The Top 5 Ethical Issues in Healthcare

Abstract 

Healthcare is one of the major causes of controversy in the US political sphere. One of the concerns is why despite the federal government extensive spending millions of people are still unable to receive the appropriate treatment. The Affordable Care Act of 2010 was introduced as a step in the right direction to achieve universal healthcare for American citizens. However, a closer look at the enforced law shows that it has numerous flaws. The following paper is intended to focus on the ethical healthcare concerns that are depicted in the implementation of the ACA as identified by the critics. It is also important to identify how the principles that were used in developing it and the appropriate practices required ensuring an ethical and effective law that serves the needs of its people. These issues will help identify the negative effects that arose following the enactment of the law as it is applied to the multiple demographics. In this discussion, the intention is to show the importance of setting up reforms that will help improve the current law while achieving the same idealized purpose. 

Introduction 

The Affordable Care Act is depicted as one of the major reforms made during the Obama administration. It is a celebrated mark on the first term of Barrack Obama’s first term as president of the US. For this reason, it is identified as Obamacare, which was first used by opponents before being reappropriated by supporters and even the president himself. It is depicted as the largest expansion in coverage of care since the passage of Medicare and Medicaid in 1965. The majority of the provisions of the ACA came into force in 2014 and before 2016 the number of uninsured persons in the country was reduced by half. Approximately 20 to 24 million additional persons registered for coverage during that year. The primary factors for this reduction in uninsured persons are increased Medicaid expansion and significant changes made in individual insurance markets. Nevertheless, the Affordable Care Act has received significant backlash on its ethical issues associated with the enforcement of the law. The following will discuss a range of ethical concerns and principles associated with the health reforms enacted in 2010. 

Ethical Concerns 

There are various ethical concerns that scholars and opponents of the healthcare reform that have been raised upon the enactment of the Affordable Care Act. It is evident that the Obamacare reforms were created with the best intention of improving coverage for individuals while enforcing provisions that would increase the number of people eligible for coverage. The ethical concerns of this law look into the sources of funding and the availability of healthcare services along with its quality. One of the major ethical concerns of the ACA is the belief that it is a direct violation of Article 1, Section8, Clause 3 of the US Constitution. “ Congress shall have the Power To lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common Defence and the general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States ” (Lachman, 2012). In this regard, the implementation of the provisions of the ACA reform forces all citizens to purchase a good or service to avoid penalties from the federal government. On the other hand, this is depicted as government-mandated and government-run programs that require taxation of the people so as not burden the moral community for those with costs for those who do not pay insurance coverage (Lachman, 2012). 

Another major concern of the Affordable Care Act is that expanding the availability of healthcare provided by government based institution to adults under the age of 65 and private healthcare for young adults will significantly increase the costs incurred by insurance companies and tax payers. In this practice, the members of the community have been opposed to this practice as it significantly increases the cost of premiums for the working class. Many of these members question whether the move by the government is ethical as it imposes costs that do not reflect the output received. In this regard, opponents for this bill will feel that the law unfairly treats them by charging more so as to cover individuals who are poor. However, as presented in the above instance it is clear that healthcare is a basic need during the lifetime of the individual. Therefore, the economic status of an individual should not be a factor to deny a person care. In this regard, the practice of the moral community helps ensure all can be covered. Insurance companies will also feel hard done by the law as it requires them to cover pre-existing conditions while a cap is set to prevent overcharging of such patients. This will mean that the organizations will suffer significant financial setbacks through the implementation of such practices. 

Another concern is that the increased availability of insurance coverage of individuals is likely to increase number of people who were previously uninsured to seek treatment that they could not afford (Hernandez-Boussard, Burns, Wang, Baker, & Goldstein, 2015). In this practice, it is evident that the number of people that will be visiting the emergency department and other healthcare department visits could experience a sudden influx. The effect could cause a significant decline in the quality of the care provided (Hernandez-Boussard et al., 2015). In the occurrence of such an influx, the healthcare providers may feel rushed or experience overcrowding of the infrastructure leading to delays in delivery of care to the patients acutely injured (Hernandez-Boussard et al., 2015). The ACA is seen us unethical as it requires that the institutions enforce measures that will lead to high quality care despite the experienced influx. 

The ACA has raised ethical concerns in the coverage of care primarily due to the insurance cover and private practice providers. The latter are more likely to show hesitance in the acceptance of coverage provided by the act as there are preset payment and reimbursement limits set by insurance companies. In this practice, there are two possible outcomes in the delivery of care. On the one hand, the private practice providers may seek to sustain the financial burden that has been encountered to ensure the highest quality of care to its patients. On the other hand, the organization may identify the need to maintain good financial health and send away patients who need critical assistance. In the latter case, the quality of care for the patients is likely to decrease. 

