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Ethics and the Affordable Care Act’s Conflicts

The full title of what is known as the Affordable Care Act is the Patient Protection and Affordable Care Act (PPACA) that was signed into law in 2010 and became effective in 2014 (Veccione, 2012). The major purpose of the Act seems not only to allow the citizens of the United States to access health care services easier but also to stay protected by the system from possible abuse (Sorrell, 2012). However, the Act has been criticized and recognized as the government’s attempt to take full control of the healthcare system and establish socialist legislation.

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In reality, the main requirement of the Act is that the vast majority of the legal US citizens have health insurance so that the services they receive are covered. The sources of such insurance can differ and involve programs such as Medicaid and Medicare, as well as private organizations and companies, individual employers, or state-based transactions (Sorrell, 2012). In addition, the Act also considers the cost of such insurance for American households, and if the latter exceeds 8% of the overall household income, the individuals of such households would be eligible for subsidized premiums. Practically, the governmental control of the healthcare system is not the purpose of the ACA; instead, the aim is to make health care more accessible, efficient, and cost-effective.

The primary goal of Obamacare/Trumpcare is to save costs of the national budget that are spent on the healthcare system and its resources; the latter goal is planned to be achieved via the enforcement of a set of mandates and regulations for the insurers, health care providers, and the state itself (Hsieh, 2014). In that way, prior to the introduction of the Affordable Care Act, doctors could potentially benefit financially from pushing unnecessary services and procedures due to having a financial interest with certain labs or cooperating which manufacturers of medical devices and equipment; today, when the ACA is active, medical practitioners are encouraged to undertreat their patients rather than overtreat them (Hsieh, 2014).

This is the case because the previous system that was based on fee for service type of payment has been replaced with what is known as the “bundled payments” – fixed sums of money that are given to hospitals and their staff per conditions despite the actual cost of the treatment; in that way, the hospitals are encouraged to spend less money on the treatments than the bundles provided by the government because in such situations the hospitals get to keep the excess (Hsieh, 2014).

However, all cases of conditions are different, and the question arises – what should be done in the cases when more resources and costs are needed in order to help a particular patient? Practically, in such situations, the patient would have to either find money to pay for the required additional services out of pocket or remain untreated (Waldman, 2013). This ethical conflict is particularly acute when the patient’s life is at stake.

Waldman (2013) mentioned several situations where doctors had no other choice but to seek ways to help their patients in a way that is unethical in regard to the government or the patients’ insurance companies. In that way, the author explained that the government’s strategy to save costs and standardize the US healthcare system enforced through Obamacare/Trumpcare and the Affordable Care Act places the medical practitioners in a very complex situation where they have to choose whether they should follow the rules and provide insufficient case and breach their ethical obligation to the patients or seek unethical measures helping them treat a patient but, at the same time, forcing them to stay in conflict with the law.

In addition, the obligatory health insurance for all the legal citizens of the US assumes access to healthcare to be a human right but not a privilege; as a result, the government is in the position of protecting and enforcing this right, as well as making sure that the basic access to health care services is given to every legal citizen (Sorrell, 2012). This aspect of the ACA presents another ethical concern that has been widely discussed in regard to the overall nature of healthcare services and whether or not they are a right, an option, or a good in the current system.

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When it comes to the responses of nurses and other health care professionals to the ethical conflicts posed by the Affordable Care Act aka Obamacare/Trumpcare, it is important to point out that taking into consideration the particular implementation of ACA is the major factor that dictates the role and actions of the practitioners. In particular, it is critical for the nurses to rectify all the potential situations that may result in injustice in health care (be it directed toward the patients or the professionals providing care).

Since the problem of resources and budgeting under the conditions of the ACA is very complicated and involves a wide range of medical professions, it is important for the nurses to ensure the support of the representatives of the other fields and disciplines for the purposes of strengthening their position in the negotiation (Sorrell, 2012). A combined effort and a multidisciplinary approach will provide a broader scope of opportunities for the professionals to address and solve the existing and emerging problems. Moreover, a collective effort is always better than an isolated attempt by a small group of professionals. Practically, the chance of success in a negotiation is higher when a larger and more diverse group of practitioners is included in the discussion.

In order for the negotiators to be able to put their point across in a clearer and more comprehendible manner, it is important that the nursing professionals rely on a certain theory and pick a single theme or aspect that will serve as the major focus of their perspective. For instance, the well-being of a patient is a very strong issue when it comes to the implementation of the ACA and the roles and opportunities of the nursing and other medical practitioners in this regard.

Social justice theory is the one that focuses on the well-being of the society in general, as well as separate individuals; this theory could be used as the framework for the negotiation, as well as an informed instruction according to which the professionals should behave and respond in complex ethical situations (Sorrell, 2012). In addition, it is also vital to provide a clear definition and description of the situations that are recognized by the nurses as social injustice in the field of healthcare and the factors that power and drive such situations. It is beneficial that nurses have a lot of daily experience with diverse healthcare setting situations from which they could draw multiple examples and illustrations of how such injustice could harm patients and practitioners.


Hsieh, P. (2014). How ObamaCare creates ethical conflicts for physicians and how patients can protect themselves.

Sorrell, J. (2012). Ethics: The Patient Protection and Affordable Care Act: Ethical perspectives in 21st century health care. OJIN: The Online Journal of Issues in Nursing, 18(1).

Veccione, A. (2012). Debating the ethical implications of the affordable care act. Web.

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Waldman, D. (2013). Medical ethics and Obamacare.

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