ABSTRACT
The affordable care act (ACA) marked a significant step forward in a very long struggle to achieve national health insurance. During the late 1980s, as health care costs continued to accelerate, national health insurance emerged once again as an important policy issue. An Election Day exit poll showed that voters preferred Clinton’s approach to health care to George Bush’s by a wide margin. By 2008, health care reform had not fully emerged as a focal point of the presidential campaign but the three leading primary candidates, Barack Obama, Hillary Clinton, and John McCain, each emphasized health care reform in their campaigns. Cost and financing have been central issues in the nation’s debate over health care reform for decades; both are addressed by the ACA. One of the more controversial aspects of the ACA was its creation of an Independent Payment Advisory Board with members appointed by the President for six-year terms and approved by the Senate.
