The PPACA (Patient Protection and Affordable Care Act) was proposed by the United States Congress and sanctioned in the year 2010 by Barack Obama, the former U.S president (Cantor & Monheit, 2016). The key provisions of the Affordable Care Act took effect in the year 2014. By the year 2016, the rate of the uninsured population in the United States reduced significantly. Approximately twenty to twenty-four million individuals had a health insurance coverage during the year 2016 (Gaffney & McCormick, 2017). The significant increase in insurance coverage was attributed to the expanded Medicaid eligibility and the primary transitions in the individual insurance marketplace. Various reports from the Congressional Budget Office indicated a significant reduction in the budget deficit and thus, rescinding the PPACA would cause a significant increase to the budget deficit. The reports also indicated that the ACA regulations brought about a significant decrease in income inequality in the sense that through imposing a one percent tax on high-income earners, the government was able to generate an average of approximately six-hundred dollars in benefits to fund families at the bottom of the income distribution chart; this amounts to approximately forty percent (Gaffney & McCormick, 2017). The regulation also brought about the delivery system reforms aimed at constraining the costs of health care and improving the overall quality of healthcare.
Ethical Challenges in an Era where Obama care/Trump care and or Healthcare Reforms Dominate
There are various ethical disputes associated with the Affordable Care Act. First, the Affordable Care Act has significantly increased the health insurance cost for many Americans. The Obama Care was aimed at accommodating low-income households in the insurance marketplace. Low-income households would receive government subsidies to enhance the affordability of the health insurance program. However, the subsidies were not rendered available for high-income households. The regulation demands the coverage of an extensive range of benefits and services, and this generally means that the health insurance program has to be generic as opposed to addressing individualized needs and this subsequently causes premiums to increase rapidly over time. Secondly, the ACA requires every individual to purchase a health insurance plan. A fine is often imposed on individuals who fail to oblige to the ACA provisions. Thirdly, the Affordable Care Act has been associated with additional taxes. The ACA also imposes additional taxes on pharmaceutical sales and medical devices. A significant tax increase was also imposed on high-income earners.
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Conflicts that exist between Ethics and Health Care Reform due to the implementation of the ACA
The PPACA has been associated with various ethical conflicts since its implementation, especially among the healthcare providers. The Obama care’s healthcare reforms present certain conflicting ethical positions amid the proposed health care reforms and professional ethics. Some of the ethical conflicts due to the implementation of the ACA include the issue of the inadequate training of various healthcare providers. The effective delivery of end-of-life care and the procedure of engaging in distressing conversations are subjects that are normally disregarded in medical education. The standard pedagogic methodology of "see one, teach one, do one" applied in various medical instructions is usually neglected in end-of-life care and therefore, numerous surgical and medical residents receive insufficient preparations for these duties and this subsequently impacts their capacity to deliver quality care to their respective patients. Research involving 296 medical residents, 1456 medical students, and 290 faculties affiliated with sixty-two accredited medical institutions in the U.S revealed that approximately eighteen percent of medical residents and students acquired formal training in providing end-of-life care (Frazier, 2016). The study also revealed that more than forty percent of the medical residents felt unprepared to train young clinicians on end-of-life care.
A sequential study involving 284 internal medicine residents in two university-based programs and one community-based program indicated that only four percent of the residents acquired useful feedback regarding a senior resident’s conversation with patients and their respective families (Frazier, 2016). Seven percent of the residents obtained positive feedback from patients in sessions with the attending physicians. Inadequate training generates an unsafe working environment, and it is associated with poor performance and hence poor quality of service. Another ethical conflict due to the ACA is the inadequate compensation of healthcare providers. Physicians who attend to patients with severe illnesses are usually driven by the selfless need to ease the patients' suffering. Howbeit, for many, selflessness ultimately confronts financial actualities. The continued difference in compensation amid physicians who use significant amounts of their time to converse with patients and their respective families and those who spend a significant amount of their time in performing medical procedure may impact the number of professionals in that field. The resource-based relative value scale of Medicare remunerates physicians highly for various invasive procedures (work per minute) as opposed to management and evaluation procedures. Management and evaluation procedures incorporate the extensive dialogues with patients and families, and it is a duty that ought to be performed by physicians who offer end-of-life care. Studies reveal that the differences in compensation amid physicians may lead to reduced job satisfaction rates and this, in turn, causes high turnover rates leading to the lack of skilled workforce in that particular field, low overall morale by employees, and the low levels of employee productivity which subsequently impact the provision of quality services (Martinez et al ., 2017).
Thirdly, the inadequate investment in various healthcare technologies required to enhance the efficiency of healthcare services poses a significant ethical issue. The lack of adequate technologies to enhance service provision impacts the quality of services offered by a particular health institution, the number of patients being attended to in a day, and the efficiency of the services provided. Lastly, the understaffing of employees (healthcare providers) by the government possess a significant challenge in the attainment of the ACA’s objectives (Larkin et al ., 2016). The understaffing of primary care providers such as medical providers, pharmacy technicians, diagnostic technicians, dental assistants, and data recorders is a common ethical issue in the United States.
