Devonna and physicians produce significantly better results at

Devonna
Stephens

Elementary
Ethics

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Dr.
Jason Fishel

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Ethics
in the Affordable Care Act

            The
Affordable Care Act, while it does have its flaws, is a drastic improvement on
former law regarding healthcare and has increased the overall happiness,
everyone considered.

            The
Affordable Care Act is a federal statute that was signed into law on March 23,
2010. Along with the Health Care and Reconciliation Act of 2010, signed into
law March 30, 2010, the act is the product of healthcare reform agenda of the
Democratic 111th Congress and the Obama administration (Sayles 632). The Affordable Care
Act established a health insurance marketplace or exchange where uninsured,
eligible Americans would be able to purchase federally regulated and, in some
cases, funded healthcare insurance. People who are not covered by insurance
through a job, Medicare, Medicaid, Children’s Health Insurance Program (CHIP),
or another source are able to purchase insurance through a marketplace or
exchange. The exchange offers healthcare insurance to members based on their
income. Most people who apply qualify for some type of tax credits that in many
cases may lower the cost of coverage. All plans cover essential health
benefits, pre-existing conditions, and preventative care. There are several
names this law goes by such as the Patient Protection and Affordable Care Act
(PPACA), Affordable Care Act (ACA), and Obamacare. It is a significant law
passed to reform America’s health care system since the Medicare and Medicaid
law, which was passed in 1965.

            The
purpose of this law is to help hospitals and physicians produce significantly
better results at reduced costs with better and easier methods of distribution.
This is established through transformation of existing methods with respect to
finances, technology, and clinical practice.

            The
ACA has accomplished this by expanding the principles of eligibility of
Medicaid so that citizens under 138% of the poverty line can be added. The ACA
has also added state-sponsored insurance plans where individuals and small
business owners would be able to buy insurance plans with subsidies for those
whose income is between 100% and 400% below poverty levels.

            Since
the election of President Donald Trump in 2016, the new administration launched
efforts to begin the process of repealing the ACA in January 2017. The Trump
administration has cited the fact that the ACA has not curbed the growth in
health care spending and the businesses have an incentive to keep employees’
wages low to make the company eligible for government insurance subsidies. The
directive to buy insurance or pay a penalty is a lower cost than the insurance
premiums. However, critics repeal note that more than 20 million people could
lose access to insurance if there is no replacement for the ACA. Popular
provisions of the ACA, such as coverage of dependents until age 26, no copays
on preventative medicines, and ending annual and lifetime limits on coverage,
would be lost with repeal (Gale).

            The
Republican Party is proposing some alternatives to the ACA, with the most
publicized being tax credits. One of the commonly advertised protections under
Republican replacement plans is to say that pre-existing conditions will not be
excluded for anyone who hasn’t had any gap in coverage. But, what about those
that have had a gap such as senior citizens of retirement age that are
transitioning into retirement. The Kaiser Foundation estimates that 52 million
people younger than 65 would lose coverage again due to pre-existing conditions
that leave them unable to be insured if going back to pre-ACA insurance plans.
As of December 21, 2016, nearly 6.4 million people had signed up for the ACA
coverage in 2017 despite the threats of repeal, 400,000 more than the year
before (Stone).

            Mainstream
healthcare groups such as American Medical Association (AMA), the American
Congress of Obstetricians and Gynecologist (ACOG), the American Academy of
Pediatrics (AAP), and the American College of Physicians (ACP), wrote to
congress stating, “We cannot go back to a time when our patients couldn’t get
coverage because of preexisting conditions, family history, gender or race.”
The HIV Medical Association (HIVMA) and related partners (AAHIVM, ANAC, RWMPC)
further noted that “access to antiretroviral therapy not only improves an individual’s
health but also the health of the community and is a critical tool to help stop
the HIV epidemic.”

            At
one point in 2011, there were about 22,000 Americans with serious health
problems who couldn’t obtain health insurance because of preexisting conditions.
The ACA has solved their problems by providing good coverage for the same
premium healthy people pay (Goodman).

A few
years ago, the uninsured rate was almost 17% with approximately 50 million
uninsured (Davis). The uninsured rate
has dropped to a low of 11% particularly helping younger people, lower income
households, and minorities. According to the commonwealth fund reported on July
2014, around 10 million people randomly aged between 19-64 had chosen to go for
a health insurance plan, which amounts to 5% of the working-age population.

