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This paper should have a clear hypothesis. Should include citations and sources. If the topic needs to be tweaked to make it clearer for the writer he/she can do so, as long as it stays along the lines of Obamacare. It is a research paper so there should also be a clear conclusion, and whether or not the hypothesis is correct.

Answer

Title: HEALTHCARE REFORM: THE PROGRESSION OF OBAMACARE

 

Contents

Benefits of Obamacare. 2

The Obama Administration’s failure to Use Consensus Building and Deliberative Democracy during Discussions on Obamacare. 5

Impact of failure of consensus building efforts on state resistance to Obamacare. 9

Conclusion. 11

References. 13

 

Introduction

The Patient Protection and Affordable Care Act, also known as Obamacare, is a healthcare reform proposal that was signed into law in March 2010. Obamacare aims to bring affordable health insurance to Americans, improve the quality of health, regulate health insurance to enhance its quality, and reduce healthcare spending in the country. Deliberations on this healthcare proposal caused sharp divisions in America, and tremendous state resistance, with proponents and opponents presenting arguments and counterarguments about the merits and demerits of the healthcare reform plan.[1] In the end, America became divided along partisan lines.

The aim of this paper is to examine the progression of Obamacare by examining the causes of political divisions and polarization that occurred during discussions on the healthcare reform law. The hypothesis of this paper is that if president Obama had adopted the principles of consensus building and deliberative democracy, the Obamacare healthcare reform strategy would have met little or no state resistance. To test this hypothesis, the paper is divided into three parts. The first part examines the benefits of Obamacare that would have endeared the healthcare reform program to Americans, the second part investigates Obama’s failure to use consensus building and deliberative democracy during discussions on Obamacare. The third part shows how state resistance to Obamacare was caused by failure of consensus building efforts on the part of the Obama administration.

Benefits of Obamacare

The Obamacare reform law brings on board numerous benefits that will benefit many Americans. If these benefits had been articulated properly and presented to the American public during discussions held in a manner that promoted consensus building and deliberative democracy, state resistance to the law would have been minimal. For instance, the law sets up a health insurance marketplace that offers Americans an opportunity to purchase federally subsidized and regulated health insurance. The law also improves Medicare, expands Medicaid, contains new tax breaks, and imposes a requirement on all American citizens to have health insurance coverage.

The politics of the healthcare plan has clouded the truth about Obamacare being the outcome of decades of ideas that emanated from both sides of the political divide as well as the country’s healthcare industry. For example, the political side that opposes the law in its current form was at the forefront in presenting similar provisions during the late 1980s. In fact, a major problem cited by opponents during deliberations on the act was that the Obama administration was forcing the new law down their throats.

The controversy has been about not just the provisions of the healthcare reform law but also the politics surrounding it. To demonstrate this, it is important to highlight the main benefits of the law. The Affordable Care Act seeks to reform the healthcare and health insurance industries with a view to addressing high healthcare costs while at the same time offering affordable health insurance to all Americans. The reforms outlined in the law are contained in a lengthy, complex document but can be summarized to provide insights into the benefits it brings to Americans and the areas that have caused controversy.

To begin with, the law offers new rights, benefits, and protections to Americans who seek healthcare services in the country’s healthcare sector. Prior to the enactment of this law, one could be denied health treatment or insurance coverage because of a preexisting condition or be dropped from coverage mid-treatment because of a minor mistake in the insurance application. Moreover, women were likely to be charged more than men whenever they sought healthcare services. More importantly, citizens lacked avenues to fight appeals lodged by health insurance companies.

The Patient Protection and Affordable Care Act is also beneficial to the over 40 million American citizens who had no access to health insurance as of 2013. Most of these people belong to the working class and simply cannot afford insurance. By expanding eligibility for Medicaid, Obamacare helps such people gain access to health  insurance, which is demonstrated in the drop in the percentage of uninsured Americans from 16 percent to 13 percent between 2013 and 2014.[2] Similarly, the new law seeks to reform Medicare by giving Medicare recipients new benefits, protections, and rights as the rest of the population.

