Introduction
The policy under analysis is Section 1557 of the Patient Protection and Affordable Care Act (ACA). It has been in effect since the ACA was enacted in 2010; thus, its legality is directly related to the status of the chosen regulation. The Act represents a solid and, more importantly, the legal basis for human rights and health care. However, during the last several years, some political parties (Trump Administration) challenged the existence of this particular law. For example, in 2021, the Supreme Court had to face the necessity of examining the constitutionality of the ACA (Keith, 2021). The case California v. Texas ended with the decision not to change the law due to no apparent injuries or threats (Keith, 2021). Therefore, the goals of Section 1557, as well as those of the ACA, are legal in terms of protection against discrimination in health programs.
Just and Democratic Characteristics of the Policy’s Goals
Promoting just and democratic health care is one of the major goals of the US government. For example, the representatives of the United States Agency for International Development (USAID) continue enhancing democratic governance and human rights to remove rampant corruption and disinformation and support just and stable conditions for the population (Democracy, Human Rights, and Governance, 2021). Similar elements can be found in Section 1557, which aims to prohibit discrimination on race, gender, national origin, and disability and use clear information to support American citizens. This comparison helps explain the goals of the policy in the context of democracy and justice. Section 1557 is based on democratic responsiveness for people of all races and classes regardless of the existing controversies between public and political opinions (Pacheco et al., 2020). American society needs to believe that the color of their skin or gender will not affect their care and the desire to receive high-quality services, and the policy gives the required guarantees.
The Policy’s Contributions to Human Rights and Social/Economic Justice
Addressing the issues of human rights and social or economic justice, most Americans cannot get rid of the idea that most of them live in poverty. The facts like 16% of children, 25% of disabled, 20% of Blacks, and 17% of Hispanics who are below the poverty line cannot be ignored (Pierson, 2019). As a result, multiple attempts to struggle against social and economic inequality are made to organize fair interpersonal relationships and services. The goals of Section 1557 cover the importance of equal treatment to the representatives of all minority groups, which contributes to the protection of fundamental human rights and the creation of a secure and stable environment. The number of uninsured citizens in the country will definitely increase without Section 1557, provoking new economic burdens. The policy helps people of all races and genders use preventive services and cooperate with healthcare providers without thinking about their financial problems at the moment when their health is damaged. Such contributions to human rights and social or economic justice make Section 1557 a unique and worthy policy for further development.
The Policy’s Contributions to Life Quality
Quality of life is a way people perceive their position in the world through the prism of existing cultural beliefs, social values, and legal standards. Talking about life quality, it is wrong to focus on some particular issues like health, wealth, or employment. Life means the ability to combine all elements, and health is one of the most integral parts. This concept plays an important role in medicine and health care because it covers different patient groups in terms of care, rehabilitation, pain relief, and overall treatment (Haraldstad et al., 2019). Section 1557 affects understanding demographic differences to offer equal services to all population groups. Thus, it is correct to say that this policy greatly contributes to the quality of life for Americans by determining the conditions under which people live.
The Policy’s Contributions to Social Relations
The debates and the growth of controversial attitudes towards the ACA are not easy to control, but the connection between American states, the federal government, and ordinary citizens is evident. Social relations need to be properly established between patients and healthcare providers, funding agencies and clients, the government, and the population (Campbell & Shore-Sheppard, 2020). They introduce a fundamental unit of interpersonal cooperation, and racial and gender differences may cause unpredictable shifts in health care. Section 1557 aims at removing disparities, which facilitates the development of interpersonal relationships at different levels. At the same time, not all Americans are ready to support all ACA policies, and the challenges related to Section 1557 evidence the possibility of new problems and public concerns. Still, the policy does not impede communication or care but strengthens the conditions under which all Americans can use free services.
The Policy and the Values of Professional Social Work
Professional social work is one of the most helpful professions in the United States. Its goals and policies are defined by multiple social and personal values that encourage decision-making (Karger & Stoesz, 2018). It is not enough for a social worker to focus on the enhancement of the well-being of the nation. It is more important to support vulnerable and oppressed individuals who live in poverty for different reasons. Regarding such values of social work and the goals of the chosen policy, their consistency can be traced from multiple perspectives. Section 1557 is directed to support vulnerable populations and eradicate racial or gender discrimination. Social workers do the same by providing people with equal support and understanding. The ACA policy is based on the values of equality and diversity observed in professional social work. These similarities should not be used to determine Section 1557 as one of the social work initiatives due to other legal and economic characteristics.
