The issue of the healthcare system reform in the United States has been a subject of great focus among politicians from either sides of the political divide. While majority of them agree that the healthcare system in the country requires some reforms in order to ensure accessibility, quality and affordability for all American citizens, they disagree on the approaches towards realizing this objective. The election of President Trump saw the beginning of the new efforts to reform the healthcare system. It entailed repealing and replacing Obama’s healthcare reform. One bill (AHCA) passed the House in a narrow 217-213 vote, but did not pass in the Senate (Politico LLC, 2016). This paper will analyze the politics around this issue with specific focus on the voting by the legislators, as well as the role of public opinion on healthcare reform.

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The partisan voting was evident during the vote on the AHCA bill. All democrats (193) voted NO against the bill seeking to repeal and replace Obama’s healthcare reform. On the other hand, out of 228 Republican legislators, 217 voted YES, 20 voted NO, and 1 did not vote (Politico LLC, 2016). The voting greatly reflected the political parties’ position which is a further reflection of the extent to which the House members are determined to demonstrate their loyalty to their respective parties. This voting evidenced the fact that majority of house members were reluctant to run counter to their party line (Mayhew, 2006). However, this was not the case at the Senate where the AHCA bill failed to pass. This development can be explained by the concept of Congressional Action which seeks to answer the question about why the Congress enacts the policies that it does. In this particular case, it is clear that the Senate sought to break away from the parochial concerns of their parties, and instead focused on the general public interest. Mayhew (2006) explains that in some cases, Congress members are motivated by the desire of making good public policy aimed at serving the national and public interest. The failure of this AHCA bill to pass at the Senate can be attributed to Mayhew’s explanation.

Most of the Republicans who voted against AHCA bill in the House came from districts that voted for Hillary Clinton. For example, in the New Jersey 7th Congressional District represented by Leonard Lance (R) who voted against the bill, Clinton got 55 percent of the votes cast against Trump’s 41.8 percent, thus a margin of 13.2 percent (Politico LLC, 2016). In the Colorado 6th Congressional District represented by Mike Coffman (R) who voted against the bill, Clinton got 48.2 percent against Trump’s 43.3 percent, thus a margin of 4.9 percent (Politico LLC, 2016). In the Florida 27th Congressional District represented by Ileana Ros-Lehtinen (R) who voted against the bill, Clinton got 58.4 percent against Trump’s 39.1 percent, thus a margin of 19.3 percent (Politico LLC, 2016). The fact that the three of the Republicans who voted against the bill come from districts where Clinton (D) won more votes than Trump (R) means that some politicians are unwilling to go against the opinion of their constituents to facilitate their re-election pursuit (Mayhew, 2006). The importance of this issue of varying voting pattern between representatives and presidency votes underpin the argument that presidency is just one of the American government players and that the other players such as the legislature can make their decisions devoid of its influence (Jones, 2005).

The public opinion about health care reform in the United States is in agreement in some issues and disagreement in others. Majority of Democrats and Republicans support the motions on the issues of reducing the amount individuals pay for health care and lowering the cost of prescription drugs (Kaiser Family Foundation, 2017). However, while majority of Republicans (63 percent) support repealing of 2010 health care law, 21 percent of Democrats only support the same. Also, while 50 percent of Republicans support the decreasing of the role of the federal government in healthcare, 26 percent of Democrats support the same (Kaiser Family Foundation, 2017). These public opinions mattered in the House as depicted by the voting patterns of legislators from respective parties. However, they did not matter in the Senate votes where it appeared that other factors beyond parties’ position and interests took precedence. Moving forward on this issue, public opinions will considerably matter but will not be the primary factor to determine the eventual outcomes.

The vote in the House, Senate and by individual members is consistent with the founders’ views of democracy. Founders had envisaged a democracy where the national policy is not held hostage by passions arousing the public (Madison, 2003). The current voting significantly adheres to this view as different factors such as party positions, public opinion and individual ideologies help to ensure that a national policy is not held hostage by specific aspect (Hamilton, 1996). The different facts act to mediate public opinions and political interests towards achieving national policies that largely serve the national interest rather than parochial interests of different actors. However, there are some elements of inconsistencies with the founders’ views of democracy. As was noted in the case of the vote in the House where all Democrats voted against the bill, it is evident that it is possible for a public policy to be held hostage to party interests. Whereas the moves by political parties to put their interests ahead of national interests are often thwarted by other players such as the judiciary, they always prove that it is important for all players in the American government to be vigilante so as to protect democracy envisaged by the founders (Madison, 2003).

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  • Kaiser Family Foundation. (2017). U.S. Public Opinion on Health Care Reform, 2017. Retrieved
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  • Politico LLC. (2016). 2016 House Election Results. Retrieved from