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Politics in ACA Debate and Implementation Essay

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Updated: Aug 23rd, 2021


A few years after its enactment, the Affordable Care Act signed by President Obama still causes ideological disputes in healthcare. This paper uses factual data and research conducted by political experts to generalize on the role of partisanism and political strategies in the legislative history of the ACA. The rise of partisanism and cohesion in the Republican Party contributed to the conservatives’ unity in the ACA debate, whereas the Democrats could make deviations from the party line. The opponents’ approaches to strategy-setting also varied greatly, and the supporters of the act relied on media coverage, negotiations with centrist Democrats, and a thorough process of legislative drafting to win. The Republicans’ efforts included alignment with the strategy of internal cohesion, the strong anti-ACA political rhetoric in the media, and some post-enactment strategies, such as sabotage campaigns and further vilification of Obamacare.


The Patient Protection and Affordable Care Act abbreviated as PPACA or ACA is among the most widely discussed healthcare initiatives implemented within the last ten years. Despite the anticipated positive outcomes, the act caused an important ideological battle focused on aid allocation to financially disadvantaged citizens and the government’s responsibilities in the field of healthcare. At different stages of the legislative process, the Democrats and the Republicans used partisanship and political strategies to turn the situation in their favor.


The arguments justifying the need for the ACA referred to the most problematic aspects of healthcare service provision. In particular, the act was said to reduce the number of uninsured people in the United States and improve the government budget balance and access to care (Hopkins, 2017). Therefore, several socially important positive effects were expected after the enactment of the initiative. However, the submission of the ACA for consideration was followed by “one of the most contentious ideological battles” in the history of the U.S. healthcare system (Choma, Barnes, Braun, & Hanoch, 2018, p. 641). The two-party political system in the country involves the presence of two large ideological groups whose values and approaches to priority-setting vary greatly and are, to some extent, built on mutually exclusive assumptions. This pattern of conflict manifested itself in different cases, including the events preceding the enactment of the ACA.

The political controversies surrounding the act of 2010 and debates devoted to its potential impact were based on the presence of incompatible opinions concerning the necessity of aid allocation to the poor. As explained by Choma et al. (2018) in their article, the division accrued from people’s propensity to support either individual- or government-based health insurance policies. The behaviors and political strategies are chosen by those supporting liberal or conservative values were reflective of the decades-long resource allocation pattern. In particular, people on the left side of the political spectrum were more likely to advocate for healthcare services accessible for citizens of any financial status. At the same time, their ideological opponents were interested in preventing increases in government control in the field of health insurance. According to Choma et al. (2018), the conflicts surrounding the enactment of the ACA can be reduced to ideological differences related to the notion of distributive justice and its limitations. Thus, despite the complexity of political strategies utilized by people on both sides of the barricades, the entire ACA debate was not something new in the United States.

Partisanism and political polarization played a significant role in the debate and legislative processes surrounding the ACA. The presence of two incompatible systems of values manifested itself in the community of the Republicans’ opinions on ACA and its potential effects related to the State budget. During the entire legislative war over the discussed act, the members of the Republican Party were consistent in their negative attitudes to the ACA. Therefore, they preferred to align their actions with the recommendations of the Senate GOP leader McConnell who declared absolute unity as the guiding principle that would help the Republicans to succeed in the battle (Chima et al., 2018; Hacker & Pierson, 2018). As for partisanism in the final steps of the legislative process, due to their unwillingness to differentiate themselves from the crowd or more individual reasons, Republicans did not vote to support the act (Hacker & Pierson, 2018). The Republican politicians outperformed the Democrats in terms of their commitment to the party line, but that unity of action did not help the GOP leaders to impact the situation and pursue their agenda.

During the legislative procedures related to the newly introduced act, the Democrats and the Republicans recoursed to the political strategy of unity to a different extent. The Republicans were aware of the need for unified opposition efforts linked to healthcare reform before the start of the ACA controversy. For greater certainty, Mitch McConnell who served as the Senate minority leader from 2006 to 2015 proposed the political approach of “unwavering obstruction” even before the start of Barrack Obama’s presidency (Hacker & Pierson, 2018, p. 559). Before the beginning of the ACA era, the President and his political allies placed reliance on an opportunity to win the support of at least a few Republicans with the help of logical arguments (Hacker & Pierson, 2018). Despite the seeming simplicity of the task, position on the ACA was a point of principle for the Democrats’ ideological opponents.

