Influence of Politics on US Healthcare Reform
One of the most notable achievements in legislation by the Obama government is to get the Affordable Care Act signed into law. The Affordable Care Act is a fulfilment of Obama’s promise in the campaigns to fix the US healthcare system if he was elected. It is also believed that this was one of the strengths of his campaigns when he ran for the presidency the first time. This essay examines the role politics played to get the Affordable Care Bill signed into law. Particularly, it focuses on the active role played by the Obama Administration to ensure that the bill was passed. The persuasiveness of the Obama administration is weighed against Neustadt’s conception of the presidency as being one of bargaining and persuasion. Neustadt’s conception in chapter 1 and the chapter on Logic in American Politics are relied on to expound on the role persuasion and bargaining played in healthcare reform. The objective of the essay is to capture the role politics played in shaping the direction that public policies take.
The 2010 healthcare act formed the subject of intense debate since its inception in 2008 until it was finally enacted in 2010. Members of the Senate Finance committee, both Republicans and Democrats, had to meet up to thirty times in order to discuss and come up with the Health Care reform bill alone. In addition, the new law has also faced the threat of annulment thirty times by republicans on claims of its non-conformity with the constitution. This was before it went through a rigorous analysis by both political factions to gain approval.
In order to get the Bill to pass through the senate in the first instance, it was necessary to take extreme care to balance the wishes of both Democrats and Republican. This presented the Obama administration with a quagmire since it was almost certain that whatever the democrats proposed would be contested by the republicans as has been the political tradition. Indeed, opposition was encountered on this basis. In order to pass through the senate, it was proposed that the bill include the individual mandate in order to prevent people from taking advantage of the law upon enactment. For political mileage, the Republicans immediately picked issues with the Bill and even challenged its constitutionality. It was strangely ironical then why the Republicans vehemently opposed the bill while they absolutely supported it before the elections. Mitch McConnell, in his capacity as the Senate Minority leader, worked tirelessly to dissuade support for the bill. It was noted by the New York Times writer, Michael Cooper, that Americans have forgotten that the mandate feature of the bill was formerly a construction of Republicans. This point clearly demonstrates the role of politics in shaping policies and other public affairs.
Negotiations had to be done in order to garner support for the bill. The negotiations culminated in the President delivering a speech when congress had a joint session after the recess in order to persuade congress for support. The president had to persuade the senate to ascend to his political agenda. This persuasiveness of the president resonates well with Neustadt’s conception of the American Presidency. Neustadt contends that just by being an American president does not mean that whatever policy is desired will be easily achieved. The president must have people skills of persuasion and negotiation in order to convince the senate and the citizenry that the bill is in their own interests. To make things harder for the president, vehement opposition always ensues on the side of the opposition party. According to Julia Lynch and Sarah Gollust attempts at healthcare reforms in 1990 hit a snug because of lack of persuasiveness. The presidency failed to convince the people that the reforms would adequately take care of their personal interests. They also argued that Obama was able to succeed with the push to get the bill enacted by being able to persuade the proponents and opponents that the bill catered for their personal interests. These arguments are consistent with the views articulated in the chapter on Logic in American Politics. In this chapter, getting people to participate in politics uses uncanny ways to win public support. Politicians do not necessarily promise to perform because of the need to satisfy the public, but in furtherance with personal goals. The trick is to be persuasive and convince the public that whatever is done is for the benefits of the public and not individual interests
Finally on November 7th of 2009, The House of Representatives passed The Affordable Healthcare Act for America though it never had the effect it was created for. However, the voter was by a narrow margin of only five votes. This further confirmed the political battle that would ensue when the reform bill by the Obama administration with the Affordable Care Act. Since the Republicans were expected to oppose the Bill in large numbers, the vote of every single Democrat was needed to counter this opposition and get the threshold of 60 votes required to propel the bill through to the next stage. Interesting events occurred that could have failed the bill at the time. For instance, one Democrat hopeful, Alan Franken, had a disputed election as a senator and the vote was put under recount. This presented the Democrats with one less vote. Unfortunately, another anticipated vote from Ted Kennedy was lost when he died. These events demonstrate how politics heavily influenced the process thus making every single vote from the Republican and Democrat senators fundamental. The President had to persuade rather than command all the Democrats to vote for the bill through intense negotiations and compromise. The political tussles at every stage of the Bill made it a herculean task to get the bill into law. The persuasion confirms Neustadt’s conception that for the president to have his way with a political agenda, he has to satisfy the needs of all involved in the policy formation process.
