Every major reform has its strengths and weaknesses, particularly when it comes to health care. The Affordable Care Act (ACA), also known as Obamacare or Trumpcare, was first initiated in 2012. Even though the Act was aimed at improving access to health care for underprivileged populations, it raised several ethical issues. This paper seeks to identify and discuss the ethical conflicts brought by the ACA.
There are two key principles of the ACA. First of all, under the Act, provider reimbursement is partly based on the quality of service provided and the patient experience of care (Lachman, 2012). Secondly, the ACA requires information about service quality and patient experience to be publicly accessible (Lanchman, 2012). On the one hand, these provisions might help to improve the overall service quality. However, on the other hand, the accessibility of information could pose risks to patients’ privacy and confidentiality. Moreover, the ACA also provided for the creation and maintenance of electronic medical records, which requires considerable resources, as well as assurance of informed consent and confidentiality (Lanchman, 2012).
Another ethical challenge brought by the ACA is the need for evidence-based practice. Although evidence-based could ensure a high quality of care, standardizing health care could have its drawbacks. For example, Pariser (2012) argues that there is a significant degree of variability in the disease process and development, which means that a standardized approach might not benefit all patients equally. Furthermore, the change in the physician payment system under the ACA might cause hospitals or medical practitioners to withhold care from clients, which would impair the overall quality of treatment provided (Pariser, 2012). Under the ACA, physicians are ranked by their costs; therefore, physicians could opt for low-cost treatment options and avoid referring the patient for further examination or treatment, as this would mean an increase in the service cost (Pariser, 2012).
There are also other practical concerns related to the healthcare environment in the United States. For example, there is an increasing shortage of nurses and physicians in the U.S., which creates an ethical challenge in the context of the ACA. By improving access to care, the Act also increases the demand for medical services. However, due to the shortage of medical professionals, the availability of care might be limited; moreover, the increased demand might put additional pressure on nurses and doctors, which could lead to stress and burnout.
Therefore, as noted by Field (2015), ” the ACA does not guarantee access to care; it merely enhances access to coverage to pay for it” (p. 668). Moreover, the ACA does not consider other barriers that might prevent access to health care, including geographical distance, reduced mobility, and more (Field, 2015). Finally, according to Pariser (2012), the Act marginalizes certain diseases that, though not life-threatening, might impair the quality of patients’ life. For instance, dermatological conditions, such as acne, psoriasis, and atopic dermatitis, are usually not included in the insurance coverage, which prevents many patients from treating them successfully.
Overall, the ACA provides many benefits to the underprivileged populations of the U.S. by improving access to insurance. However, many ethical challenges have to be overcome to ensure comprehensive and consistent availability of medical services. In particular, it is crucial for the government to address the increasing shortage of physicians and to improve coverage of conditions and diseases that impair patients’ quality of life.
Field, R. I. (2015). The ethics of expanding health coverage through the private market. AMA Journal of Ethics, 17(7), 665-671.
Lachman, V. D. (2012). Ethical challenges in the era of health care reform. MedSurg Nursing, 21(4), 248-251.
Pariser, D. M. (2012). Ethical considerations in health care reform: Pros and cons of the affordable care act. Clinics in Dermatology, 30(2), 151-155.