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Healthcare Reform and Ethics in Nursing Viewpoint


The recent healthcare reforms, including the Affordable Care Act that was passed during Obama’s presidency and the Trump administration’s subsequent attempts to repeal it, concerned themselves with the availability of health insurance as well as the federal costs of healthcare. The policies have been the subject of significant amounts of criticism related to their financial and ethical implications. This essay explores the role of nurses in the negotiation of ethical conflicts in the past and present, as well as the treatment of patients who do not have insurance.

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The Effects of the Reforms

The Affordable Care Act, also known as Obamacare, was passed in 2010. According to Manchikanti, Helm, Benyamin, and Hirsch (2017), its primary purposes were the increase in the number of insured citizens, the improvement in the quality of care, and the reduction of its costs. It has succeeded at the first of its aims, as over 20 million previously uninsured people have received coverage due to the enactment of the law.

However, the positive consequences of the new policy were accompanied by adverse outcomes. Manchikanti et al. (2017) state that approximately 6 million people ended up losing their health insurance because of the Affordable Care Act. Furthermore, they claim that it has not worked well for the middle and working-class and that the other two goals of the program have not been met at best and ended up being affected negatively at worst. According to Manchikanti et al. (2017), the costs of maintaining a practice have increased, and the number of independent practitioners has declined.

President Trump’s administration has attempted to partially or entirely repeal the Affordable Care Act. According to Saltzman and Eibner (2016), the effects of the proposal would have led to a decrease of 15 to 25 million in the number of insured citizens. Furthermore, it would considerably increase the out-of-pocket medical costs for individuals enrolled in individual market coverage, significantly limiting access to health care as a result. For now, however, the Affordable Care Act is still used in full.

The History of Conflicts in Nursing

According to D’Antonio, Fairman, and Whelan (2010), the citizens of America have identified nursing as the most ethical profession in recent years. This recognition stems from the image of the trade that has been shaped by the efforts of nurses to resolve ethical conflicts in the past as well as the present. Nurses have often been the drivers of moral progress, even as the profession was met with disregard and had to struggle with various issues.

The American occupation of the Philippines that began in 1898 serves as a good example. The United States held the territory by force, suppressing armed uprisings and leaving a generally negative impression on the population. However, D’Antonio et al. (2010) state that “even staunchly nationalist Filipino historians recount the US public health campaigns in the Philippines without any critique whatsoever” (p. 17). The nurses who worked in the program came into direct contact with the natives, administered care, trained local nurses, and left a positive impression.

Nurses also significantly affected the methods of waging war, enabling the administration of professional care on the battlefield and decreasing the mortality rates. War is dangerous and fundamentally unethical, but according to D’Antonio et al. (2010), Florence Nightingale set a new standard for wartime nursing, changing the perception of battlefield hospitals as disreputable places that were not for respectable people. As a consequence, the influence of nurses both in the army and among the civilian population increased, leading to the recognition of nursing as a vital profession.

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The Role of Nurses in Conflict Negotiation

Both the Affordable Care Act and the attempts to repeal it result in ethical conflicts because they limit access to healthcare or negatively affect the quality of treatment and medical costs. Furthermore, they create a financial gap in the availability of healthcare that leads to inequality. Although nurses cannot individually exert significant influence on the large-scale effects of these policies, they may be able to influence the situation through patient advocacy.

According to Ronnenbaum and Schmer (2015), patient advocacy includes informing patients about healthcare options, various procedures, and the goals of care. As patients are often unfamiliar with the structure of healthcare and do not know which treatments are necessary, an explanation can help them choose the optimal treatment plan and receive high-quality care without inflicting unnecessary costs on themselves. Furthermore, it may address patient concerns such as medical mistrust of health illiteracy, which would lead to improved outcomes.

Ronnenbaum and Schmer (2015) claim that the concept of patient advocacy is underdeveloped and has significant gaps. They point out issues such as the lack of a professional definition, inadequate advocacy measuring tools, and cultural unawareness. The relationship between patients and healthcare institutions should be one of trust, which is achieved through attention to the patient’s personal and cultural needs as well as clear communication and mutual acknowledgment.

Treatment of Uninsured Patients

Patients who come to the hospital without health insurance but can pay for the necessary procedures should be treated in the same fashion as insured patients, as there is functionally no difference between the two types. However, uninsured people often cannot afford treatment, and hospitals are not required to provide non-lifesaving care to such patients. Nevertheless, nurses can assist them via the medium of patient advocacy.

A nurse may be able to inform a patient that cannot afford the necessary procedures about health assistance programs that may be available in the area. Such programs are often explicitly targeted at uninsured people to provide them with critical financial assistance. A nurse should be able to suggest the most appropriate organizations for the patient’s issue after some research and refer them to that program, allowing them to receive care.

If there are no appropriate programs, the nurse should look for non-financial sources of help for uninsured citizens. They may refer the patient to a community health clinic or a direct primary care provider, which generally tend to offer lower prices, the same standard of care, and programs specifically for people who do not have insurance. It may also be possible to work out a payment plan for the original bill if the total sum is too much for the patient.


Historically, nurses have earned nation-wide acclaim for their efforts in the resolution of ethical conflicts. They can continue the trend in light of the recent healthcare reforms through implementing patient advocacy. The policy helps establish a relationship of trust between health care institutions and their patients and ensures a high standard of care. It also allows the nurse to assist patients who are not covered by insurance despite the Affordable Care Act.

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D’Antonio, P., Fairman, J. A., & Whelan, J. C. (2013). Routledge handbook on the global history of nursing. London, Great Britain: Routledge.

Manchikanti, L., Helm, S. II, Benyamin, R. M., & Hirsch, J. A. (2017). A critical analysis of Obamacare: Affordable care or insurance for many and coverage for few? Pain Physician, 20(3), 111-138.

Ronnebaum, E. D., & Schmer, C. (2015). Patient advocacy and the affordable care act: The growing need for nurses to be culturally aware. Open Journal of Nursing, 5, 237-245.

Saltzman, E., & Eibner, C. (2016). Donald Trump’s health care reform proposals: Anticipated effects on insurance coverage, out-of-pocket costs, and the federal deficit. Web.

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