Other benefits of the law include cost assistance subsidies, the enforcement of provisions that require all full-time workers to be provided with full health coverage as of 2016, as well as numerous exemptions on the “Individual Mandate” requirement. The requirement for all full-time workers to be provided with health coverage is important because it will help offer coverage to individuals who are neither covered by the expansion of Medicaid nor the subsidized private insurance. To pursue universal coverage even further, the law imposes a monthly fee for every month an individual goes without coverage. This fee is imposed federal income taxes levied on the individual. Requirements such as this one have triggered fierce opposition, with some Americans claiming that the Obama administration is forcing the reform law down their throats. Curiously, these opponents fail to point out that the law gives citizens numerous opportunities to avoid paying this fee. A case in point is the “short coverage gap” exemption, whereby an individual is allowed to go without insurance coverage for three month without being compelled to pay a fee.

The Obama Administration’s failure to Use Consensus Building and Deliberative Democracy during Discussions on Obamacare

Despite the numerous benefits of Obamacare, the law faced stiff state resistance. Although the law was eventually enacted, majority of states continue to resist it in one way or the other. The enactment was a historic decision for the country; however, it marked only one step in a long policy-making process requiring numerous steps. It is important to examine the issue of state resistance in detail because it will greatly determine whether or how soon America will take the next step forward. Presently, the states have taken over the next  step in the policy-making process. This step entails implementing various provisions of the Affordable Care Act. In states where resistance was stiff, one may expect a lag in the implementation process or attempts to reform the provisions of the law altogether.

State resistance to Obamacare has taken different forms. A cursory view of various explanations for this resistance creates the impression that political factors have taken precedence over economic considerations. Some of the reasons given for the failure to implement the law include high implementation costs, too much work, dislike for the plan by residents, and the huge amount of work involved.[3] However, these reasons tend to be expressed mainly along party lines; for instance, opposition to the law has tended to originate predominantly from states ran by Republican governors. In most states, governors, insurance commissioners, and attorney generals, all of whom play a crucial role in the implementation of the law, tend to express views that somewhat give a hint about their party affiliations. This demonstrates that the contentious issues are being shaped around politics as opposed to economics.

Healthcare reform is a serious issue that needs not attract views modeled along partisan lines. The issues under contention are grave enough to warrant consensus-building and democratic deliberations from both sides. The Obama administration had the upper hand in this debate not just as the primary force behind the healthcare reform plan but also as the party that enjoys the power of incumbency. The administration made poor choices in the way it sought to secure grassroots support for this law. It failed to adopt a consensus-building approach to trigger objective discussions by Americans across the political divide. A case in point is the poor choice of venues for discussions in 2009. Other areas of serious weakness included poor goal articulation, a lackadaisical approach to the formation of coalitions, and poor selection of negotiation partners.[4]

President Obama took his policies directly to the masses before first mobilizing support from the political class. No ground rules had been set before the president embarked on this tumultuous journey, and this explains why numerous conflict management and meeting management issues arose. Confrontation with opponents of the law could have been avoided if a professional approach had been adopted in creating room for large-group policy discussions. In the end, it appeared that Obama administration was unrealistic about winning grassroots support for Obamacare through forums such as town-hall meetings.

Senior officials in the Obama administration seemed to have been taken aback by disruptions in meetings aimed at promoting the healthcare reform plan. This is largely because they were buoyed by a very strong majority in Congress as well as Obama’s dramatic presidential victory. President Obama’s strategists were overconfident of securing grassroots support for the plans to overhaul the healthcare industry, given that the president had been elected after an aggressive campaign founded on the concept of “change”. The resulting optimism about the administration’s political prospects may have heavily influenced the decisions to take the reform plans directly to the American people.

The lack of planning triggered controversy, with numerous controversial sessions depicting embarrassing situations where senators struggled to control unruly crowds. The sessions seemed embarrassing because the senior politicians seemed virtually alone as they tried to set ground rules for the meetings. The absence of professional meeting managers in such high-level, complex policy discussion forums was unsettling even in the eyes of the American public.