Ethical Principles of the ACA 

It is evident that the creation and establishment of the ACA has been primarily on a set of ethical principles to achieve the best possible outcomes. One of the major principles for this law has been to respect autonomy in terms of providing insurance, guidance, and choices. In this case, all Americans are given the opportunity to utilize a healthcare system designed to achieve positive results. In this case, one has the opportunity of making intelligent choices of seeking care through the guidance provided. Furthermore, the American citizens are likely to receive good coverage as the insurers should accept applicants at rates that are affordable based on population averages. 

Another important ethical principle that is a major foundation of the affordable care act is nonmaleficence. This is described as the ability to do no harm. In this case, it is depicted that the health reform has been set in place as an effective measure of ensuring that all members of the community have the appropriate coverage and accessibility to health services. Prior to the enforcement of the law, it was evident that millions of people in the US society were without health insurance hence at risk of suffering high costs of care. In the aftermath of the implementation of Obamacare, it was evident that many members of the community are now covered and capable of receiving basic care hence the law does not harm them. 

The Affordable Care Act is depicted to be based on the principle of benefitting others. There are a host of essential health benefits that are guaranteed by law that spread across ten categories. Some of them include doctors’ services, mental health services, prescription drug coverage, inpatient and outpatient care, pregnancy and childbirth, and more services. In this regard, it is evident that the health reform is a clear beneficiary for general population. In particular, those who previously did not have coverage are set to benefit from this law as they drastically increase the healthcare services they are set to receive. 

The practices of the ACA are set on the ethical principle of justices. In this case, the aspect of achieving high quality care rests on the shared responsibility of its members. In this practice, all American citizens who are believed to have the capability of paying significant premiums are required by law to make payments that will lead to the government provided healthcare. The individual shared responsibility payment is a basic measure of ensuring that the government does not subsidize the care provided to the people in need. It is evident that all members will not suffer the risks covered at the same time allowing for increased coverage of individuals. 

Finally, the ACA is based on the ethical principle of fidelity whereby it presents to the people as it has promised. The Obamacare reform sought to increase the number of people who have insurance cover so as to possible achieve universal healthcare. The number of people who enrolled for the program reached 10.4 within the first year of its implementation. The institution of the law was able to achieve significant records in its coverage of American citizens by 2016 as it reduced the uninsured persons by nearly half. In this regard, the provision of this law is seen as faithful as it delivered what it promised to the people. 

Best Practices for Achieving Effective health Reforms 

The organization and enforcement of the health reform identifies the importance of ensuring best practices in the delivery of care. In this case, commercial or professional procedures will incorporate these measures as they are either accepted or prescribed as the most effective or appropriate in delivery of quality and affordable care. One of the most important “best practices” is improving care delivery. In this case, the plans for healthcare reform should look towards rewarding physicians and medical practitioners who keep their patients well and manage chronic illnesses in healthier results (Lichtenstein, 2012). This practice is more likely to reduce the cost of spending and ensure high levels of coverage. Blue Cross and Blue Shield insurance companies have enforced such practices in their insurance plans that will greatly benefit the respective individuals covered (Lichtenstein, 2012). High quality care will guarantee reduced hospital visits which translate to lower premiums that are offered by the private institutions. 

It is noted that to achieve a good healthcare reform it is essential that members of the society who benefit from it are provided with power to achieve good health. In this regard, the primary measure of any healthcare reform is to bring about a culture that empowers customers to pursue the quest for achieving good health (Lichtenstein, 2012). This practice will avoid instances of patients being reliant on the system that does it for them. For instance, patients will have tools to make smart and intelligent choices about their health as they find good doctors, the best hospitals for receiving treatment, and the costs of care received. This practice has been a basic factor in the ACA reforms as it enables applicants to take an active role in ensuring they can achieve improved care (Lichtenstein, 2012). Through the practice, members of the society are aware of the areas or sources of quality care and will make an effort to seek treatment from these institutions. 