            In
the same way, the Rand Corporation’s official report claims that there has been
a drastic effect of ACA on employers offering medical insurance coverage plans,
as they have increased by more than 8 million. Also, individuals applying for
Medicaid has increased by 6 million.

            Around
4 million people are currently being covered through the federal and state
marketplaces and a little less than a million people choose to become
uninsured, owing to third-party insurance coverage plans. While experts are
unsure about a million people opting out of the insurance plan, it’s still a
very small number because it only represents about 1 percent of the working
population. Meaning that a little less than 7.5 million people have elected to
choose marketplace insurance policies and have successfully made payments on
their premiums.

            According
to a survey on ACA law statistics, young adults have chosen to stay on their parent’s
coverage plan until they are age 26. The same survey has also brought forth
welcoming news that after the acceptance of this law, the body mass index in
young adults has reduced by an impressive rate. Once again, proof that the ACA
law has helped improve quality of life and health of citizens.

            The
ACA offers new ways for consumers and providers to hold insurance companies
accountable. The intention of the law is to expand health care coverage to most
U.S. citizens and permanent residents by requiring most people to have or
purchase health insurance (HealthCare.gov). Citizens have a
choice of private insurance, employer-paid insurance, Medicaid, Medicare, or
state-based insurance exchanges.

            ACA
holds insurance companies accountable. It also helps individuals keep their
costs down. The ACA requires insurers selling policies to individuals or small
groups to spend at least 80% of premiums on direct medical care and efforts to
improve the quality of care. However, this does not apply to self-insured
plans. This would be a good area to simply make changes to the current policy
as opposed to getting rid of it all together and adapting what the Trump
administration is proposing which, from what I can understand, is less that
stellar and will wipe out all, or a majority of, the progress made under
“Obamacare”.

            Under
the ACA there are currently no lifetime and annual limits. ACA restricts and
phases out the annual dollar limits a health plan can place on most of its
benefits. The ACA eliminated these limits completely in 2014. The ACA puts
consumers in charge of their health care, not insurance companies. The
following rights and consumer protections are available.

            Preventative care. Individuals may not
have to pay a copayment, co-insurance, or deductible to receive recommended
preventative health services, such as screenings, vaccinations, and counseling (Lachman).

            Doctor choice and ER access. Individuals
can choose any available participating primary care provider and they can
access out-of-network emergency rooms without prior approval. ACA prohibits
health plans from requiring a referral from a primary care provider before
women can seek coverage for obstetrical or gynecological (OB-GYN) care (Lachman).

            People 65 and older. ACA offers eligible
senior citizens a range of preventative services with no cost-sharing. ACA also
provides discounts on drugs when older adults are in a coverage gap (Lachman).

            Individuals
with chronic illnesses benefit a great deal from palliative care services, not
just at end-of-life care but throughout the disease progression. The ACA
focuses on chronic disease management is best exemplified by this phrase: “An
integrated care approach to managing illness which includes screenings,
check-ups, monitoring and coordinating treatment, and patient education (HealthCare.gov).”

            In
2007, the Ethical Force Program of the American Medical Association found three
core American values underlying health care system reform: equality of
opportunity, justice, and compassion (Sade).

            There
were many long debates that occurred before the passage of the ACA and there
was not much attention devoted to “moral justification” for collectivizing
health care. That doesn’t always happen. In fact, President Clinton’s White
House Task Force on National Health Reform in 1993-1994 developed a list of
principles and values described as “fundamental national beliefs,” which
included universal access to health insurance, comprehensive benefits, equal
benefits, fair procedures, just to name a few. Members of this ethics subgroup
said in their analysis of ethical principles that “the equality is basic
because health is a necessary condition for individuals to pursue their goals (Sade).”

            The
question of what we as Americans want from a health care system is just a
prevalent today as it was before the passing of the ACA in 2010. Many of us, in
my opinion, want equality throughout the system. We want a high quality of care
that can and will provide the greatest benefit to us in our society and as
individuals. We want to have the freedom to choose for ourselves the who, when,
and where of our health care. We want our healthcare to be affordable as well
as top of the line. Costs did go up for some people when the ACA passed, but it
also made insurance for many more affordable than it was prior to the law. The
ACA has, when everyone overall is put into consideration, has met these items
that us, as a society, wants thus increasing overall happiness, everyone
considered.

