Healthcare Reform and Congress’ Role in the Legislative Process

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Healthcare Reform and Congress’ role in the Legislative Process

This is not a story of good versus evil. Nor is it a tale of right versus wrong. The decision of the morality and constitutionality of the new healthcare law is for someone else to make. This paper simply seeks to address Congress’ role in the long and confusing process of passing healthcare reform. As a group, we attempted to consider every major policy actor in the healthcare reform process. We identified seven major actors: the Obama administration, Congress, the congressional budget office (CBO), advocacy groups, the insurance industry, public opinion, and the legal challenges of the law. While each actor played a specific role in the policy-making process, the bills were ultimately produced and passed by the two bodies of Congress. Therefore, considering the actors and perspectives within Congress and how they framed the issue of healthcare reform will help explain the outcome. Background

“One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project. Most people are a little reluctant to oppose anything that suggests medical care for people who possibly can't afford it.” Sound familiar? This seems to echo the opinions of the opposition to the current healthcare reform law, but in actuality it was said almost 50 years ago by a man who didn’t live long enough to see the current healthcare debate. That man was former president Ronald Reagan, and contrary to what appears to be the case at times, the new healthcare reform is not the first attempt by Congress to bring government involvement into the healthcare sector. There have been advocates for some form of government-involved healthcare since at least 1935, when President Franklin D. Roosevelt signed into law the Social Security Act. Although there was a push for addressing affordable healthcare coverage for everyone, ultimately the law settled on addressing the problem of unemployment insurance and financial security for elderly. Over the next 30 years, as healthcare costs grew and fewer people could afford health insurance, the support for government involvement and regulation in healthcare mounted until eventually the passage of the Social Security Amendments Act in 1965. This law most notably established a health insurance program for the elderly, known as Medicare, and a similar program for the poor, known as Medicaid. The passage did not come without its fair share of opposition though; a mere four years prior, President Reagan gave a 10-minute speech, including the above quote, on how the implementation of Medicare would lead to socialism. Over the past 50 years since the passage of Medicare and Medicaid until the recent healthcare reform law of 2010, this warning of government involvement in healthcare inevitably leading to socialism and the end of the American dream has never lost its political potency. Using this political rhetoric has made further attempts to expand government involvement in the healthcare industry largely unsuccessful. What makes Reagan’s quote so interesting is that he is on one hand framing the issue as one of a symbol of anti-socialism, and on the other hand, offering a warning to future politicians not to allow this issue to be framed “as a humanitarian project”. Essentially, Reagan has hit on one of Deborah Stone’s fundamental ideas of policy making: “strategic representation” of the issue. With this concept in mind, let us explore the recent healthcare reform debate and its process of becoming a law. Healthcare Reform 2009/2010

After eight years of the Bush administration, the public wanted a change from the current political track in Washington. That change came in 2008 with the election of President Barack Obama and large Democratic majorities in both the House and the Senate. With President Obama’s domestic priorities...
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