The increasingly aging and terminally ill populace require an increased pool of healthcare providers to meet their complex needs. Short-staffing has a significant impact on the level of employee productivity and this, in turn, impacts the quality of services offered to patients. Service quality is likely to suffer in instances where few healthcare workers are available to attend to a huge number of patients. These practitioners may be forced to work faster to manage a high volume of patients, and this leads to an increase in errors during practice. Understaffing also inflicts an increased level of stress among health care providers by making them responsible for an extensive amount of work. An increased workload always inflicts significant levels of stress on an employee as he strives to complete his assigned duties on time and to attain the performance expectations of the organization. Increased stress decreases an employee’s morale, his job satisfaction rate, and it impacts negatively on the overall quality of service (Larkin et al ., 2016).
How Nurses should negotiate such Conflicts and how Nurses Historically addressed the issue of Ethics in their Profession
Nurses should advocate for the nurse practitioners’ full practice leverage. The ACA’s implementation allowed over thirty-million individuals to access services provided by primary care providers. According to the current patterns of consumption, the demand for primary care practitioners is expected to increase rapidly when compared to the physician supply (Frazier, 2016). This particular imbalance will probably worsen due to the growing population of the aging individuals who in turn, require healthcare resources.
Additionally, more patients demand the provision of critical services in healthcare. The current number of physicians is incapable of keeping up with this increased need for health care services. Constraints imposed on resident physicians' hours of practice have also affected inpatient care. The reevaluation of the outdated laws on state practice and the sanctioning of Nurse Practitioners' FPA (Full Practice Authority) is, therefore, needed to improve health care access and create high flexibility levels in the establishment of patient-centered medical homes and other healthcare delivery models. The sanctioning of Prescriptive Authority and Full Practice Authority proposals will enable nurse practitioners to be highly effective and efficient in the delivery of primary care services. Secondly, nurses should advocate for the proper staffing of health practitioners and the adequate training of individuals in the profession. Effective staffing will allow the optimum utilization of human resources, improve employee morale and job satisfaction, the hiring of competent personnel, and it will increase the overall productivity of healthcare practitioners and improve the quality of services provided (Cantor & Monheit, 2016). The proper training of healthcare practitioners will enhance greater productivity and the provision of quality healthcare services. Nurses should also advocate for the sufficient funding of various training procedures in the profession to improve competency. Lastly, they should support for the improvement of technologies provided across multiple healthcare institutions. Historically, nurses handled various ethical conflicts in the profession by reviewing the legislated professional code of ethics.
What Happens to Patients who still do not have Insurance?
Under the ACA (Affordable Care Act), one is obliged to be under a particular insurance plan (Martinez et al ., 217). If one is in a position to pay for a health insurance program but opts not to purchase it, one will face the fines inflicted under the Affordable Care Act. The penalty is commonly referred to as the Individual Shared Responsibility Payment or the Individual Mandate. The imposed fine is usually due when one files one’s taxes. For instance, for the 2017 tax year, one will incur a 2.5 percent tax imposition of one’s aggregate household gross income (Martinez et al ., 217).
In conclusion, the Affordable Care Act was sanctioned with the objective of significantly reducing the costs of health care and extending insurance coverage to numerous citizens of the United States. However, since its enactment, it has been associated with various ethical challenges. Some of the challenges include the insufficient training of healthcare practitioners, the under-staffing of healthcare practitioners, and the insufficient compensation of certain health practitioners. To address these challenges, nurses should advocate for the sanctioning of the Full Practice Authority, the sufficient training of practitioners, and the proper staffing of practitioners within the health care system.
References
Cantor, J. C., & Monheit, A. C. (2016). Reform of the individual insurance market in New Jersey: Lessons for the Affordable Care Act . Journal of Health Politics, Policy & Law , 41(4), 781–801.
Frazier, L. A. (2016). More than the Affordable Care Act: Topics and themes in Health Policy Research. Policy Studies Journal , 44, S70–S97.
Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity. Lancet , 389(10077), 1442–1452.
Larkin, D. J., Swanson, R. C., Fuller, S., & Cortese, D. A. (2016). The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform. Journal of Evaluation in Clinical Practice , 22(1), 133–140.
Martinez-Hume, A., Baker, A., Bell, H., Montemayor, I., Elwell, K., Hunt, L., Hunt, L. M. (2017). “They treat you a different way:” Public insurance, stigma, and the challenge to quality health care. Culture, Medicine & Psychiatry , 41(1), 161–180.
Skinner, D. (2016). The politics of Native American Health Care and the Affordable Care Act. Journal of Health Politics, Policy & Law , 41(1), 41–71.
