ideology and social policy paper

Running head: IDEOLOGY AND SOCIAL POLICY PAPER 1

Ideology and Social Policy Paper

Stephen Annest

Northwest Nazarene University

SOC WLFR PLCY/SRVS

SOWK630

Professor Scott Slater

February 5, 2015

IDEOLOGY AND SOCIAL POLICY PAPER 2

Abstract

This paper is written on the subject of healthcare reform, and the legislation commonly known as

ObamaCare or the ACA (Affordable Care Act). The purpose of this paper is to introduce the

reader to the ACA in order gain general understanding of the dichotomizing issues that surround

the legislation. Through exploring the legal grounds on which the ACA was judicially approved,

understanding both conservative and liberal concerns, and citing specific beneficiaries and

losers, the reader is provided with a sense of perspective as to how the ACA came about and

what affect it has on the United States healthcare system.


Ideology and Social Policy Paper

The healthcare reform known as Obamacare, or the ACA, is a fine example of politically

dichotomizing legislation. The ACA or Affordable Care Act, along with the Healthcare and

Education Reconciliation Act (which amended the ACA), constitutes “the most significant

regulatory overhaul of the U.S. healthcare system since the passage of the Medicare and

Medicaid in 1965” ("PPAC Wiki," 2015, para. 1). This paper will briefly overview and

critically examine the main benefits offered through the ACA. After a brief overview, which

will include how and why the courts ruled on the ACA, the motive and target audience of the

ACA will be considered. Given a general understanding of what the ACA is, who its designed

for and the precedent on which it stands, conservative and liberal viewpoints will then be

reviewed. Moral considerations that drive passionate debates between parties will be discussed

and illuminated via a discussion of EMTALA (Emergency Medical Treatment and Labor Act)

and PFR (Prevention of Freeriding). Concluding quotes and ideas from various sources will

advocate for the ACA and suggest bipartisan efforts as key for its’ future success and

effectiveness.

The ACA is healthcare legislation promoted and signed in to law by President Obama on

March 23, 2010. Its’ chief benefits include subsidies for those who are eligible and insurance

exchanges that encourage easily accessible, and understandable policies. These insurance

exchanges are “presented… in plain English for easy comparison. Or as President Obama often

put it, “buying health insurance would now be like going online to buy an airplane ticket” (Brill,

2014, p. 18). Also under the new law insurance companies cannot “turn away people with pre-

existing conditions or even take those conditions into account” (Brill, 2014, p. 18).


It is debatable whether or not the subsidies help the target audience, especially in some

states (more on this later). It is also arguable that the insurance exchange created by ObamaCare

is not as simple or understandable as need be. “Buying health insurance is exponentially more

complicated than buying a plane ticket”, commented Brill (2014) in response to Obama’s claim

that insurance exchanges were set-up to emulate the intuitiveness of air travel web sites.

Considering the importance of finding the right insurance plan for ones’ needs, many people will

still require an insurance agent to walk them through the process. Navigating different levels of

coverage featuring multiple levels of premiums, co-pays, co-insurance, and deductibles can be

daunting to say the least. Still, given that the insurance exchanges help those without job related

coverage to find an array of competing products, “none of which would be allowed to have the

bait and switch” limits that insurance companies have traditionally used, the overall benefit to

the target population is positive (Brill, 2014, p. 18). The bait and switch strategies afore

mentioned include limiting the amount of coverage per day so that over all coverage is mitigated

significantly.

Who is the target audience for the ACA? Put simply, the uninsured, and those “people

with incomes below 400% of the poverty line (up to about 94,000 for a family of four…)” (Brill,

2014, p. 18). The uninsured (willing or not) are mandated to have insurance, and those that are

eligible for help will get some. It is this regulation of commerce (particularly the mandate to

have insurance) that was of the highest concern to the courts.

