Running Head: ROLE OF EXECUTIVE ORDER IN ACA Role of Executive Order in ACA 2 Role of Executive Order in ACA By: Ameki Lee Dr. White MPA6501 SU01 State and Local Government and Intergovernmental Relations Role of Executive Order in ACA Affordable Act Care has been a significant issue in Texas State for the past seven years. Texas governor, Greg Abbott has been on the frontline in fighting the implementation of the Act in Texas and America. The governor's office claims that the penalties related to avoiding the Act are unconstitutional and not democratic (Toussaint, 2017). Furthermore, the Governor argues that the Affordable Care Act should be put on halt while the cause is being liquidated. However, the governor does not concentrate on improving the policy rather than doing away with it. Greg Abbott believes the pre-existing conditions are the major barriers for the effectiveness of the act. The Affordable Care Act allows people to purchase the policy even with pre-existing conditions. In favor of the governor, the act should limit the purchase of the act during such conditions with the aim of reducing the cost as well as the rates of insurance. Therefore, an appeal can be made based on the governors value since most Americans are complaining about the same issue (Toussaint, 2017). Affordable Act Care was implemented under the executive administrative policy. In America, an executive order is directed by the president on the managers of various federal governments with the aim of forcing policy to law. In 2013, former president of America Barack Hussein Obama issued a directive on the implementation of the Affordable Care Act (Rovner, 2018). The current President, Donald Trump began fighting the Act by attacking the executive committee and even dismantling it. An executive order is written, signed and published by the president's office and directed to various federal departments. The Executive order directed all agencies responsible under the Affordable Care Act provision that will provide a regulatory and fiscal burden on entities that will be reluctant on adopting a policy. Also, the Executive Order directs the same agencies to offer greater flexibilities and collaboration on implementing such healthcare policies. Since the implementation of the Affordable Care Act in 2010, the policy has suffered various criticisms in its debate. For those who believed that the primary goal of the Act was to make insurance more affordable didn’t achieve their purpose. However, the policy has caused more Americans to have access to medical insurance hence fostering a healthy nation. Since the Act is applicable in improving the public health of all Americans, it includes various resources in healthcare like materials, funds, personnel and other things that can be utilized in the provision of healthcare service. The act is also responsible for ensuring all medical care institutions have the necessary resource for effective operations (Ba.

1. Running Head: ROLE OF EXECUTIVE ORDER IN ACA
Role of Executive Order in ACA
2
Role of Executive Order in ACA
By: Ameki Lee
Dr. White
MPA6501 SU01 State and Local Government and
Intergovernmental Relations
Role of Executive Order in ACA
Affordable Act Care has been a significant issue in Texas State
for the past seven years. Texas governor, Greg Abbott has been
on the frontline in fighting the implementation of the Act in
Texas and America. The governor's office claims that the
penalties related to avoiding the Act are unconstitutional and
not democratic (Toussaint, 2017). Furthermore, the Governor
argues that the Affordable Care Act should be put on halt while
the cause is being liquidated. However, the governor does not
concentrate on improving the policy rather than doing away
with it. Greg Abbott believes the pre-existing conditions are the
major barriers for the effectiveness of the act. The Affordable
Care Act allows people to purchase the policy even with pre-
existing conditions. In favor of the governor, the act should
limit the purchase of the act during such conditions with the aim
of reducing the cost as well as the rates of insurance. Therefore,