The Democrats’ plan to obtain the Republicans’ support was never realized since the representatives of the Republican Party were united ideologically. In their discussion of the prerequisites to conservatives’ commitment to the party’s ideas, Hacker and Pierson (2018) analyze changes in the GOP’s political orientation from a historical perspective. The Republicans’ consonance in the U. S. Congress in 2010, the researchers explain, can be regarded as part of a larger strategy tracing its origins back to the 1990s (Hacker & Pierson, 2018). In that decade, the rate of political polarization in the United States increased rapidly. It needs to be noted that the process was heavily asymmetrical since the two leading parties “did not move away from each other at equal speeds” – the Democrats’ leftward movement was much less intense than the Republicans’ rightward tilt (Hacker & Pierson, 2018, p. 560). Later, in the era of the ACA debate, the tendency in question manifested itself in the Republicans’ negative attitudes towards the initiative aimed at widening health coverage in the United States.

Unlike their opponents, the members of the Democratic Party were likely to analyze the act’s potential benefits and disadvantages from different perspectives instead of toeing the official line of their political group. Certainly, the Democrats demonstrated partisan behaviors and did their best to prove the need for the ACA, but there was no absolute cohesion. For instance, in March 2010, more than thirty members of the Democratic Party voted against the ACA, but the diversity of opinions within the party did not lead to the conservatives’ victory since the latter had no numerical superiority (“Who voted against Affordable Care Act,” 2014). Importantly, since the ACA debate of 2009 and 2010, the situation with ideological unity in the Republican Party has changed (Blendon & Benson, 2017). As a result, nowadays, conservatives face difficulties in selecting the best ACA replacement option.

Numerous strategies were used by both pro-Obamacare politicians before and during the ACA debate. As for the Democrats led by the President, they used multiple levers of influence over the U. S. population, including mass media, to proceed from the possibility of change to the need for healthcare reform. As an example, in autumn 2009, to lay the groundwork for the public and state-level discussion of the ACA, Barrack Obama gave a Congressional speech to go into the merits of the existing healthcare system (Hopkins, 2017). The problem of the healthcare reform was imminent, and Senators in the United States prepared more than one thousand official statements to express their position on the ACA (Hopkins, 2017). In general, the media rhetoric of the Democrats who supported the ACA was based on appeals to the quality of healthcare services that would increase and the number of uninsured citizens in different income groups (Hopkins, 2017). However, the advertising efforts did not undermine their political opponents’ cohesion.

Despite the long-term effects of the GOP’s efforts to increase the unity among the members of the party, the Democrats managed to select strategies that helped them to profit from the legislative process. As an example, their success in passing the ACA is often attributed to their “full use of the committee process” (Kessler, 2017, para. 7). In particular, the members of the Democratic Party relied on the process of drafting hundreds of proposed amendments to make the law more acceptable and understandable to U.S. citizens (Kessler, 2017). Instead of engaging in open discussions with their ideological rivals, some representatives of the Democratic Party, including Harry Reid, worked without public knowledge to win the support of centrist Democrats who were uncertain in their position on the law (Kessler, 2017). As a result of private conversations, some of the centrists’ proposals, such as abortion coverage changes, were implemented to win more votes (Kessler, 2017). Thus, persistence and flexibility during negotiations helped pro-ACA politicians to reduce the influence of some Democrats’ limited partisanship on voting patterns.

The enactment of the act encouraged the Republicans and their supporters to resort to various political propaganda strategies hastening the repeal of the ACA. Among the most discussed approaches to prevent the act’s proper implementation were the organization of sabotage campaigns, including information blocking, ultimatums delivered by state governments, and demonization of the ACA in the media (Blendon & Benson, 2017; Hopkins, 2017). Rhetorical decision-making presents an important part of the opposition’s post-enactment strategy. Apart from the use of catchy phrases, such as “the death panel,” those opposing the act have tried to make its alleged unconstitutionality a publicly accepted truth (Hopkins, 2017, p. 684). Political strategies surrounding the act change over time but are still reflective of the sides’ partisanship.


To sum it up, the ACA is rightfully considered as one of the acts shedding light on the divergence of political attitudes to healthcare provision in the United States. In the ACA legislative process, polarization causing increases in partisanship was used by both the Democrats and the Republicans as a significant resource. Moreover, the entire debate became more complicated due to the use of political propaganda and negotiation techniques, as well as long-term strategies increasing cohesion.


Blendon, R. J., & Benson, J. M. (2017). Public opinion about the future of the Affordable Care Act. New England Journal of Medicine, 377(9), 1-7.

Choma, B. L., Barnes, A. J., Braun, R. T., & Hanoch, Y. (2018). Dissecting the politics of “Obamacare”: The role of distributive justice, deservingness, and affect. Journal of Applied Social Psychology, 48(11), 634-642.

Hacker, J. S., & 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.

Hopkins, D. J. (2017). The exaggerated life of death panels? The limited but real influence of elite rhetoric in the 2009–2010 health care debate. Political Behavior, 40(3), 681-709.

Kessler, G. (2017). History lesson: How the Democrats pushed Obamacare through the Senate. The Washington Post. Web.

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