During these meetings, it was evident that the possibility of the Obama administration reclaiming lost ground in these public discussions depended on how they responded to the arguments raised by opponents of Obamacare. Unfortunately, the unrealistic conception of public discussions that was portrayed by senior government officials, including cabinet officers and senators, created the image of a government that was not serious about reaching out to representative samples of all interest groups. For example, the government should have refrained from holding meetings of less than 200 participants in congressional districts of more than half a million voters.[5]

Opponents of Obamacare seized the opportunity to attract media attention during chaotic meetings, thus creating the impression to the American public that something was terribly wrong with Obama’s healthcare reform plan. This conception was reinforced by a reasoned debate that was driven along partisan and polarized lines. During this debate, the idea that Obama had mistaken his victory for guaranteed support for Obamacare was reinforced; the president and his strategists had clearly removed their mandate from its appropriate context: the political context.

In the wake of stiff opposition and protests during meetings, the government officials found themselves in an unfamiliar defensive position. Their unwillingness to engage in consensus-building and deliberative democracy only made matters worse. For example, House Leaders Steny Hoyer and Nancy Pelosi claimed that the protestors were “un-American”. This statement triggered accusations of First Amendment violations among the protestors. In another example, Democrats retreated from the direct public discussions and opted to limit their messages to press releases. This way, the administrated seemed to be backtracking on a complex issue of healthcare reform; it was seen to be standing in the way of a transparent debate at the national level.

The polarization of democratic deliberation by opposition interest groups was greatly responsible for the unusually spirited rebellion against Obama’s healthcare reform proposal. Yet the Obama administration contributed to this situation immensely through its failure on the “consensus-building” front. Gradually, subsequently meetings were quickly deteriorating into highly partisan affairs between those who opposed government participation in the healthcare industry and senior administration officials who sought approval for Obamacare.

 

Impact of failure of consensus building efforts on state resistance to Obamacare

Failure to build consensus on the part of the Obama administration triggered hard-line positions among opponents of the proposed law. In most Republican states, for instance, participants lobbying for the rejection of the plan posed loaded questions aimed at distracting government officials from their campaign of seeking popular support for the Patient Protection and Affordable Care Act. Although one may argue that the opposition during meetings was spontaneous, evidence points to a situation where the opposition was planned. For example, Tea Party supporters seemed to follow the same, often aggressive approach, in planning strategies before meetings started, disrupting them, and finally addressing the media.

Moreover, most of the loaded questions touched on the same issues, yet the opponents had not held any public forum to consolidate their ground and forge a common front by outlining the provisions of the healthcare plan that they wanted removed from the plan. A major area of concern was the claim that the American taxpayer would be overburdened by new debts arising from the implementation of the reform law. In fact, it is against the backdrop of this argument that some states have shown reluctance in implementing some of the provisions of the law, for example the establishment of health insurance exchanges. Others such as Missouri have even gone to the extent of barring state officials from liaising with the federal health insurance exchange. Although the Obama administration has provided counterarguments to show how the benefits of the law outweigh the increased tax burden, the channels used to present this argument cannot facilitate the process of easing off partisan divisions. This has created a situation where America has become even polarized. The Obama administration should have sustained its efforts to win the support of all states in order to secure their goodwill during the implementation phase.

There are numerous examples where states have demonstrated their ability to reject the implementation of laws forced down their throats by the federal government. By mid-2013, 27 states had expressed their resistance, albeit covertly, to Medicaid expansion as provided for under Obamacare.[6] States that have towed the line of the national authority have benefited immensely because the new healthcare law obligates the federal government to pay 100 percent of costs relating to Medicaid expansion and 90 percent in subsequent years.[7] It is wrong for the Obama administration to remain complacent under the expectation that the financial assistance being provided by the federal government will be too much for these states to resist. Such an approach only enhances the notion that the administration was never committed to consensus-building. The government seems to have left the task of deliberating with state authorities to business interests and hospitals, who continue to lobby for the expansion based on the argument that the federal assistance will go a long way in creating jobs.

In the past, government-managed healthcare systems have tended to display suboptimal performance. Critics of Obamacare continue to question the wisdom behind the popular notion that government is more capable of managing the country’s healthcare industry than the private industry.[8] Even those who support the new law would affirm the existence of many situations in which government has failed to manage healthcare successfully, with obvious examples being Medicare and Medicaid. The administration’s inability or unwillingness to spearhead reasoned counterarguments in inclusive forums where participants from across the political divide are invited have led to an even wilder claim that the Affordable Care Act is a socialist agenda.

