Affordable Care Act’s Aims, Benefits, and Challenges


The Affordable Care Act (ACA) ratified in 2010 was a decisive step that, in many ways, transformed the American healthcare system and, in particular, the principles of medical insurance. The initiative of Barack Obama, then US President, singled out supporters and opponents of this law, and each side had its individual motives. The ACA’s assessment from political and legal perspectives can help identify the key aspects that have influenced the state of American healthcare and suggest potential changes and additions that may contribute to transforming the industry for the better.

Actors in the Passage of the ACA

The main initiator of the signing of the ACA was the administration of President Barack Obama. The Democratic Party turned to the Senate, and by a majority vote, the decision was ratified. However, based on the results of the vote, 34 representatives of the party spoke out against the signing of the ACA (“Obamacare review,” n.d.). According to Frontline (2010), Joe Biden, who was the vice president at the time, also spoke out against signing the Act, arguing that none of the healthcare projects he knew had proven effective. However, through Senate approval, the ACA was ratified in 2010.

Stakeholders’ Motives

Barack Obama played a key role in the fight over the adoption of the ACA. One of his main motives was to address the problem of poverty in the country and provide poor citizens with better access to health services (“Obamacare review,” n.d.). According to Béland et al. (2019), Republicans perceived the law unfavorably, guided by the fact that insurance changes in legislation would entail more costs than the state could afford. Most Democrats, in turn, promoted the idea of the need to implement the ACA by stating that the law could address acute problems, thereby meeting the population’s needs. Thus, the set goals were achieved, and the Act was signed.

Ways to Shape Public Opinion

To promote the ACA, the Democrats took into account several important criteria that confirmed the need for ratification of the document. Béland et al. (2019) argue that the party relied on “growing support for the law among intermediary groups, a growing number of constituents, as well as positive evaluations of the reform” (p. 411). This means that the initiators of the reform were guided by the opinion of electors, interacted with representatives of the authorities at different levels, and monitored views on potential changes. According to Frontline (2010), the Republican strategy was characterized by partisan politics aimed at discrediting the actions of the Democrats. As a result, with the support of the majority, the ruling party achieved the desired outcome.

Forms of Policy Related to the ACA

Different types of policies define the characteristic principles of management and control. Hadfield and Turner (2021) give four forms of policy – “regulatory, distributive, redistributive, and constituent” (p. 4). In relation to the ACA, each of these forms may be considered, and Frontline (2010) compares the Act to a deal requiring concessions and tactical decisions. The regulatory policy implied taking steps to ratify the Act and its key provisions at the legislative level. The distributive policy was to allocate resources and assign liabilities to responsible parties. The redistributive practices were based on the assessment of the existing base from the perspective of creating a system of control and management over new legislation. Finally, the constituent policy implied shaping strategies for a phased transition to a renewed healthcare program.

Legal Challenges of the ACA

The ratification of the ACA was accompanied by some challenges and barriers from a legal standpoint. For instance, according to Béland et al. (2019), its adoption required approval and could not be based on the president’s exclusive will. In addition, difficulties arose in defining the procedure for insurance, in particular, the principles of granting preferential terms and the involvement of individuals. Interstate agreements required revision since the planned Act did not comply with the regulatory framework existing at that time (“Obamacare review,” n.d.). Finally, the involvement of navigators was also complicated, which hindered the free participation of persons assisting the population in choosing insurance conditions.

Potential Policy Modifications

If each challenge were successful, some modifications would be necessary. Firstly, interaction with all legal subjects would be essential to obtain consent, for instance, to develop special drafts of legislative changes. In addition, at the constitutional level, this would be necessary to define the categories of parties admitted to insurance services. To comply with the interstate conditions, additional congressional decisions would be required to modify the principles of the federal health law. Creating a verification system for navigators would need to be organized to ensure sustainable work with the population.

Other Possible Solutions

Despite the difficulties, the president had other options to consider to reform the healthcare system. According to Frontline (2010), Barack Obama could count on Congress and the decision of this board after providing all the necessary facts to support the ratification of the ACA. In addition, the president could initiate a referendum in support of the new Act and urge the population to pay attention to the upcoming changes, highlighting the imperfections of the current system. These steps were available to Obama in accordance with his official status as head of state.

Alternative Solution to Address the Healthcare Crisis

To address the healthcare crisis, engaging numerous stakeholders in the national medical insurance system was a successful solution. In particular, in accordance with the ACA, accountable care organizations were outlined, which grouped different interested parties and ensured coordination of healthcare services, and provided freer and less expensive access to medical services (“Obamacare review,” n.d.). The initiative to raise national healthcare was associated with support given to institutions interested in reducing costs (Frontline, 2010). Alternatively, President Obama could have created an individual board to oversee insurance services and regulate public insurance.

Effects of the Trump Tax Cuts

The Trump tax cuts of 2017 had a significant impact on the ACA, in particular, the financial aspect of the Act. As Béland et al. (2019) argue, “by zeroing out the penalties imposed by the mandate (rather than repealing the mandate itself), Republicans also generated over $300 billion in savings” (p. 415). For the then ruling party, this was a step towards the abolition of the ACA, and to eliminate the bill, the subsequent cancellation of the mandate for compulsory insurance is a logical decision. To strengthen the ACA, this is critical to raise corporate income taxes and eliminate the provisions on tax deductions on capital expenditures.


The Affordable Care Act was an important document that changed the American healthcare system and introduced new terms of medical insurance to the population. Despite the challenges that President Obama faced during the adoption of the ACA, the Act was ratified with support from Congress. The specific operating conditions for all stakeholders define the principles of engagement and regulation. The Republicans’ decisions to eliminate the ACA could be revisited through a change in the current fiscal law.


BĂ©land, D., Rocco, P., & Waddan, A. (2019). Policy feedback and the politics of the Affordable Care Act. Policy Studies Journal, 47(2), 395-422. Web.

Frontline. (2010). Obama’s deal [Video]. PBS. Web.

Hadfield, A., & Turner, C. (2021). Risky business? Analysing the challenges and opportunities of Brexit on English local government. Local Government Studies, 1-22. Web.

Obamacare review. (n.d.). Ballotpedia. Web.

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