2. an appeal can be made based on the governors value since most
Americans are complaining about the same issue (Toussaint,
2017).
Affordable Act Care was implemented under the executive
administrative policy. In America, an executive order is
directed by the president on the managers of various federal
governments with the aim of forcing policy to law. In 2013,
former president of America Barack Hussein Obama issued a
directive on the implementation of the Affordable Care Act
(Rovner, 2018). The current President, Donald Trump began
fighting the Act by attacking the executive committee and even
dismantling it. An executive order is written, signed and
published by the president's office and directed to various
federal departments. The Executive order directed all agencies
responsible under the Affordable Care Act provision that will
provide a regulatory and fiscal burden on entities that will be
reluctant on adopting a policy. Also, the Executive Order
directs the same agencies to offer greater flexibilities and
collaboration on implementing such healthcare policies.
Since the implementation of the Affordable Care Act in 2010,
the policy has suffered various criticisms in its debate. For
those who believed that the primary goal of the Act was to make
insurance more affordable didn’t achieve their purpose.
However, the policy has caused more Americans to have access
to medical insurance hence fostering a healthy nation. Since the
Act is applicable in improving the public health of all
Americans, it includes various resources in healthcare like
materials, funds, personnel and other things that can be utilized
in the provision of healthcare service. The act is also
responsible for ensuring all medical care institutions have the
necessary resource for effective operations (Barbaresco,
Courtemanche & Qi, 2015).
Various changes would have been made on the Affordable Care
Act with the aim of improving it. Parts of the Act requirement
must be redesigned with the purpose of enhancing patient
experience while minimizing medical errors. The most attacked

3. provision of the policy is its position in the insurance exchange.
The fundamental of democratic medical law is that people
would opt in or out without strict provision. However, the ACA
allows young people to choose out of the policy requirement by
incurring fines that are extremely low compared to purchasing
the act. The main change on the Act would be reviewing its
penalties and making it optional for all Americans. The focus of
any Health Insurance Policy should be on improving the quality
of health care for all Americans on an affordable cost
(Barbaresco et al., 2015). The main role of the interest group is
to influence policy reformation. Interest groups accomplish this
by lobbying the policy. Before lobbying, interest group ensures
that the policy is to the best of interest to the public. The
presence of an interest group helped to shape the ACA policy by
ensuring it would be affordable to every American.
References
Toussaint, J. S. (2017, April 05). Improve the Affordable Care
Act, Don't Repeal It. Retrieved from
https://hbr.org/2016/11/improve-the-affordable-care-act-dont-
repeal-it
Rovner, J. (2018). This lawsuit is the latest threat to the
Affordable Care Act. Retrieved from
https://www.nbcnews.com/health/health-news/texas-lawsuit-
threatens-affordable-care-act-n906376
Barbaresco, S., Courtemanche, C. J., & Qi, Y. (2015). Impacts
of the Affordable Care Act dependent coverage provision on
health-related outcomes of young adults. Journal of health
economics, 40, 54-68.
Running Head: COURSE PROJECT PART III
Course Project Part III

4. 6
Course Project Part III
By: Ameki Lee
Dr. White
MPA6501 SU01 State and Local Government and
Intergovernmental Relations
Determine whether your chosen policy is important to the
general population.
The affordable care at is important to the general population
since all Americans have the right to access to quality health
care at an affordable cost. Since the introduction of the act in
2010, millions of the Americans can access the medical
coverage they need. Under the act, individuals are covered by
their parent's insurances until they reach age 26. This allows
millions of high school, college students and graduates to
continue receiving medical coverage under their family until
they are in a position to find a job and pay for their healthcare
plan. However, this has resulted in controversies since all
Americans are legally required to get covered or face a tax
penalty (Sommers et al., 2015).
Apart from youths, women are also the greatest beneficiary of
the Affordable care policy. Today, women with affordable care
plan cannot be denied treatment of cancer or pregnancy service.
In other words, no woman can be turned down according to their
condition under this act. Pregnant women under the policy can
access free checkups during and after pregnancy ensuring they
can afford the coverage. In short, the act provides equity and
women will no longer be charged higher premiums compared to
men hence improving the general quality of care to all
Americans (Sommers et al., 2015).

