Running head: IDEOLOGY AND SOCIAL POLICY PAPER

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

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

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

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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 Obamas 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 illconsidered 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

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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 transactionsto 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, makers vs moochers, or 99% vs
1% and its 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

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public programs may or may not be effective in bringing people out of poverty or protecting
them from financial catastrophe, still Massachusettss 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 isnt 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

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cant have the same ideology or else they would both be proponents of the ACA, right? Well no,
its 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 its 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

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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 dont get the service, but I think thats 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 arent bad people who dont 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
Whos 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 cant stand how we the public
elect people whose true allegiance is to a political party or political ideal. I think its high-time
that we elect and hold accountable those who will work for the people, not for party, or for reelection. Is this nave? It probably is, but that wont 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

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name-calling and the character attacks. Its 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).

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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.