Affordable Care Act Resilience in President Trump’s Era: Discussion Essay

Political science

Write a 5-page paper on the Affordable Care Act’s resilience in Trump’s era. Use the reading by either Neustadt or Howell to explore a policy goal pursued by President Trump since his election (and how he was either successful or unsuccessful). Among the many options you might consider: are attempted repeal of the Affordable Care […]

President Trump’s Failure to Repeal the Affordable Care Act


Unlike other Republican candidates who participated in the 2016 presidential election, President Donald Trump was undoubtedly the least well-equipped to lead the health reform changes. It is explained by his lack of concrete policy prescriptions, his tepid and superficial interest in the issue, and his insufficient knowledge concerning it. Unsurprisingly, political polarization and competitive party politics consist of counterattacks and accusations exchanged during campaigns (Valelly 94). As such, President Trump received many votes for promising to abolish the Affordable Care Act (ACA). According to Neustadt’s insights, the citizens expect the president to attain far more than their authority allows since the federal government is responsible for the country’s social welfare, commerce, and economy (Howell 244). However, the Trump administration has failed to repeal ACA because of the incoherent vision of President Trump for health reform, his polarizing personality, the lack of political capital, and ineffective persuasion and bargaining efforts.

An Incoherent Vision of President Trump For Health Reform

The replacement and repeal of the Affordable Care Act (ACA) became an essential promise only toward the end of Trump’s campaign due to its generated applause. Trump felt no compulsion to offer a comprehensive strategy for what would substitute ACA (Conover). Instead, his regime has consistently pledged to launch a legislative repeal plan for ACA that would protect individuals with pre-existing health conditions, reduce costs, and help people maintain coverage. In particular, the Trump administration proposed to replace ACA with a scheme titled “Health Reform to Make America Great Again” (Weissert and Weissert 149). The changes put forward in this Act comprise permitting the insurers to sell policies through state lines, presenting block grants to sponsor Medicaid programs, and allowing people to retrieve the totality of disbursements for individual health policies from their federal tax returns. The government has abolished the individual mandate, which subsequently caused the insurance premiums to intensify (Simmons-Duffin). Accordingly, the actions of the Trump administration have undermined the initiatives of ACA, reducing the number of education programs stipulated by it and diminishing its outreach.

The Democratic Party is more ideologically assorted as there are more self-identified Democrats as equated to Republicans. In addition, electorates who consider themselves liberals and take liberal standpoints on issues such as the national health insurance reform are overwhelmingly Democrats (Valelly 90). Based on Neustadt’s insights, the current presidents are required to address almost every conceivable economic and social problem. However, they seemed doomed to failure from the very beginning because they were only armed with authority to recommend the appointment of judges and bureaucrats and propose and veto legislation (Howell 244). Thus, the underlying cause of the failure to repeal ACA is the lack of a coherent vision for a healthcare policy demonstrated by President Trump.

The task has proven impossible for the Republican Party due to the sharp differences between conservative senators who aimed to undo as much of ACA as conceivable regardless of the consequences and the more reasonable members who have been wary of the possibility of millions of citizens losing health insurance. The latter have openly advocated keeping some of the most popular provisions of Obamacare (Conover). Apart from that, these two groups with different ideologies have also experienced challenges regarding the issue of how to profoundly cut Medicaid by putting a hard spending cap on the entire program and ending the ACA expansion. Even as President Trump maintained that the priority of his regime was to repeal and replace ACA, he offered only casual promises that complicated the matters and made it challenging for Congress to reach a consensus.

The Polarizing Personality of President Trump

Generally, President Trump receives negative ratings from various parties and the public regarding his characteristics. He is also rated lower compared to his predecessors in the categories of being well-informed, empathetic, and trustworthy (Conover). The brash style of President Trump appears to have intensified the degree of partisan polarization that was profoundly evident during the Obama regime. As a result, Democrats seemed determined to oppose the presidency of Trump. Healthcare is a crucial issue, and polls demonstrate that electorates trust Democrats more than Republicans on the subject because the latter has consistently failed to repeal ACA and presented nothing efficient to replace it with (James). Trump should have persuaded at least eight Democrats in the Senate to succeed in this matter.

The study committee of the Republicans argued against the notion that the Republican Party would not be able to fix the systems they decided to destroy (Conover). Nonetheless, their proposal recycles some of the unsuccessful strategies tried by the Republicans in the course of the 2017 healthcare debate. It raises questions regarding how the same changes would lead to a different outcome during the second implementation attempt. Apart from that, the proposal has been put forth at a time when the focus of Washington lies mainly on the growing impeachment scandal regarding the presidency of Trump (Luhby). His chances to persuade the Democrats seem remote at this stage as the latter appear enthusiastic about finding any opportunity to question the legitimacy of his election. Such a political setting makes it unlikely to introduce advancements in the discussed policy.