Current Proposals for Policy Reform
Proposals to Amend the Policy
In light of recent events and court decisions, some proposals to amend the ACA policy reform have been developed, and new ideas are constantly observed in modern discussion. In 2022, the Department of Health and Human Services (HHS) introduced a new rule to interpret Section 1557 and strengthen nondiscrimination conditions (Keith, 2022). Since its introduction in 2010 and the 2016 rule, including sex stereotyping and gender identity, Section 1557 has undergone multiple evaluations based on the concerns raised by the Trump administration. In 2016, the proposal included the issues of gender expression and transgender status. Now, the goal is to change the policy by reapplying to third-party administrators, extending it to more healthcare providers, and interpreting the ban on sex discrimination (Keith, 2022). The improvements should clarify the impact of marital/family/parental status and remove the application of discriminatory clinical algorithms among healthcare providers in decision-making and telehealth services (Keith, 2022). The pandemic has increased the development of new technologies to support distant communication and care. Section 1557 should be improved to ensure that all people, including those with disabilities and limited language knowledge, obtain information and services on equal grounds.
The Impact of Political, Social, and Economic Forces
The current proposals have reasons to be offered and discussed at the state and national levels. The main political force is the contradictions between the representatives of the Republican and Democratic parties. The Trump era was associated with a desire to rewrite the Obama-era regulation during the last several years (Keith, 2022). The necessity of cutting federal support for cheap healthcare services divided politicians into several groups, provoking new debates and litigation processes. Section 1557 is associated with certain economic effects because ACA-based insurance protects people against financial consequences and increases the ability to afford high-quality care at the government’s expense (Campbell & Shore-Sheppard, 2020). However, the number of unpaid bills is not easy to control. Besides, uninsured low-income individuals could cover their debts, but the representatives of other vulnerable groups had to struggle for their rights.
The Medicaid expansion provoked additional assessments of vulnerable populations regarding their federal civil rights, but no attention was paid to discrimination based on religion. The 2016 rule addressed such issues as English proficiency and communication with people with disabilities. The 2020 rule underlined the importance of enforcement requirements and the distinctions between “sex” and “biological sex” (Keith, 2022). In 2022, the rule was improved in terms of gender-affirming care. Discrimination continues gaining a new meaning, and more categories emerge, shaping care standards. Promoting social freedoms and equal care becomes a serious force for Section 1557 proposals.
Enactment of Proposals
The HHS issued the latest proposal to Section 1557 in the summer of 2022. During October 2022, HHS representatives should gather and analyze public comments about the rule to ensure that sex stereotypes, characteristics, and orientation are properly related to sex discrimination (Nsien, 2022). As soon as a final rule is created, the government will need 60 days to implement the regulation officially. Then, all health insurance marketplaces and organizations under HHS must apply the proposed rule and develop improved policies. It is planned to hire a policy coordinator to examine administrative changes and enhance compliance (Nsien, 2022). Past proposals published in 2016 (pregnancy termination and gender identity) and 2020 (discrimination definition based on sex) prove that some rules may be immediately enacted while others can be sustained. Still, the 2022 proposal has already been announced, while not enacted. More time and evaluation are required to take the last legal steps and strengthen the issue of nondiscrimination in health care.
Proposals’ Outcomes: Intended and Unintended
Certain intended and unintended consequences of the policy may be related to the recently offered proposals. One of the major expected outcomes is the introduction of an expansive definition of discrimination on the basis of sex (Keith, 2022). Three lawsuits were reported in different states during the last several years, proving that discriminating activities affect healthcare quality. The interpretation of Section 1557 is associated with certain concerns because people need more clarity on how to protect transgender youth or offer gender-affirming care. The reduction of mental health problems and emotional breakdowns should be observed. Unintended elements are based on public opinions and the level of definitions’ clarity. At this moment, no legal challenges are associated with the proposal.
Conclusion
Vulnerable populations expect to get high-quality protection from the government to cover their basic needs and use care services equally with other citizens. In the United States, the number of individuals in the vulnerable population has decreased under Section 1557 of the ACA (Campbell & Shore-Sheppard, 2020). However, controversies related to gender identity and misunderstandings in judgments are not easy to regulate. Thus, diverse populations need additional proposals to demonstrate their interests and choose their lifestyles without biased judgments. The proposal for the chosen policy will directly impact diverse and vulnerable populations who need protection and safety guarantees. Including new definitions of gender identity will allow them to apply for equal care without answering inconvenient or inappropriate questions or facing critical and usually negative looks in healthcare facilities.
References
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