5. Another way the Affordable care act is vital to the general
public is by making insurance companies accountable. The
accountability includes insurance company focusing on the
provision of reliable and effective service to all Americans
rather than being profit oriented. This minimizes amounts taken
from Americans since the company can only account for the
percentage usage in insurance coverage.
Identify the key interest groups actively involved in the policy
area and the policy preferences of the interest groups. Are there
competing interest groups?
The main reason for the past failure of the health care reforms
is that special interest groups were lobbying the government
hence blocking such changes. Interest groups have hugely
impacted the medical reforms of America as they attempt to
shape the medical care to their own needs. The main role of the
interest group is to influence policy reformation. Interest groups
accomplish this by lobbying the policy. Before lobbying,
interest group ensures that the policy is to the best of interest to
the public. The presence of an interest group helped to shape
the ACA policy by ensuring it would be affordable to every
American. Interest groups like the American Hospital
Association and Families USA shaped the final ACA policy to
reduce the level of un-insurance (Wherry & Miller, 2016).
Furthermore, the two interest groups made the policy favorable
such that the insurer was willing to accept the strict regulations,
pice control and accountability of the cover. Furthermore, the
interest group ensured that the act had policies that will
improve the living standards of all Americans. Furthermore, the
ACA complain made the private insurance reduce their price
since public healthcare could also provide affordable and
quality care at an affordable price (Haeder & Weimer, 2015).
Since the Affordable Care Act has been an area of debate in
America, many interest groups are sprouting up supporting or
opposing the care with the aim of gaining public attention.

6. Although interest group is meant to represent the needs of the
public, the competition for relevance could lead to undermining
their primary role. Conservative corner interest group, on the
other hand, was against the ACA reforms claiming it wasn't
differenced from the previous medical coverage and that it was
costly. Many analysts argued that the interest group was
influenced by its political affiliation and the desire to compete
while seeming unique (Wherry & Miller, 2016).
Identify the policy preferences of the political parties in the
policy area.
It’s been eight years since the implementation of the affordable
care act but it has received opposition from a small group of
Congress and Republicans. The two have cooperated in
opposing the implementation of the insurance policy. Much of
the Republican resistance can be attributed to the intense policy
demanders. They claim that the plan is not equitable and only
specified to a particular group of people. Republican believe
that the ideology behind the affordable care acts
uneconomically since those who can pay for the healthcare
service, unwilling pay for those who cannot. Therefore, the act
is likely to destroy America's economy. Although the common
perception of Americans is that the republican will reject
anything from Obama, they also provide evidence to oppose the
act (Haeder & Weimer, 2015).
On the other hand, Democrats are the major supporters of the
ACA. Due to the recent objection and regular court appeals, the
Democrats have decided to advance the ACA to suit new
preferences. Democrats believe that doing away with the act
will disrupt medical coverage for many Americans hence they
are concentrating on rebuilding the private insurance market.
Democrats perceive expansion of current public programs could
be the best way to make Americans struggling with the high
cost of healthcare access the health insurance (Haeder &
Weimer, 2015).
Identify a legislative activity that affects the policy and the key

7. legislative actors. Is the legislature of your state actively
involved in this issue? If so, explain how it is actively engaged
in this issue. If not, explain how it can be actively involved in
this issue.
The affordable care act policy has received support as well as
criticism in America. The main source of criticism is the
legislatures siding with the Republicans. Recently more than 20
states have challenged the constitutionality of Obamacare. The
initial lawsuit against ACA made it clear that the act was going
against the law by imposing tax penalty to adults without the
policy (Huntington et al., 2011). Furthermore, mandating
everyone to purchase the policy is unconstitutional and issues of
federal power. Moreover, seven health states have threatened to
come together and form their health policy that operates outside
the ACA. Therefore, the legal language of implementing the
policy varies from one state to another mostly according to their
political affiliations. Major Rebulican legislator against ACA
policy includes John Wyoming, Roy Blunt and Susan Collins
Maine.
Ted Cruz, Senator of my state, Texas is among those actively
engaged in the new ant-Obamacare lawsuit. The senator's
lawyers argue that ACA’s most popular provisions should be
eliminated for good. Led by Texas, various senates have begun
to repeal the ACA terming it unconstitutional. Ted claims that
since the Congress has no right to order people to use ACA
policy, therefore it should impose a tax penalty on those not
having insurance (Huntington et al., 2011).
References
Haeder, S. F., & Weimer, D. L. (2015). You can't make me do
it, but I could be persuaded: a Federalism perspective on the
Affordable Care Act. Journal of Health Politics, Policy and
Law, 40(2), 281-323.
Huntington, W. V., Covington, L. A., Center, P. P., Covington,
L. A., & Manchikanti, L. (2011). Patient Protection and
Affordable Care Act of 2010: reforming the health care reform