Intense negotiations resulted in the vote getting approval by all democrats at sixty against thirty-nine. All Republicans rejected the bill except one who did not vote. It means that if all the Democrats did not support the Bill, it would not have attained the threshold, simply because of politics that ensured Republicans opposed the individual mandate on the simplistic front that it was the Democrats proposing it. If the roles were reversed, perhaps the Democrats would have also rejected the bill in equal measure. The Next State was to make the House of Representative disregard their earlier bill and support the Senate Bill upon its approval by the required threshold.
Apart from political tussles between the Democrats and Republicans, the bill also encountered legal opposition that culminated in the Supreme Court deciding on a 5-4 vote in National Federation of Independent Business v. Sebelius. The Bill was challenged on the basis of it being unconstitutional with the inclusion of the individual mandate requirement in the context of taxation by congress. The Supreme Court approved the constitutionality of the Act in a similar fashion as it did with the case of . In MacCullorch, the Supreme Court had to decide the Constitutionality of the Congress creating a national bank, opening its branch in the states (Maryland). Consequently, the court was to decide if the state had the capacity to tax such a bank if its creation was legal. Because there were no express provisions in the constitution to specifically prohibit or allow congress to create the bank, the Supreme Court had to interpret widely what the Congress could do in furtherance of the objects of the constitution. In the court’s interpretation, it followed by implication that if the Congress had the capacity to create the bank as was determined; it would amount to a nullity if Maryland was allowed to tax the Bank, being interpreted as overturning the constitution. In the present case where the Supreme Court had to decide on the constitutionality of the individual mandate, the similarity is that the constitution does not hold similar express prohibitions or acceptance of it. However, the Supreme Court has the onus to construct what should be done based on constitutional principles and development of the law over the years.
Relying on the basis of the size of government, big government requires a lot of money to run. This further requires that resources are efficiently utilized to ensure no wastage. Savings, especially on government expenditure is also a priority. The government’s push to have the bill enacted into law was definitely intended to cut costs of health insurance. Making Health Insurance mandatory would lead to more tax revenues as well as lower the cost of insurance and government expenditure on health related matters. Overall, it would leave the government with more money to spend in other avenues of economic development. Apart from the legal challenges and the difficulty to enact a law, some conservative lobby groups with a similar standpoint to the Republican Party have discouraged people from taking out insurance and undermining the Act. Such groups spread propaganda on the law and polarized the citizenry that it would increase the cost of healthcare and interfere with already existing insurance policies.
The above analysis of the challenges that the Affordable Care Act faced prior to its enactment demonstrates the role of politics on public policy in America. It comes out clearly that party politics determines greatly what the opinion and action of a segment of the US politicians will be on a particular matter. It reveals that the substance of any matter is disregarded in favour of the political stance in order to arrive at very important decisions.
Works Cited
Cooper, Michael. "Conservatives sowed th Idea of Healthcare Mandate Only to Spurn it Later." 2 July 2012. New York Times. 12 November 2014.
Julient Eilperin., Michael Fletcher., & Anne Kolburt. Obama's Promises. Political Performance. Washington Post: The Washington Post, 2010. Newspaper. 12 November 2014.
MacCulloch vs. Maryland. No. 17 US 316. The Supreme Court. 1819.
National Federation of Independent Business v. Sebelius. No. 2566. The Supreme Court. 2012.
RWJF. "RWJF Research and Publications." 13 June 2011. Robert Wood Johnson Foundation Website. Web. 21 November 2014.
Zinn, Howard. Big Government for Whom? 18 April 1999.
