Conclusion

Abstract

This is the concluding chapter of the book, which synthesizes its main arguments and analyses, and discusses the prospects for sustaining the Affordable Care Act and its goals of providing all Americans with access to affordable, high-quality health insurance and healthcare provision. It discusses the evolution of liberal arguments for the expansion of healthcare, including how contemporary healthcare reform rhetoric reflects historical rhetoric, but is also distinct from it. It recaps the rhetorical strategies used by the four presidents discussed to advance their healthcare reforms. It pays particular attention to the current rhetoric of Republicans, who continue to be adamantly opposed to both the Affordable Care Act and to universal health insurance. It discusses the policies they have proposed as alternatives, as well as the tensions between Republicans holding public office in state government who have shown greater sympathy for the Affordable Care Act than Republicans serving in Congress. It analyses some of the flaws in the Affordable Care Act, including its lack of effective cost controls, its provisions for health insurance that has very high deductibles, which can be prohibitive for millions of Americans, and, consequently, the increase in underinsurance even as the Affordable Care Act has been implemented. It also discusses how the American social imaginary and moral order has changed historically and questions how it may continue to evolve. It considers this question in light of the upcoming presidential elections and the clear division between the Republican presidential candidates, who wish to repeal the Affordable Care Act and end its provision of health insurance on a near-universal basis, and the Democratic presidential candidates, who support and wish to expand upon it, improve it, and, in the case of Bernard Sanders, move to a more comprehensive government-provided single-payer healthcare system. It concludes by raising questions to consider about the future of the Affordable Care Act and of healthcare reform.