Even with public and business support growing, passage of health care reform was not guaranteed. Stakeholder mobilization against the ACA remained strong among anti-tax and antigovernment conservatives, older Americans who feared it would reduce their Medicare benefits, and parts of the health care industry. As a result, in designing the ACA, the Obama administration emphasized working within the existing health care system. To earn the support of hospitals, doctors, and insurance companies, the ACA included many millions in government subsidies for health care, all of which would eventually be paid to the health care industry. To assuage voters who opposed new taxes, the ACA would instead be funded by requiring individuals and employers to bear the costs of expanding coverage. To earn the vote of those who feared “creeping socialism,” the government abandoned the idea of a government-run insurance system (such as an expanded version of Medicare). Finally, to earn the support of the major pharmaceutical manufacturers, the government promised new regulations that would reduce competition from foreign drug manufacturers and manufacturers of generic drugs. Thus, the Obama administration chose, in essence, health insurance reform over health care reform
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