The 2010 Health Care Reform Bill
In March 2010, President Obama signed into law the 2010 Health Care Reform Bill. This reform is considered as one of the most expansive social legislation enacted in decades in the United States mainly because it is aimed at extending insurance coverage to approximately 30 million additional Americans. The process of developing and passing this bill was very rigorous with many emerging issues being linked to the entire decision-making process.This paper seeks to analyze the decision-making process and issues that were linked with this process during the development and passing of the Health Care Reform Bill.
The main sources of public health policies include the local, state, or federal legislation, regulations, as well as court rulings that are passed and given authority to govern the provision of health care services. Apart from public policies, key players in the private sector, such as hospitals and accrediting bodies can also come up with institutional or business policies that affect health care. The policy making process is made up of many different phases including the formulation, implementation, and evaluation phases. Each of the decision-making processes and issues that fall between the stages of developing and passing the health care reform bill are categorized within the formulation phase of a public policy.The public policy decision-making process is strongly connected to the political process in a country.
The 2010 Health Care Reforms Bill decision making process began in 2008 when Senate Finance Committee held numerous hearings with regard to the healthcare reforms between May 2008 and November 2008. After all the hearings had been made, the Senate Finance Committee released a comprehensive white paper with policy options based on the hearings that had been conducted and called for subsequent healthcare reforms to be made. In November 2008, there was an agreement between the Senate Finance Committee and the Senate Health, Education, Labor, and pensions committee (HELP) in November 2008 to commit to pass the comprehensive bill for health care reform. During the 2008 presidential election campaigns, President Obama had also made the health care reform agenda one of his key promises for the electorate. This is why upon clinching the presidency seat, the Obama administration delegated the Congress to draft a detailed health care reform proposal. There were further developments on this health care reform legislation after the Senate Finance Committee collectively engaged health policy and industry experts in discussing the formulation of the bill.
In terms of the constitution, Congress is mandated with all the legislative powers and rights needed in enacting the necessary and proper federal laws. The Senate and the House of Representatives are chambers of the Congress that are given the Congressional responsibilities of making decisions. The 2010 Health Care Reforms Bill was therefore introduced at the same time to both the House of Representatives and the Senate through a Representative and a Senator respectively for reading. After the reading of the bill in the House and the Senate, it was further assigned to Health Committees by both the House’s speaker and the Senate’s Majority Leader for scrutiny within their respective chambers.
The House of Representatives assigned three committees to examine the Affordable Health Choices Act, while two committees within the Senate were assigned the task of amending the bill. Each of the three versions of the bill that the House of Representatives committees produced after the amendment was voted out of the chamber’s committees and so were the two versions of the Senate Finance Committee and the Senate HELP committee. The initial drafts of the legislation and its amendments were rejected because the reform proposal was aimed at creating a new health insurance program that would be run by the government and would be known as “public option”. This program would give American citizens an alternative to private healthcare insurance policies. Even though, the reform proposal was heavily criticized for reiterating socialism policies that were contrary to the American ideologies, the Republicans were more concerned about the increased tax burden that Americans would face and the fact that the reform would also cover illegal immigrants.
Both chambers of the Congress faced a dilemma with regard to the decision-making process concerning theethical issues in the health sector, like abortion. In order to agree on this contentious issue, the policy makers were forced to acknowledge the powers of individual states when passing legislation on this issue. Even though the bill mandated individual states to choose whether to ban abortion coverage in the exchange plans offered, both chamber committees were in agreement that all individuals purchasing plans through the exchanges would be compelled to pay for abortion coverage using their own funds (Silverleib, 2009).
On 30th October, there was a second attempt to amend and pass the legislation and the House Speaker re-introduced the Affordable Health Care for America Act into the chamber. Subsequently, the Act, which contained a combination of the proposed amendments that had been previously made in the three House committees, was narrowly passed in November 9, 2009.On the other hand, the Senate introduced and passed the Patient Protection and Affordable Care Act, which was a combination of the two versions of health care reform that had been developed and rejected in the past by its two committees. After this, the chambers exchanged the passed bills for further scrutiny with the main aim of passing an identical bill or agreeing to another version of one branch. President Obama then unleashed his own version of the health care proposal and this was heavily drawn from the bill proposed by the Senate.
The House of Representatives agreed on the version of the bill tabled by the Senate but Congress agreed on a set of amendments to the act. The House of Representatives, which was mainly composed of Democrats passed the Patient Protection and Affordable Care, Act and the package of reconciliation fixes despite lackluster support from the Republicans. Having been approved by the two Congressional chambers,the bill combined with additional package of fixes for it that was now named the House Reconciliation Act of 2010. Its final version the final version was forwarded to the president’s desk for signing into law and President Obama signed it on March 23, 2010. This particular health care reform is expected to reduce the increasing costs of health care services as well as extend insurance coverage to most Americans (Council of Economic Advisers, 2009).
The decision-making process of the development and subsequent passing of the 2010 reform bill was not devoid of political and ideological differences. The differences were mainly between Democrats who were vouching for the reforms, and the Republicans and Tea Party supporters that strongly opposed the bill. On their part, the democrats believed that it was the government’s responsibility to improve the lives of the American people by offering insurance coverage to those who could not afford it. However, the Republican perceived the bill as an interference with the freedom of the people because it compels most individuals to carry health insurance or pay penalty for noncompliance.
The republicans further opposed the growing involvement of the government in subsidizing the cost of health care for every American citizen because it perceived this as being an aspect of socialism, an ideology that Americans are strongly opposed to. Private insurance providers on their part were against the bill, because it directly affected them and they feared it could destroy the existent system for private insurers.The Democrats and other supporters of the bill were convinced that, if passed, it would reduce the health care costs. There were also those that opposed the bill on the premise that financing the expanded health insurance coverage could result in a rise in the federal deficit level and general taxation with the aim of catering for the increased health care costs (Huffington Post, 2010). It is clear from this analysis that the development and passing of the health care reform bill was not only a tedious task but also entailed making amendments and critical decisions.
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Council of Economic Advisers. (2009, June). The economic case for health care reform. The Executive Office of the President of the United States. Retrieved from: http://www.whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf
Huffington Post. (2010, Mar. 18). Senate votes to debate health care reform bill. Retrieved from: http://www.huffingtonpost.com/2009/11/21/senate-votes-to-debate-he_n_366598.html
Silverleib, A. (2009, Dec. 24). Senate approves health care reform bill. CNN. Retrieved from: http://www.cnn.com/2009/POLITICS/12/24/health.care/