In the quest to achieve quality care, insurance customers seek health plans that are tailored to their particular needs and those that are affordable. In this regard, offering the better value to the customer is the most important factor in the delivery of health reforms. The Affordable Care Act should have the ability of providing the citizens with rates that are better off that those provided by private insurance companies. The Blues companies boast the most extensive provider networks, the largest claims database in the country, a great understanding to appropriate approaches to care coordination, and a history of performing cost-effectiveness research (Lichtenstein, 2012). In this regard, such corporations pose a major threat to the government’s ability to ensure competitive rates. Blue Shield and Blue Cross have the reach, flexibility, information, and expertise to realize such outcomes making it one of the major competitors of the ACA reforms (Lichtenstein, 2012). 

Negative Impacts of the ACA 

The brief preview of the ACA will show that children and youth will special needs are likely to benefit from these health reforms. However, there are many disadvantages that exist in the implementation of this practice to this particular demographic. It is evident that there were private employer-based insurance covers that were present before the enactment of the ACA. The ACA identifies them as grandfathered and exempt from particular provisions of the law. In this regard, they prevent effective enforcement and possibility of achieving continuous, universal, affordable, and adequate care. Another critical issue presented by this health reform practice is the lack of issuing the definition of the ten essential benefits as part of the law. In this practice, states along with their insurance plans define what will be considered as essential benefits. This practice is detrimental to the enforcement of the ACA reforms as they incorporate the use of the previous market standards and oppose the clinical best practice guidelines. The ACA also authorized the Children’s Health Insurance Plan (CHIP) to run until 2019 before being incorporated into market plans offered by private sectors and exchanges. It will mainly affect poor and nearly poor children who are not eligible for Medicaid. In this regard, it will adversely affect the programs intended for special needs children and youth. 

The ACA has been depicted to have a negative impact in the emergency department usage. Research has shown that the ethical concerns of a possible influx in the healthcare institutions are indeed true according to records collected from Florida, California, and New York between 2009 and 2011. It is evident that the population ages group of 26-31 years experienced a significant increase in ED visit rates not because of trauma related injuries but illness-related diagnoses (Hernandez-Boussard et al., 2015). The increase is seen to be a result of the lack of private insurance. In this incidence, the uninsured patients and beneficiaries of Medicaid were the most likely to experience a significant rise in ED visits as opposed to those with private insurance (Feldman, Buysse, Hubner, Huffman, & Loe, 2015). The ACA also increased a special provision in the care coverage where young adults 19-25 years are capable of retaining coverage under their parents’ employer-sponsored care or individual purchased health insurance plans (Hernandez-Boussard et al., 2015). This practice was intended to increase private insurance coverage that may influence the use of care services available. 

Another major concern in the ACA law is the impact it has on employers. The impact of the law on businesses largely depends on the competitive landscape, strategy of compensation, and characteristics of the workforce (Feldman et al., 2015). According to the reform, employers must provide healthcare benefits for all full-time workers but not the part-time workers. As a result, the organizations should ensure that the latter employees retain their status or risk penalties from the government. The businesses are significantly affected in their ability to recruit workers based on the compensation and benefit packages provided. 

Conclusion 

From the above report, it is evident that the while the Affordable Care Act of 2010 was drawn up with the best intentions, its implementation has created negative effects. The numerous implications of the ACA have led to concerns on the ethical standing of the law in terms of its treatment of the people. In this case, it is evident that the law becomes the first federal law to force citizens to take up medical cover or risk penalties or charges for any violations. While according to the constitution, the foundation of the law is intact, it is seen as a violation of human treatment. Individuals who do not wish to utilize the government sponsored healthcare should not be required to pay the premiums. This is one of the various ways in which the ACA fails to uphold an ethical standing in its implementation. It is important that the current administration develops significant measures that will help improve the law while maintaining its positive view on the treatment of the community members. 

References 

Feldman, H. M., Buysse, C. A., Hubner, L. M., Huffman, L. C., & Loe, I. M. (2015). Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. Journal of Developmental and Behavioral Pediatrics, 36 (3), 207-217. 

Goodman, J. (2015) Six Problems With The ACA That Aren't Going Away . Health Affairs, Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20150625.048781/full/ 

Hernandez-Boussard, T., Burns, C., Wang, N., Baker, L. & Goldstein, B. (2015). The affordable care act reduces emergency department use by young adults: Evidence from three states. Health Affairs (Millwood), 33 (9), 1648-1654. 

Lachman, V. (2012). Ethical Challenges in the Era Of Health Care Reform. Medsurg Nursing, 21 (4), 248-251. 

Lichtenstein, M. (2012) Best practices for transforming healthcare . Blue Cross Blue Shield, Retrieved from https://www.bcbs.com/the-health-of-america/articles/best-practices-transforming-healthcare