8. for the new decade. Pain physician, 14(1), E35-E67.
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T.
(2015). Changes in self-reported insurance coverage, access to
care, and health under the Affordable Care Act. Jama, 314(4),
366-374.
Wherry, L. R., & Miller, S. (2016). Early coverage, access,
utilization, and health effects associated with the Affordable
Care Act Medicaid expansions: a quasi-experimental
study. Annals of internal medicine, 164(12), 795-803.
Running Head: PART II:COURSE PROJECT
1
PART II:COURSE PROJECT
4
Part II:Course Project
By: Ameki Lee
MPA6501 SU01 State and Local Government and Internal
Government Relation
Dr. White
09/05/2018
Just as indicated in the part one of the assignment, the
implementation of the affordable care policy in all states within
the US are pegged on both the federal current constitution and
the constitutions of the specific states.in this particular
assignment, the implementation of affordable care act policy
would be based on the constitution of my state which is
Louisiana State. Louisiana State is the 31 most extensive and
the 25th most populous state within the country and has its
largest city base in New Orleans. Louisiana State uses the
constitution of 1974 which described the distribution of powers
between the federal government, state official and the local

9. governments. (Tarr, 2000)
The affordable care act policy is addressed in the Louisiana
State constitution under the former healthcare policies that
existed before such as Medicare and Medicaid programs in the
country. Just as provided in the federal constitution regarding
the powers and responsibility of the state, Louisiana State
constitution provides that it would be the responsibility of the
state to provide healthcare services to its citizens in conjunction
with the local authorities. The affordable care policy is not
directly addressed in the constitution though it has been
implemented under other policies that exist in the constitution
such as Medicare and Medicaid programs. The constitution of
Louisiana State has majorly vested this particular policy in the
executive arm of the state government. (Tarr, 2000)
The affordable care act policy was an act of the federal congress
which indicates that it is applicable in all states within the
united states of america.in my own perception, dealing with the
affordable care policy would majorly revolve around legislative
process instead of constitutional approach. This indicates that if
there is any amendment that is supposed to be effected on the
affordable care act policy, then it should take the direction of
the legislative process by the members of the congress in the
country which would in turn affect its implementation in all
states that includes Louisiana State. (Huntington, et al, 2011)
The affordable care act policy has majorly been a topic that has
received support and at the same time equal criticism. The
policy was majorly adopted to increase healthcare quality at
affordable cost. It aimed at increasing the number of citizens
who had healthcare insurance hence subjecting them to
affordable care. Many citizens allied to the democrat party
within the Louisiana State have been known to be the main
supporters of this particular policy. They have majorly argued
that since inception of this policy in 2010, the healthcare sector
has experienced tremendous implications of positive
dimensions. (Huntington, et al, 2011)

10. On the other hand, this particular policy has also received a lot
of controversy and criticisms majorly from legislators and
citizens who are allied to the Democratic Party within Louisiana
State. The opponents of this program have majorly argued that
the federal government has imposed harsh taxation measures on
their citizens in a bid to recover funds to support this program.
This they have opined that has increased healthcare cost which
is an irony as compared to the act provision that provides that it
is affordable. The republicans have actually made plans to
appeal and replace this act that has majorly been experienced
since president assumed power.
In my own examination, I feel the policy ought to have been
subjected to public interest before being implemented. The
policy actually got its way into being law due to the fact that it
was engineered by the then ruling party. The reason why it out
to had been subjected to public interest is the fact that it has
exposed us citizens to high taxation and high cost of living. The
public could have had chance to give their views and its
adoption could only be narrowed down to those who supported
the same idea.
References
Huntington, W. V., Covington, L. A., Center, P. P., Covington,
L. A., & Manchikanti, L. (2011). Patient Protection and
Affordable Care Act of 2010: reforming the health care reform
for the new decade. Pain physician, 14(1), E35-E67.
Tarr, G. A. (2000). Understanding state constitutions. Princeton
University Press.
Running Head: PART 1: PUBLIC POLICY IN THE US
FEDERAL SYSTEM 1