The Lack of Political Capital

In addition to individual flaws, President Trump lacks the political capital necessary for safeguarding the replacement of Obamacare, which encompasses public mood concerning revocation. Political capital is the inspiration, trust, and goodwill that politicians cultivate among their voters through pursuing policies that the public likes (Kauppi 210). It is possible to apply this goodwill to implement unpopular legislation, as Obama did with ACA, without severely damaging the support of one’s political party. As an illustration concerning popularity, the public approval rating of Obama was historically higher than that of Trump (Simmons-Duffin). Moreover, the general mood has also shifted in favor of Obamacare. The point is that a politician gains political capital by enhancing his or her credibility, boosting ratings, earning approval, and cultivating influence and trust, all of which President Trump has not done. Without it, his chances of leading the repeal of Obamacare have been virtually impossible.

Ineffective Persuasion and Bargaining Efforts

A divided intergovernmental lobby also played a role in Trump’s failure to repeal ACA. The legislation introduced by Congress with the aim to replace Obamacare scored low ratings among the public and led to strong disapproval from various healthcare stakeholders, including doctors and hospitals. Congressional Republicans, after the 2016 polls, attempted to solicit government input to listen to policy propositions (Thompson et al. 398). More radically, the national policymakers aimed to legitimize their proposal by curbing the opposition of as many governors as possible to win the endorsement eventually. They needed to accomplish this by concentrating on the opinions of the formal associations of governors in this regard, namely, of the National Governors Association (NGA). However, the policymakers found that the Association was less focused on repeal and replacement politics (Thompson et al. 398). In this way, Congress focused on the standpoint of the formal associations of governors, including NGA, but it failed to persuade them of the need to accept their view.

Rival ideologies, the opposite and competing approaches to understanding fundamental issues, have led to the inaction that the Constitution facilitates (Valelly 44). NGA highlighted that any changes should not transfer the costs to the states; moreover, they stressed that Congress should provide adequate time for the states to respond and review the proposed modifications. In brief, the lobbying has failed because NGA preferred to target a plan of reform that ensured no one lost healthcare coverage due to ACA replacement. According to Neustadt, a president must possess excellent persuasion skills if they want to succeed, and the key to presidential achievement is the ability to convince and persuade other political actors that his interest is similar to theirs (Howell 245). Considering this fact, Trump failed because he did not seem to understand that power is about cajoling legislators, trading promises, brokering deals, bargaining, and negotiating.

Although the association of both Democratic and Republican governors reinforced their policies, none of them served as a leading conduit for congressional policymakers. The bargaining efforts failed because NGA plays a limited role that partly mirrors its propensity to be more valuable to governors under the circumstances of divided partisan administration at the federal level (Thompson et al. 400). More so, it was problematic to address the detachments among Republican governors: their biased relationship was never amended during a discussion of a proposal for repealing and replacing ACA. Instead, different Republican governors acted individually and informally in ad hoc groups to present their standpoint to the members of Congress (Thompson et al. 402).

In essence, the sharp interparty polarization, which portrays the politics in America, shows that the Republicans are profoundly devoted to a program of reduction in government spending, the privatization of social policy, and tax cuts, while the Republicans aspire to find new sources of revenue and develop new social policy initiatives (Valelly 47). Partisan compromise is essential when passing legislation, and in each party, the governors have more incentive to use NGA as a vehicle. The weakening of the role of NGA mirrors disruptive forces of unequal partisan polarization (Thompson et al. 403). In such a setting, it becomes exceedingly challenging to forge bilateral concessions among the members.


All in all, the failure of President Trump to repeal ACA is not tactical. Instead, he has refused to redress or acknowledge his intention’s fundamental issues. As a result of his contradictory viewpoint regarding health modification, the negative perception of his personality by the public, the lack of political capital, and unsuccessful persuasion and bargaining efforts, the Republicans have had a hard time abolishing and substituting Obamacare despite achieving control on all levels of government. The Republicans, in this case, face a significant policy problem. While they promised to repeal and replace ACA, they are stuck because they have never reached an agreement on the issues in Obamacare they would fix, the goals the replacement would achieve, and the alternative that would be implemented.

Works Cited

Conover, Chris. “Why Trump’s Efforts To Repeal And Replace Obamacare Will Fail: Part III-Donald Trump.” Forbes, 31 Mar. 2017,

Howell, William G. Power Without Persuasion: The Politics Of Direct Presidential Action. Princeton University Press, 2003.

James, Kent. “OP-ED: Battle over MFA May End up Hurting Democrats.” Observer-Reporter, 27 Oct. 2019,

Kauppi, Niilo. Toward a Reflexive Political Sociology of the European Union: Fields, Intellectuals and Politicians. Springer International Publishing, 2018.

Luhby, Tami. “Conservative Republicans Unveil Obamacare Replacement Plan.” CNN, 22 Oct. 2019,

Simmons-Duffin, Selena. “Trump Is Trying Hard To Thwart Obamacare. How’s That Going?” NPR, 14 Oct. 2019,

Thompson, Frank J., et al. “Trump and the Affordable Care Act: Congressional repeal efforts, executive federalism, and program durability.” Publius: The Journal of Federalism, vol. 48, no. 3, 2018, pp. 396-424.

Valelly, Richard M. American Politics: A Very Short Introduction. Oxford University Press, 2013.

Weissert, William G., and Carol S. Weissert. Governing Health: The Politics of Health Policy. Johns Hopkins University Press, 2019.

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Published On: 01-01-1970

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