Justice Holmes suggested that, “great and pressing cases might lead to emotional and ill-

considered decisions by judges” (Whittington, 2013, p. 274). The questionable legality of the

ACA is such a grant case, that the Supreme Court wanted to make its decision based upon

precedent and reason rather than emotional appeal. The Supreme Court decided that legality of


the ACA was to be found in one of two precedents. The first case is found in the commerce

clause of the constitution. This clause authorizes congress “to regulate commerce… among the

states” (Whittington, 2013, p. 277). This power to regulate commerce is famously declared by

Judge Marshall to be “plenary” and “absolute”. The question is whether or not congress can

regulate “those who are not involved in any economic transactions…to prepare for such a

transaction” (Whittington, 2013, p. 278). The court was not willing to grant this particular power

to congress, so they went with precedence number two: the taxation provisions of the

constitution. The Supreme Court decided that although congress does not have the power to

compel it does have the power to tax. So, in a brilliant legal slight of hand the court found a way

to substantiate the ACA on legal grounds. “Congress can tax those who refuse to buy health

insurance, but it cannot compel them to buy insurance” (Whittington, 2013, p. 279). The

Supreme Court may have come to an agreement on the ACA, but for the rest of the United States

it remains a highly debated topic.

Conservatives and Liberals represent a classic dichotomy of political ideology in the

United States. Pick almost any issue and Google red vs blue, maker’s vs moocher’s, or 99% vs

1% and it’s easy to see the inflammatory bipartisan nature of our political climate. Since

healthcare and the passing of the ACA is a polarizing issue, exploring the ideology that divides

and impassions the debate between the “red” (conservative) and “blue” (liberal) factions of our

political landscape would be advantageous (Cohn, 2012). In order to illustrate how the country

is divided over Healthcare it might be beneficial to briefly examine one red state and one blue.

“The quintessential blue state is, of course Massachusetts. Their health care is available

to almost everybody, regardless of income or preexisting medical conditions” (Cohn, 2012, p.

22). Welfare benefits are generous and millions are spent on public housing. The propensity for


public programs may or may not be effective in bringing people out of poverty or protecting

them from financial catastrophe, still “Massachusetts’s residents get a lot more help from their

state government than people who live elsewhere in the United States” like Texas (Cohn, 2012,

p. 22). Texas (a dark “red” state) is not the slightest bit interested in providing the kind of

protection for its constituency that Massachusetts provides. “It has more uninsured residents

than any other state in the county” and “its lawmakers have repeatedly refused money from the

federal government to expand health insurance for kids” (Cohn, 2012, p. 23). Its welfare is

stingy at about 300$/month for eligible families and the state-housing budget is 5.5 million, a

pittance when compared to that of Massachusetts. So why does such a grand expanse separate

the programs offered from the conservative (or red) state, and the liberal (or blue). The answer is

that red and blue states have different values, different viewpoints, and moral ideology isn’t it?

There are of course, a myriad of viewpoints within any one group, and conservatives or

liberals are no exception. For the purposes of the paper however, two moral arguments should

suffice to illuminate conservative and liberal ideologies concerning the ACA. The first moral

argument is called Just Sharing and it is stated like this: “The financial burdens of medical

misfortunes ought to be shared equally by well and ill alike unless individuals can be reasonably

expected to control those misfortunes by their own choices” (Menzel, 2012, p. 584).

Surprisingly to some, this argument is well accepted among both liberals and conservatives. Yes,

conservatives have a heart (allegedly, wink wink) they just differ from liberals on how as a

nation, state, or community to uphold this moral principle. Mostly the red believes that an

individual should not be forced into sharing. This does not mean that reds do not share. In fact,

reds through Church and other community-based organizations do a great deal of sharing. So, it

can be argued that liberals and conservatives agree on sharing but disagree on how. But they


can’t have the same ideology or else they would both be proponents of the ACA, right? Well no,

it’s not that simple. Examining the second moral principle might help.