To mitigate state resistance, government officials need to examine what really went wrong less than two years after the president was overwhelmingly elected on a popular mandate of change. An assessment of the approach that was used to shore up support for the law offers the Obama administration to improve its practices as far as deliberative democracy is concerned. An appropriate starting point in this investigation should involve determining whether state resistance was occasioned by political climate, healthcare issues, or naiveté on the part of the government administrators regarding ways of seeking support for public policies at the grassroots level.

Conclusion

The Obama administration made serious mistakes in its decision to take the healthcare debate directly to the people without proper planning of meetings and avenues of consensus-building. Based on the analysis presented in this paper, it is evident that Obamacare presents numerous benefits that Democrats should have used to mobilize support at the national level. These benefits by far outweigh the tax burden that the law imposes on American households. The state resistance that town-hall meetings of 2009 triggered among Republicans and interest groups across the social spectrum demonstrates that something was seriously wrong with the government’s approach.

The paper concludes that Obama’s administration failed to use consensus building and deliberative democracy during discussions on Obamacare. This led to state resistance, which today poses a serious threat to the process of implementing the new healthcare reform law. As demonstrated by the loaded questions that opponents repeatedly posed, the resistance arose from political rather than healthcare issues. In conclusion, therefore, this paper confirms the hypothesis that if president Obama had adopted the principles of consensus building and deliberative democracy, the Obamacare healthcare reform strategy would have met little or no state resistance.

 

References

Blumenthal, David and Sara Collins. “Health Care Coverage under the Affordable Care Act — A Progress Report.” New England Journal of Medicine, 371, no. 1 (2014): 275-281.

Lowande, Kenneth and Sidney Milkis. ““We Can’t Wait”: Barack Obama, Partisan Polarization and the Administrative Presidency.” The Forum, 12, no. 1 (2014): 40-52.

Quadagno, Jill. “Institutions, Interest Groups, and Ideology: An Agenda for the Sociology of Health Care Reform.” Journal of Health and Social Behavior, 51, no. 2 (2010): 125-136.

Rigby, Elizabeth and Jake Haselswerdt. “Hybrid Federalism, Partisan Politics, and Early Implementation of State Health Insurance Exchanges.” Publius, 43, no. 3 (2013): 368-391.

Rigby, Elizabeth. “State Resistance to “ObamaCare”.” The Forum, 10, no. 2 (2012): 29-44.

Thompson, Frank and Michael K. Gusmano. “The Administrative Presidency and Fractious Federalism: The Case of Obamacare.” Publius, 2, no. 6 (2014): 119-127.


End Notes

[1] Lowande, Kenneth and Sidney Milkis. ““We Can’t Wait”: Barack Obama, Partisan Polarization and the Administrative Presidency.” 12, no. 1 (2014): 40-52.

[2] Blumenthal, David and Sara Collins. “Health Care Coverage under the Affordable Care Act — A Progress Report.” New England Journal of Medicine, 371, no. 1 (2014): 275-281.

[3] Quadagno, Jill. “Institutions, Interest Groups, and Ideology: An Agenda for the Sociology of Health Care Reform.” Journal of Health and Social Behavior, 51, no. 2 (2010): 125-136.

[4] Rigby, Elizabeth. “State Resistance to “ObamaCare”.” The Forum, 10, no. 2 (2012): 29-44.

[5] Thompson, Frank and Michael K. Gusmano. “The Administrative Presidency and Fractious Federalism: The Case of Obamacare.” Publius, 2, no. 6 (2014): 119-127.

[6] Rigby, Elizabeth and Jake Haselswerdt. “Hybrid Federalism, Partisan Politics, and Early Implementation of State Health Insurance Exchanges.” Publius, 43, no. 3 (2013): 368-391.

[7] Rigby, Elizabeth and Jake Haselswerdt. “Hybrid Federalism, Partisan Politics, and Early Implementation of State Health Insurance Exchanges.” Publius, 43, no. 3 (2013): 368-391.

[8] Lowande, Kenneth and Sidney Milkis. ““We Can’t Wait”: Barack Obama, Partisan Polarization and the Administrative Presidency.” 12, no. 1 (2014): 40-52.

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