11. PART 1: PUBLIC POLICY IN THE US FEDERAL SYSTEM
2
Part 1: Public Policy in the US Federal System
By: Ameki Lee
MPA6501 SU01 State and Local Government and Internal
Government Relation
Dr. White
08/25/2018
My policy choice for this particular assignment would revolve
around healthcare. This is one sector that interests me so much
in that the healthcare is all about the people’s welfare in the
country. Since inception of independence in 1776, the
government has been involved in a series of healthcare
legislative act with the most recent one being the affordable
care act commonly abbreviated as ACA. The subject specific
policy for this assignment would hence revolve around
affordable care act in the country. This policy was adopted
under president Obama’s administration in 2010 and has always
been dubbed as ‘Obama care’.
The affordable care act received a lot of criticism especially
from people allied to the Republican Party. Most recently the
republicans under President Donald Trump argued that this
particular policy subjected the US citizens into unnecessary
taxation hence initiated a bill to cap it off. Luckily the policy
survived being discontinued and is still a subject of discussion.
The policy has been very critical in the US healthcare system in
that it has increased the number of US citizens being insured. It
has also improved healthcare quality and patients can easily
acquire healthcare services at affordable costs.
The affordable care policy has majorly been dispensed in
similar dimensions just as compared to other previous
healthcare policies such as Medicare and Medicaid insurance
schemes. According to Bovbjerg, Wiener, and Houseman,
(2003) the U.S government is designed in federalism way in

12. that it has a central government and the state government. The
affordable care act policy is a policy that has majorly been a
responsibility that is bestowed to the federal government and at
the same town the state government. This is demonstrated in
funding the policy whereby the federal government has a
portion of funds that it remits to all state based on a given
formula. On the other hand, the state governments also fund this
program from revenues that they collect from various sources
within the specific states.
In dispensing services under this policy, the two government
have concurrent powers is clearly outlined in the constitution.
This actually dates back to the first constitution that was drawn
up in Philadelphia in 1787 that adopted federalism. Under this
constitution, the various states within the country were
empowered to run their own affairs including healthcare
services, This indicates that despite the state active role in
dispensing affordable care policies, the federal government has
overall powers and is even involved in financing the policy.
This indicates that there is concurrent commitment to this
policy as the state government funds and runs the program at
their level while the federal government funds the states. The
Kaiser Family Foundation. (2012)
The involvement of the state and the federal government in this
particular policy is actually pegged to the US constitution. The
first constitution that was adopted under by the US government
defined the roles of the federal and the state governments. The
constitutions outlined that the state government has the
authority to control healthcare activities. This has been
demonstrated by the state’s role in ensuring that the affordable
care policy is implemented in all the states under governor’s
leadership. Alternatively the constitution also provides that the
federal government is supposed to finance all the states in
dispensing their services. The federal government has ensured
that they operate under this constitutional provision by
providing funds every year under a particular formula to all the

13. states in the country. The Kaiser Family Foundation. (2012)
In my own assessment I feel the constitutional distribution of
power in supporting this policy has extensively been successful.
Since the inception of this policy in 2010, the policy has had
tremendous implications on US citizens. This is one particular
policy that the various states have implemented without hurdles
due to the federal government commitment in dispensing funds
to support the program. The state governments have also been
committed in devising ways of raising funds towards supporting
this particular policy.
References
Bovbjerg, R. R., Wiener, J. M., & Houseman, M. (2003). State
and Federal Roles in Health Care: Rationales for
AllocatingResponsibilities. In J. Holahan, A. Weil, & J. M.
Weiner, Federalism and Health Policy (pp. 25-57). Washington,
D.C.: Urban Ins
The Kaiser Family Foundation. (2012). A Guide to the Supreme
Court's Affordable Care Act Decision.Washington, D.C.: The
KaiserFamily Foundation