Voted as the Most Outstanding Mayor of the Philippines in 2002,[1] the town of San Fernando was transformed into a city under Aquino's reign through the ratification of Republic Act 8990.

While studying at UST, Aquino also garnered the leadership award for his ability to manage and organize events of great relevance to the university.

Aquino endeared himself there with the people of San Luis, and was instrumental in motivating the local townsfolk to help and contribute in the various community efforts that benefited the area (maintaining the cleanliness of the hospital, etc.).

As the elected president of the Kiwanis and Jaycee clubs, Aquino was chosen and appointed as an Officer in Charge or OIC councilor in 1987.

He was facing off against the then incumbent Mayor, Paterno “Pat” Guevarra, and other seasoned, better funded and more experienced politicians like Rosve Henson (his former running mate) and Mario Garcia.

On August 13, 2008, President Gloria Macapagal Arroyo picked Aquino to be the president and CEO of the Philippine Health Insurance Corporation (PhilHealth), a tax-exempt, government owned and controlled corporation (GOCC) of the Philippines, which is attached to the Department of Health.