Feldstein’s Statement to Repeal ACA
An economist's framing question followed by two applied deliverables. The grid and the testimony are graded on a real bill, so choose one that is actually moving.
Editorial process
Last reviewed · August 23, 2026
Cost-benefit is a framing device, not a calculation
The interesting thing about a cost-benefit statement in a legislative fight is that it almost never settles anything, and understanding why is the point of the first task. Cost-benefit analysis requires you to decide what counts as a cost, what counts as a benefit, over what time horizon, and to whom, and each of those choices is contestable. A coverage expansion looks expensive over ten years and cheaper over thirty if it prevents disease; it looks costly to the federal government and beneficial to state budgets and to households. So the analysis functions as a framing device rather than as a calculation, and legislative leaders use it to make a position sound arithmetic rather than ideological. That observation is what the first question is actually asking for. Naming those assumptions is the first task, and it is a stronger answer than agreeing or disagreeing with the figure itself.
The two applied deliverables are graded on whether you engaged with a real bill, so choose one that is genuinely moving through the process rather than a famous historical act, and check its current status rather than assuming it. The grid asks for proponents and opponents, and the useful version names the actual organisations rather than abstract interests, because a bill's prospects turn on which associations have registered support. Press coverage is a question about salience, and the honest answer for most bills is that there is very little, which is itself informative. For the testimony, write it as testimony: address the committee, state your credentials and standing to speak, make one argument well rather than four adequately, and handle the opposing case by naming it fairly before answering it. The amendment is the part students under-develop, and it should be specific enough to be drafted, since a request to strengthen the bill is not an amendment.
Likely learning objectives
- Treat cost-benefit analysis as a framing device with contestable assumptions.
- Locate a bill's actual position in the legislative process.
- Name specific organisational proponents and opponents.
- Draft an amendment specific enough to be written into a bill.
Assignment instructions
Read the full question
Review every instruction before using the planning guidance that follows.
Post an explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid). Based on the health-related bill you selected, complete the Legislation Comparison Grid Template. Be sure to address the following: Determine the legislative intent of the bill you have reviewed. Identify the proponents/opponents of the bill. Identify the target populations addressed by the bill. Where in the process is the bill currently? Is it in hearings or committees? Is it receiving press coverage? Feldstein’s Statement to Repeal ACA Part 2: Legislation Testimony/Advocacy Statement Based on the health-related bill you selected, develop a 1- to 2-page Legislation Testimony/Advocacy Statement that addresses the following: Advocate a position for the bill you selected and write testimony in support of your position. Describe how you would address the opponent to your position. Be specific and provide examples. Recommend at least one amendment to the bill in support of your position. Legislation Comparison Grid Template Feldstein’s Statement to Repeal ACA Use this document to complete Part 1 of the Module 2 Assessment Legislation Comparison Grid and Testimony/Advocacy Statement Health-related Bill Name Description Federal or State? Legislative Intent Target Population Status of the bill (Is it in hearings or committees? Is it receiving press coverage?) General Notes/Comments Legislation Comparison Grid Template Rubric Criteria Percentage Unsatisfactory (0.00%) Less than Satisfactory (80.00%) Satisfactory (88.00%) Good (92.00%) Excellent (100.00%) Comments Points Earned Content 70.0% The Scope of Your Future Role as an Advanced Registered Nurse, Including Any Regulatory, Certification, or Accreditation Agencies That Define That Scope 20.0% A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is not included. A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is present, but it lacks detail or is incomplete. A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is present. A discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is clearly provided and well developed. A comprehensive discussion of the scope of the future role as an advanced registered nurse, including any regulatory, certification, or accreditation agencies that define that scope, is thoroughly developed with supporting details.
What this policy assignment requires
- 01An explanation of how the Feldstein cost-benefit statement affected repeal and replace efforts.
- 02An explanation of how such analyses affect legislative leaders' decisions on national policies.
- 03A completed Legislation Comparison Grid for a selected health-related bill.
- 04Coverage of legislative intent, proponents and opponents, target populations, current status and press coverage.
- 05A one to two page Legislation Testimony and Advocacy Statement.
- 06A response to the opposing position with specific examples, and at least one recommended amendment.
The analysis, the grid, then the testimony
What the statement does
Analyse the Feldstein cost-benefit framing and its contestable assumptions.
What the assessor is likely looking for
Assumptions identified rather than the conclusion accepted.
How analyses move legislators
Explain the use of economic analysis as political cover and agenda framing.
What the assessor is likely looking for
A mechanism of influence rather than a claim that evidence matters.
Selecting the bill
Choose a live bill and establish its intent and current status.
What the assessor is likely looking for
Status verified rather than assumed.
The comparison grid
Complete proponents, opponents, target populations and press coverage.
What the assessor is likely looking for
Named organisations on both sides.
The testimony
Write to the committee, state standing, and make one argument thoroughly.
What the assessor is likely looking for
Form appropriate to testimony rather than to an essay.
Answering the opposition and amending
State the opposing case fairly, answer it, and draft a specific amendment.
What the assessor is likely looking for
An amendment with concrete language behind it.
Where bill and policy analysis data sits
Recommended databases
- Congress.gov
- KFF
- American Nurses Association
- PubMed Central
Search sequence
- 1.Find a live bill and confirm its committee status before writing the grid.
- 2.Search registered support and opposition rather than inferring interests.
- 3.Read a policy analysis of the cost framing you are critiquing.
- 4.Look up the professional association's advocacy position for your testimony.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Legislative and Political Advocacy for Nurses
American Nurses Association · 2024
Professional advocacy structures, for the standing you claim in testimony.
Policy analysis of the legislation the Feldstein statement concerns.
Cost data, for testing the assumptions inside the cost-benefit framing.
Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda
Journal of Health Care for the Poor and Underserved · 2014
A worked example of policy creating a role, for the target population analysis.
State Practice Environment
American Association of Nurse Practitioners · 2024
State-level advocacy, for how proponents and opponents actually organise.
Before you submit
Common mistakes
- Treating a cost-benefit analysis as an objective calculation.
- Choosing a historical act rather than a bill currently in process.
- Naming abstract interests instead of actual organisations.
- Writing an essay rather than testimony addressed to a committee.
- Recommending an amendment too vague to be drafted.
Submission checklist
- Have you identified the contestable assumptions in the cost-benefit framing?
- Is your bill currently in process, with its status checked?
- Are proponents and opponents named as organisations?
- Is the testimony addressed to a committee with your standing stated?
- Could your amendment actually be drafted as written?
Use this guide to plan and review your own work. Follow your institution's rules and read Brinevia's academic-integrity policy.
Written by
Maren Caldwell
MSN, RN, CNE
Medical-surgical nursing, pharmacology and NCLEX preparation
Maren is a registered nurse with over 15 years of clinical and educational experience in medical-surgical nursing. She writes on NCLEX preparation, patient care fundamentals, pharmacology and evidence-based practice.
Reviewed by
Dr. Tessa Redmond
DNP, RN, CNE
Evidence-based practice and clinical education
Tessa is a doctorally-prepared nurse educator. She reviews Brinevia content for clinical accuracy and alignment with current evidence-based guidelines.