Obamacare and Policy Making

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The policy making surrounding the Patient Protection and Affordable Care Act, or as it is known Obamacare, was a highly contentious process. Debates were held not only in the legislative branches of government but also between individuals who either believed that the act infringed on their rights or that the act was necessary to reform the broken healthcare system the United States currently has. The policy making process is designed to be able to create programs and policies which are effective and beneficial. The policy making surrounding Obamacare resulted in the creation of an act which was diluted and ineffective in achieving health care reform.

The topic of health care reform was one which President Obama campaigned upon during his election and worked towards making a landmark piece of legislation during his term. President Obama began working with Congress to draft the legislation however the process was disrupted by both lobbyists from pharmaceutical or medical industries and Republicans who refused to work with the President to develop a bipartisan act. Rather the House of Representatives developed the Affordable Health Care for America Act. The House eventually was forced to abandon their act once President Obama made changes to his original plan for health care reform such as abandoning a public option in favor of individual mandates. The House and Senate eventually passed Obamacare however this was not the end of the process as Republicans fought against the constitutionality of the Act and eventually took it to the Supreme Court.

The main reason for the Republicans contention against the act were due to issues of federalism. Republicans believed that health care reform should be up to individuals states as the  federal government should not mandate that everyone needs to have health insurance. President Obama’s proposal was similar to the health care reform that Mitt Romney instituted in the state of Massachusetts. While Republicans did not have the same objections to Mitt Romney’s plan, they did object to President Obama’s proposal as they believed the act infringed on states’ rights. Republicans also contended that Obamacare was unconstitutional and provided multiple ways in which this was the case. “ These include infringing on state sovereignty; commandeering state officials to enforce federal law; forcing states to enter into coercive (Medicaid) contracts; and violating the spending power — all tied to the Tenth Amendment” (Shapiro, 35). However as was determined by the Supreme Court Obamacare was not unconstitutional as long as it was a tax. As the United States government is able to tax its citizens Obamacare is not unconstitutional. Although the act had originally been conceived as a protection rather than a tax, the change made it so the act was not repealed. 

The debate surrounding the constitutionality of the act was only a part of the discussion as many argued the pros and cons of the policy. Supporters of the program argued that the program would ensure that more individuals have health insurance. This would result in reduced costs for hospitals who see many patients using emergency services for routine medical procedures. The medical community would also see an increase in patients. “There will be more individuals presenting themselves to physicians and hospitals, and there should be more funding to provide for the increased care burdens” (Souter, 54) The act would also improve the health of US citizens as individuals would be inclined to seek preventive care if they have health insurance. The pros of Obamacare from a liberal perspective would be that every individual should have the right to health care as it improves the quality of life of those who do. From a conservative perspective argument would be made that individuals should make their own decision to obtain health insurance and that the government should not force them to do so. They may also cite personal responsibility as a reason as those who are hardworking Americans are able to obtain insurance from their employer or can afford their insurance.

The arguments against Obamacare strongly cite the negative economic results of the act rather than any healthcare benefits that may be gained. The cons of the policy are that it would force small businesses to pay more either in health insurance or in taxes for not providing health insurance. This would result in the failure of more small businesses which would hurt the economy. The tax aspect of Obamacare is also not feasible as the IRS would be unable to penalize those who do not have health insurance. “Interestingly, the IRS does not have the same collection authority and tools at its disposal to collect these charges as it does for failure to pay income tax.” (Souter, 56). Obamacare also takes away the freedom of individuals to choose their insurance plans and would place the decisions of what kind of treatments they would be able to get in the hands of the federal government. Feldstein (2009) argued that the policy would in fact be rationing health care and services which would not increase the health benefits received by individuals. From a liberal perspective it may be argued that while these points may be valid if more lives are saved by ensuring that everyone has health insurance that the financial cost of Obamacare is justified, even if the political socialization of immigrants is required.

The justification of the financial costs need to be determined by whether or not the policy is effective. The goal of Obamacare was to reform health care and ensure that the health of individuals is improved by increasing their access to healthcare. However, the weakening of the policy has resulted in an act which does not increase individuals’ access to health care. By not including a public option in the act individuals are still being forced to either pay for their health insurance or pay a penalty for not having the coverage. Individuals must still make the decision to pursue one option or another by weighing their economic costs versus their health costs. Had the policy included a public option all individuals would have provided coverage without having to make that decision. Rather than making concessions and compromises to get a weakened act passed, policymakers need to keep in mind the eventual goal of the policy. As Obamacare is a diluted version of the original health care reform plans it is not effective in achieving its goal of health care reform and therefore is not justified in the financial costs it has created.


Feldstein, M. (2009). Obamacare is all about rationing. Wall Street Journal.Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §2702, 124 Stat. 119, 318-319 

Shapiro, I. (2010). Long, Strange Trip: My First Year Challenging the Constitutionality of Obamacare, A. FIU L. Rev., 6, 29.

Souter, P. D., & Gurevitz, J. (2012). Health and Taxes: What Obamacare Now Means for Employers. Financial Executive, 28(7), 54-57.