Healthcare policy is often heavily debated. The last three presidents have all had different positions when it comes to healthcare policy and reform which is discussed as follows.

Similar to Obama, President George W. Bush wanted to address the cost of healthcare and insurance for individuals (Falit, 2006, p. 632). President Bush hoped to decrease cost while increasing quality and competition throughout the healthcare sector across the US (Falit, 2006, p. 632). Bushes plan included allowing individuals to purchase private Health Spending Accounts (HSA) and deduct the premiums from taxes. He also planned to increase HSA contribution limits. He also proposed benefits that would allow small businesses to purchase health insurance for employees the same way that large businesses do (Falit, 2006, p. 635).

President Obama created “Obamacare” which is also known as the Affordable Care Act (ACA). While it seemed that almost everyone understood the term “Obamacare” on a very basic level, one third of Americans still did not realize that Obamacare and ACA were the same thing (Milstead & Short, 2019, p. 11). The Affordable Care Act was created to address major concerns in healthcare such as the high cost of care, increasing access to care, improving outcomes and more (Silberman, 2020). In 2010, prior to implementation of The Affordable Care ACt, more than 46 million Americans were without medical insurance (Silberman, 2020). The ACA required that employers offer affordable insurance plans to their employees, and if they failed to do so would be fined instead (Silberman, 2020). Additionally, the ACA mandated that individuals have personal health insurance or pay a tax penalty (Silberman, 2020). It also allowed parents to keep children on their health insurance plan until the age of 26, regardless of marital status (Silberman, 2020). Additionally, people could not be denied insurance due to pre-existing medical conditions. Obamacare proved to be an effective plan, but not without problems. Many individuals felt that their constitutional rights were infringed upon by being mandated to have healthcare, an issue that was taken all the way to the US Supreme Court. The court ruled in support of the individual mandate. Other reasons that Obamacare proved to be controversial was due to expense to employers and individuals through mandates and coverage. Obamacare also provided coverage for acupuncture in many states, which may not be considered essential, as obamacare goal was to increase equitable access to “: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care” (Fan, 2014, p. 390).

President Donald Trump had plans to “repeal and replace Obamacare” (Béland et al., 2018). Under President Trump, Paul Ryan created the American Health Care Act (AHCA). The AHCA implemented age based tax credits, and many older adults saw an increase in cost of healthcare (Béland et al., 2018). The AHCA also reversed Medicaid expansion. The Better Care Reconciliation Act was created but was rejected. It seems that the Trump administration wanted to allow more freedom to US citizens and attempted to repeal the individual coverage mandate, but this did not pass. There are still people out there who chose to pay the tax penalty, arguing that the tax penalty still costs less than paying for personal health insurance.

All of these previously discussed healthcare reform policies were controversial, as is most healthcare discussion today. The Bush Administration seemed to not create too many waves, as they tried to increase access to healthcare and improved benefits of healthcare spending accounts, but did not actually make many changes to insurance or the actual cost of healthcare. While this was a nice change, many people still do not have equitable access to HSAs due to income restrictions. I personally think this was a step in the right direction. Obama had a huge health care reform policy, which was one of the large healthcare reform bills in the last 50 years. I think Obama did a lot of great things with his bill. One thing that I would not have mandated was the individual coverage. While I fully understand why this was done, it upset many people who did not want to pay for health insurance and felt more financial restraint when this was set in place. However, it seems that having to pay for health insurance is better than being stuck with a bill after an accidental injury or illness. While Trump had the plan to “dismantle” obamacare, he was not completely successful with this. I do understand why he increased the cost of healthcare for older adults, and why he supported higher costs to those with pre-existing medical conditions. However, I would not have increased the cost to elderly. My husband had a cardiac arrest when he was in high school during a cross country race. To this day he feels it would be fair if his health insurance cost more, as he requires more care and resources now that his health insurance covers. After living with him and understanding his perspective, I also understand why some people think it is fair to have a higher premium due to pre-existing medical conditions. However, I do not know where it would be appropriate to draw a line with pre-existing medical conditions. Some sources consider conditions such as Acne or Pregnancy a pre-existing medical condition which I find baffling. So with all of this being said, because it would be very hard to draw a line, I do support Obama and how he made it illegal to charge more or decline coverage due to a pre-existing medical condition.

Béland, D., Rocco, P., & Waddan, A. (2018). Obamacare in the Trump Era: Where are we Now, and Where are we Going? Political Quarterly, 89(4), 687–694. https://doi-org.ezp.waldenulibrary.org/10.1111/1467-923X.12527

Falit, B. P. (2006). Recent Developments in Health Law The Bush Administration’s Health Care Proposal: The Proper Establishment of a Consumer-Driven Health Care Regime. Journal of Law, Medicine & Ethics, 34(3), 632–639. https://doi-org.ezp.waldenulibrary.org/10.1111/j.1748-720X.2006.00079.x

Fan, A. Y. (2014). “Obamacare” covers fifty-four million Americans for acupuncture as Essential Healthcare Benefit. Journal of Integrative Medicine, 12(4), 390–393. https://doi-org.ezp.waldenulibrary.org/10.1016/S2095-4964(14)60035-2

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Silberman, P. (2020). The Affordable Care Act : Against the Odds, It’s Working. North Carolina Medical Journal, 81(6), 364–369. https://doi-org.ezp.waldenulibrary.org/10.18043/ncm.81.6.364