The second moral principle is called: PFR or Prevention of Free-Riding. It pertains to

people who receive benefits without paying for them, and as such is directly related to the debate

about ACA. PFR states that: “A person should pay her share of the costs of a collective

enterprise that produces benefits from which she cannot be excluded, unless she would actually

prefer to lose all the benefits of the enterprise rather than pay her fair share of its costs” (Menzel,

2012, p. 587). This argument is widely proliferated by conservatives who oppose the ACA. It

seems intuitive and fair that a person (all things being equal) should have to pay or contribute to

a collective enterprise in order to receive benefits. This is just common sense. Well, it may be

common but it’s not complete. This country suffers many levels of inequality, from “race”, to

education, to mental illness. Circumstances are not equal, so to apply this argument to the ACA

would be inaccurate. Liberals would also point out that PFR is not a good argument for another

reason. The PFR principle hinges on the idea that those who do not pay can feasibly be keep

from receiving benefits, and since EMTALA was introduced in 1985 this has been not the case

when it comes to healthcare. EMTALA or the Emergency Medical Treatment Act states that we

must treat (give benefits) to those who need emergency care whether they can pay for it or not.

In effect “since they cannot realistically be excluded from the benefits” then PFR does not stand

as a good argument against the ACA. The United States is paying for health care one way or

another (Menzel, 2012).

So far I have given a brief overview of the ACA, talked about how the courts found legal

standing, defined the target audience of the ACA, and introduced conservative and liberal

arguments and ideology. I painted the United States red and blue to illustrate the polarizing


nature of our political environment. Now to expound on how I see the ACA my personal point

of view will now be brought to bear.

In short I see both sides of the argument. Conservatives I think have good reason to

advocate for the freedoms of the individual. Maybe its because I was raised here in Idaho, but a

part of me gets twitchy when the government starts coercing the individual into buying a service.

Liberals say they are only taxing the individual if they don’t get the service, but I think that’s a

“tomato/tamato” kind of defense. Liberals on the other hand, have the right heart, offering

healthcare to all. It just seems like the communal/human/responsible thing to do, and as pointed

out earlier we as a nation are to paying for healthcare anyway (ETMALA). The conservatives

need to realize that Obamacare is happening and may be the best thing to happen for many poor

and underprivileged, so instead of complaining they should get involved. Finally, Liberals need

to understand what they are asking of conservatives (ideologically), and need to be more

compassionate and understanding with them. Republicans aren’t bad people who don’t care

about he poor, underprivileged, or ill. They are people wo disagree about the method and

mechanism of healthcare, not the need to provide it.

What we really need is bipartisan communication and cooperation. Quotes like

“Who’s ever at fault down there at 1600 Pennsylvania Avenue should have been gone long ago”,

have no place in productive politics (Rogers, 2013, p. 1). I just can’t stand how we the public

elect people whose true allegiance is to a political party or political ideal. I think it’s high-time

that we elect and hold accountable those who will work for the people, not for party, or for re-

election. Is this naïve? It probably is, but that won’t stop me from advocating for it. To put this

another way, we the united states, liberals and conservatives, are married to each other. For this

marriage to work we need to respect one another, be willing to compromise, and stop all the


name-calling and the character attacks. It’s just not productive, and if the ACA or any legislation

is to work “It has to work for conservatives and for liberals” alike, not one or the other

(Branham, 2010, p. 31).


References

Branham, M. (2010). The language of health reform. Capitol Ideas, 53(1), 31.

Brill, S. (2014). Hate obama, love obamacre. Time, 183(3), 18.

Cohn, J. (2012). E pluribus duo. New Republic, 243(16), 21-23.

Menzel, P. T. (2012). Justice and fairness: A critical element in U.S. health system reform.

Journal of Law, Medicine & Ethics, 40, 582-597.

Patient Protection and Affordable Care Act. (2015). In Wikipedia. Retrieved February 5, 2015 ,

from http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

Rogers, A. (2013). Why one democrat will vote against the president on obamacare. Time, 1.

Whittington, K. E. (2013). Our own limited role in policing those boundaries. Journal of Health

Politics, Policy & Law, 38, 273-282.

ideology and social policy paper

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