Politics of Patient Protection and Affordable Care Act

Public opinion on ACA has been polarized for the past decade, and the Trump administration has made several attempts to repeal it. However, quite a few Republican governors have not supported the changes. Thompson et al. (2018) note that all the governors who voted against the proposed legislation represented Medicaid-expansion states. Notably, most of them were from the states that voted for Hillary Clinton in 2016. Even though these cases prove that reelection ambitions can take precedence over partisanship, in some states, governors directly opposed ACA despite the public opinion. Richardson (2019) notes that in some Republican states, such as Idaho, Nebraska, and Utah, voters had to resort to ballot measures to overcome the governors’ choices not to expand Medicaid. Barber (2016) claims that winning the support of more conservative primary voters could be the driving force behind these governors’ unpopular decisions. Overall, while some governors rely on the majority’s opinion in their choices, others value the principles of partisanship over their voters’ interests.

Public opinion can have a significant impact on Congress initiatives. Richards (2017) cites a case with EpiPen prices as an example. When Mylan, the company that produces EpiPen, increased the prices by 500% over the 8-year period, activists launched the public campaign to draw the attention of Congress. The reaction of the legislators forced Mylan to reconsider their policies. Moreover, the following investigation resulted in a 465$ million fine for the company. Notably, throughout the years, Mylan was hiring lobbyists that pushed the legislature to ensure a more effective EpiPen distribution. However, the activists’ effort forced Congress to recognize the issue and protect the constituents’ interests.

Re: Examples

The first example focuses on the differences in attitudes toward ACA among Republicans and Democrats. As repealing Obamacare was one of Trump’s promises prior to the 2016 election, it is likely indeed that he will continue the attempts to replace it. His voters have consistently shown the preference for AHCA (American Health Care Act) over ACA, and the majority of the constituents believe that Trump will eventually succeed in his efforts (Kirzinger et al., 2017). However, it is important to notice that only 14% of the voters believe that the suggested legislation fulfills most or all of the promises made by the president (Kirzinger et al., 2017). It indicates Trump’s low credibility among the population, including a large proportion of Republican voters, and can prove to be a decisive factor in the coming elections.

The first example emphasizes the influence of the voters’ opinion on legislation. Richards (2017) confirms that “members of Congress will likely respond to their constituents, meaning public opinion will also be correlated with the positions of individual legislators” (p. 42). Richards (2017) adds that since the opinions on ACA remain polarized, neither of the parties will gain a significant advantage in the nearest future. Therefore, unless the general public opinion sways dramatically, it is unlikely to have a decisive impact on the decisions of Congress.

The second example rightfully points out that the majority of the Republican governors supported the new plan. However, Thompson et al. (2018) note that the governors that opposed AHCA gained significant media attention. Therefore, despite the intention of Trump’s administration to repeal ACA, the absence of consensus within the Republican party might hinder his efforts even if he is reelected.

The second example also identifies the impact of the legislators’ stance on the ACA on their political future. While it is difficult to disagree, Barber (2016) shows that the necessity to cater to more radical voters can influence governors’ choices. Those can define the outcomes, as Richardson (2019) notes that “the battle over Medicaid policy shifted to the states” (p. 438). Despite certain limitations, the waivers largely allow the local legislatures to make independent decisions on their policies (Thompson et al., 2018). Therefore, direct democracy in the form of ballots can prove to be the most effective way for the voters to make an impact.


Barber, M. J. (2016). Representing the preferences of donors, partisans, and voters in the US Senate. Public Opinion Quarterly, 80(S1), 225-249. Web.

Kirzinger, A., DiJulio, B., Hamel, L., Sugarman, E., & Brodie, M. (2017). Kaiser Health tracking poll – May 2017: The AHCA’s proposed changes to health care. Kaiser Family Foundation. Web.

Richards, R. (2017). Public opinion and Congressional responsiveness in policy making (Publication No. 10258044) [Doctoral dissertation, Duke University]. ProQuest Dissertations Publishing.

Richardson, L. E., Jr. (2019). Medicaid expansion during the Trump presidency: The role of executive waivers, state ballot measures, and Attorney General lawsuits in shaping intergovernmental relations. Publius: The Journal of Federalism, 49(3), 437-464. Web.

Thompson, F. J., Gusmano, M. K., & Shinohara, S. (2018). Trump and the Affordable Care Act: Congressional repeal efforts, executive federalism, and program durability. Publius: The Journal of Federalism, 48(3), 396–424. Web.

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