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The Affordable Care Act (ACA) signed into law in March 2013 by President Obama included goals are : “to expand access to insurance, increase consumer protections, emphasize prevention and wellness, improve quality and system performance, expand the health workforce and curb rising health care costs (King, Martha,2011).” Although these goals are beneficial to society, there has been many political efforts to replace/repeal this law. Some of the reasons are that the ACA raised taxes on individuals making over $200,000 per year, obligated businesses who had more than 50 employees to provide health benefits, imposed a tax penalty for individuals without coverage, increased premiums for those who already had coverage and increased taxes for medical supply manufacturers (Amadeo, K, 2020). Legislators must perform a cost-benefit analysis when it comes to supporting efforts to repeal/replace the ACA when it comes to being elected. Supporting the repeal of the ACA would benefit business owners, medical supply companies, insurance companies, those who make over two hundred thousand dollars per year. This population is primarily who fund election campaigns. Legislators must weigh how much it will cost them if they vote to repeal the ACA. The reality is that “policymakers are not necessarily focused on how real people will be affected by changes to Obamacare or Medicare or Medicaid but rather on how the changes will affect their own re-election chances (Milstead, J. A., & Short, N. M. (2019).

Legislators also perform analysis of voters and their views to influence which policies will be at the forefront of their campaign. People will vote for the candidate who they think will support policies that will benefit them. During the Trump campaign in 2020, he supported decreasing funding for Medicaid and enforcing stricter rules for who can receive coverage. The Biden campaign supported to expand Medicaid and extent full benefits with no premiums (Pifer, R. 2020,“Election 2020: Trump and Biden's starkly diverging views on healthcare). Lower income individuals voted for Biden and higher income individuals voted for Trump. According to exit polling in the 2020 Presidential Election in the United States, 57 percent of surveyed voters making less than 50,000 U.S. dollars reported voting for former Vice President Joe Biden. In the race to become the next president of the United States, 54 percent of voters with an income of 100,000 U.S. dollars or more reported voting for incumbent President Donald Trump (Duffin, E. 2020).