Paper 1: Health Care Reform


In March 2010, Congress passed and President Obama signed the Patient Protection and Affordable Care Act ("ACA"). Imagine that you are a senior advisor to an interest group that is trying to figure out why the ACA passed and how to influence the law going forward. You can choose one of the following two interest groups to address:

  • The Club for Growth, a large conservative interest group that opposes the ACA.
  •, a large liberal interest group that supports the ACA and wants to further expand access to affordable health care.

Please write a five-page essay in which you make and defend an argument about why the bill passed and what the group should do now. In the course of your essay, you should address the following questions:

  1. Why was President Obama successful in passing health care reform whereas earlier reform efforts had failed?
    • How did changes in the political landscape open a policy window in 2009–2010 that made it easier to pass health care reform?
    • How was the ACA designed to minimize the opposition of health care interest groups such as insurers, doctors, and hospitals that previously had opposed health care reform in the U.S.?
    • How did legislative coalition leaders use techniques of persuasion, procedure, and modification to win over enough members of Congress to pass the bill?
  2. In the conclusion of your essay, provide a brief recommendation to the interest group on the political strategy it should pursue to modify the ACA. Remember that the Club for Growth would like to repeal or scale back the ACA, while MoveOn would like to further expand it. Your recommendations should be tailored to whichever interest group you choose to address. Your recommendations could include advocacy at either the state or federal level. Be sure to consider the political feasibility of your recommendation.

Student Examples

The examples below appear courtesy of MIT students and are used with permission. Examples are published anonymously unless otherwise requested.

The Affordable Care Act: How It Passed and Where to Go from Here (PDF)

The True Costs of the Affordable Care Act (PDF)

The Passage of the Affordable Care Act (PDF)