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History of the Affordable Care Act and Ethics


The Affordable Care Act (ACA), also known as Obamacare, was adopted in 2010, and the purpose of the law was to provide proper health care services to more people in the United States who had been deprived of access to such services. Although the legislation was approved by many health care providers and the public, there is also much criticism, particularly in terms of ethics (Haislmaier, 2013; Hsieh, 2014). Barack Obama’s successor Donald Trump proposed modifications to the health care legislation, and the proposal was criticized from the ethical perspective, too (Thompson, 2017). Critics have claimed that Obamacare creates conflicts of interest and moral dilemmas, and Trumpcare violates fundamental principles of medical ethics.

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Obamacare: Conflicts of Interest

First of all, the conflict of interest created by Obamacare is among health care facility administrators, physicians, and patients, and a major threat associated with it is undertreatment (Hsieh, 2014). The law provides for the bundled payments system, in which hospitals receive a fixed amount of money for treating a certain condition. In case health care providers do not manage to provide adequate and sufficient treatment within the bundle’s limitations, additional costs will be defrayed by the facility.

But if treatment is provided for less than the bundle, the facility can keep the rest. This system is likely to create the risk that physicians will be undertreating patients, e.g. by using cheaper drugs or shorter interventions, because they will be interested in saving up the excess from the bundled payments.

Obamacare: Moral Dilemmas

Second, it has been argued that Obamacare poses ethical dilemmas for employers. The legislation strengthens the federal control over health care coverage requirements, and the dilemma that employers may face is associated with “morally-questionable procedures” (Haislmaier, 2013, para. 8).

Such procedures are connected to contraception, sterilization, and abortion; many people in the United States think that public money should not be spent on these aspects of medical care, and there are other questionable aspects, e.g. sex-change treatments or embryonic stem cell-related therapies. Employers who are unwilling to cover procedures associated with contraception and reproduction can be penalized according to Obamacare, which critics think is unfair and propose to “add a conscience exemption” (Haislmaier, 2013, para. 10) to the legislation.

Trumpcare: Medical Ethics

Finally, the opposition to Trumpcare was manifested in the claims made by the American Medical Association (AMA), which stressed that the proposed legislation would violate the fundamental principle to do no harm (Thompson, 2017). According to the AMA, the proposal imposes limitations on the federal obligation to provide proper health care services to anyone who is in need of them. A particular part of the draft that attracted criticism was the one that prohibits patients from using their coverage at Planned Parenthood (or any other organizations that offer abortion services). The AMA claims that this provision violates patient autonomy and freedom of choice.


Critics have questioned Obamacare and Trumpcare and referred to the legislations’ incompliance with major ethical principles. Obamacare creates the threat of conflicts of interest, in which physicians may opt for undertreating their patients, and moral dilemmas, in which employers are compelled to cover health care costs that they find morally inappropriate. Trumpcare can create barriers to the provision of health care to needy patients and limits the areas in which coverage can be used. Identified conflicts should be addressed by policymakers to ensure that the health care reform will not prevent practitioners from acting ethically in their practice.

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Haislmaier, E. (2013). ObamaCare creates moral dilemma. Web.

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

Thompson, A. (2017). The nation’s largest medical group opposes Trumpcare. Web.

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