance industry was critical on the ACA with the support of the Republican leaders hence move by the planners of the ACA to ensure that the insurance industry was shaped by the state-based system in building the federal oversight. This strategy enhanced the willingness and intergovernmental coordination in coercing insurance companies at the states’ levels to lower their premiums in accordance to the ACA mandate. The federal government and other interest groups understood that the lowering of premiums would increase the number of health insurance enrollment thus expand the policy pools, which would not interfere with the gains of the companies. However, the strategic planning and implement did not end the issues of critics arguing and even filling a case in the U.S. Supreme Court to question the constitutional violations of the ACA. The political divide in the country makes it possible to ensure that the ACA does not violate the constitution (Jost, 2011). However, the essence that Republicans are opposed to the expansion of the Medicare and Medicaid with the past presidential elections campaigns and Trump’s win raising concern on the future of the ACA as discussed later in the paper.
The introduction of the Health and Human Services (HHS) by the Congress is one of the issues that have increased the constitutionality of the ACA funding and accountability. The HHS tend to move without facing review or unimpeded by the judiciary (Jost, 2011). The move by the legislature demonstrates that the HHS can engage in dubious financial and unconstitutional means to waive any Medicare statute of civil and criminal penalty. The essence that such programs can only be influenced by Congress resulted in cases against the constitutionality of the HHS role in preventing abuse of federal authority in the states. However, the essence that changes in the programs such as the IPAB that is immune from Judicial interference can only be changed through a three-fifths majority (Jost, 2011) reduces the chances of abuse of power thus enforcing the checks and balances under the watch of the Congress.
Public Policy, Elections, and Media
Scholars concur that the media plays a key role in shaping political opinions thus influencing the public votes on whether to support or reject any political issue (Pacheco & Maltby, 2016 and Blendon & Benson, 2017) ). However, the positive depiction of the ACA may have resulted in public support, but it would require more than positive media depiction to be a durable policy. Chattopadhyay (2015) is critical that the understanding of the depiction of ACA beneficiaries is the best way to establish the durability of the ACA. Chattopadhyay uses three questions to portray the ability of the ACA to enhance economic heterogeneous aspects as required, the ability to offer the youth’s new political relevance and the themes of beneficiary deservingness to promote the ACA. The study investigated newspapers from August 2013 to January 2014. It was evident that the ACA benefited the people from different economic levels but it also caused loss of insured people or Medicaid qualifications thus portraying that it issue of economically heterogeneous failed to boost its durability.
The ACA also failed to provide any new political relevance to the youths. However, the use of the theme of deservingness played a key role in supporting the value of the ACA thus enhancing its durability. The author warned that the theme along with the increasing costs of healthcare and lose of beneficiaries can change the theme of deservingness (Chattopadhyay, 2015). The author demonstrated that the continued depiction of the ACA in a beneficial manner means that ACA will increase its durability but the positive opinions must also be built on the transformative formulation to solve the issues of economic heterogeneous and provide political roles to the under 26 years youths. Failure to perform such tasks and the continued call by the Republicans to cut the government intervention on the private sector and loss of beneficiaries of the Medicare and Medicaid among other negative issues is likely to hinder ACA durability.
Voting and Election Process
According to Reynolds and Hall (2018), the media mainly news channels and health insurance advertisement influenced the public views and belief that they understood the ACA. The study also demonstrated that investments in the advertisements paid off due to the increased voting for the ACA even for some Republican Congress Members (Reynolds & Hall, 2018). According to Fowler, Baum, Barry, Niederdeppe & Gollust, (2016), the increased support of the bill by the public resulted in Republican candidates in the 2014 Senate race to support or mention it during their campaigns. The personal goals of winning the elections resulted in these leaders supporting social welfare rather than opposing the wishes of their voters. The lack of unity and voting as a block by the Republicans is one of the main cause of cause of the bill passing into law since the Democrats were able to use the public and the media to gain support from some Republicans.
The political divide in the country also affected the acceptance of the news and depiction of the ACA with the Republican supporters viewing the negative opinions as depicted by their party whereas the Democrats’ supporters ignored the flaws of the ACA to support their parties (Pacheco & Maltby, 2016). The extend conversation and Trump’s claim that he would ensure the retrenchment of the ACA led to the loss of votes from the beneficiaries of the ACA. Trump loss of the popular vote is a depiction that the ACA and Social policies were key in influencing the voting during the last election (Hacker & Pierson, 2018). In order to keep his word, the Trump’s administration tried and almost succeeded in the retrenchment of the ACA but failed by two votes from the Republicans who feared that retrenchment would result in the loss of Medicare and Medicaid that was vital to their states’ citizens.
Conclusion
The paper analyzed the ACA’s constitutional issues and the factors such as media and public opinion in determining the passing and implementation of the bill. It was evident that under the U.S. Constitution, Obama’s move was faced with issues of violating the federal and states power separation but the ability to navigate through involving the states and enhanced inter-governmental coordination played a vital role in the voting process and its implementation. The study also demonstrated the learning and imitations used to spread the ACA to different states and the positive media influence in enhancing the durability of the ACA. The recent scare of retrenchment after Trump’s victory demonstrated that the inter-political support and voters power through voting in elections was instrumental in solving the ACA.
References
Blendon, R., & Benson, J. (2017). Public Opinion about the Future of the Affordable Care Act. New England Journal Of Medicine , 377 (9), e12.
Chattopadhyay, J. (2015). Are press depictions of Affordable Care Act beneficiaries favorable to policy durability. Politics & The Life Sciences, 34 (2), 7-43.
Fowler, E., Baum, L., Barry, C., Niederdeppe, J., & Gollust, S. (2016). Media Messages and Perceptions of the Affordable Care Act during the Early Phase of Implementation. Journal Of Health Politics, Policy And Law , 42 (1), 167-195. doi: 10.1215/03616878-3702806
Hacker, J., & Pierson, P. (2018). The Dog That Almost Barked: What the ACA Repeal Fight Says about the Resilience of the American Welfare State. Journal Of Health Politics, Policy And Law , 43 (4), 551-577.
Jost, T. (2011). The Real Constitutional Problem with the Affordable Care Act. Journal Of Health Politics, Policy And Law , 36 (3), 501-506.
Pacheco, J., & Maltby, E. (2016). The Role of Public Opinion—Does It Influence the Diffusion of ACA Decisions?. Journal Of Health Politics, Policy And Law , 42 (2), 309-340.
Reynolds, M. E., & Hall, R. L. (2018). Issue Advertising and Legislative Voting on the Affordable Care Act. Political Research Quarterly, 71 (1), 102.
Sparer, M. S. (2011). Federalism and the Patient Protection and Affordable Care Act of 2010: The Founding Fathers Would Not Be Surprised. Journal Of Health Politics, Policy & Law, 36 (3), 461-468.
Volden, C. (2017). Policy Diffusion in Polarized Times: The Case of the Affordable Care Act. Journal Of Health Politics, Policy & Law, 42 (2), 363-375.