            When
access to quality health care is a right as opposed to being only an option or
even a privilege then the healthcare reform holds large moral weight. The ACA
aids in helping us as a society more forward toward a universal health
insurance with a subtext that everyone deserves access to basic health care.

            If
we can understand how specific human contexts and conditions form and keep
barriers on how to make improvements to our well-being, then health
professionals of all types can make a difference in helping to “provide the
human good health to both individuals and societies (Sorrell).”

            Possibly
the most common argument that supports of collectivization of health care is
that the need for health care is different from all the other areas of human
activity, even basic needs, such as food, clothing, and shelter. For most
people, health care is a minor element of health. Accomplishing a proper
balance of all the activities that lead to good health is highly personalized
considering individual talents and abilities, so each person needs the freedom
to be able to determine how best to use personal time and limited resources to
gain and maintain good health (Sade).

            Since
1986, the Emergency Treatment and Labor Act has prohibited hospitals from
refusing acute care to any individual who could not afford to pay (CMS.gov). This lack of
distributed justice for the insured is one reason why insurance is not
affordable, as this could cause significant harm to individuals and families
already struggling financially. Therefore, the ethical principles of beneficence
and nonmaleficence are supported by the features of Affordable Insurance
Exchanges and the development of Consumer Operated and Oriented Plans (Lachman).

            Ethical
reasoning for health care reform has relied primarily on distributive justice
as justification for change, specifically due to lack of access to care for the
underinsured and uninsured (Lachman). According to the
U.S. Census Bureau, 46.3 million people in the United States were uninsured in
2008 (ProCon.org).

            Quality
has always been a focus of the ACA in the preventative field and with quality
measurement. Two essential principles of the ACA are that:

1.     Provider
reimbursement for health services is based, in part, on the relative quality
and patient experience of the care provided.

2.     Information
about that comparative quality and patient experience will be publicly
accessible (Lachman).

 

While
some people may disagree with this bill, I personally, from a utilitarian
perspective, agree with Obama’s policy on healthcare as it is an improvement on
previous laws and serves to increase the total happiness and utility in the
state. Previously, the United States government didn’t require insurance
companies to justify price increases which allowed private companies to exploit
consumers and charge exorbitant premiums for insurance policies. With this law,
the government implements its “exchange” option, subsidizing health insurance
for some, as well as requiring insurance companies to publicly announce and
defend any increases to premiums of more than 10 percent which should provide
more insight into a company’s actions resulting in lower prices and an increase
in the quality of health insurance providers. Not only does ACA help decrease
prices, but it also provides more widespread and available health care and
Medicare to those who previously couldn’t afford it. If more people have access
to health insurance, then more people will be able to receive regular health
care which will increase happiness as well as utility.

A
libertarian would argue that “Obamacare” restricts peoples’ freedom and
therefore is not better than the laws that preceded the ACA which would also
imply that the unhappiness of the minority would outweigh the happiness of the
majority, the utilitarian would argue that this is not the case. While some
would say that restricting peoples’ right to choose between having and not
having health insurance is not an improvement for the newer law, it is only one
specification; that one specification is outweighed by the larger effects of
the bill, that more people in the United States could afford, and would be
receiving, health insurance and care. A utilitarian would even argue that by
denying this bill you are refusing some people their right to life which could
be worse than denying someone their freedom of choice.

In
conclusion, the ACA has provided a forum for debate about not only health care
insurance, tools to maintain financial stability of its systems, and strategies
to ensure access to millions of people, but also has contributed to defining
American society’s values. It is easy to argue against the individual mandate
impingement on choice and freedom. However, other provisions provide children,
adults, and elders with coverage and services that will help keep them healthy
and support them in their management of chronic disease, while alleviating the
fear of bankruptcy.

The
Supreme Court will decide the legal matters in ACA, but it will not resolve the
ethical ones. The principle of autonomy was never meant to abandon the moral
relationships that continue to be necessary for the human good. “The nurse
respects the worth, dignity and rights of all human beings irrespective of the
nature of the health problem” (American Nurses Association (ANA)
7).

 

Works Cited

American Nurses Association (ANA). Code of Ethics
for Nurses With Interpretative Statements. Silver Spring, MD, 2001.

CMS.gov. Emergency Medical Treatment & Labor
Act (EMTALA). 2012. 10 November 2017.

Davis, Alyssa. www.gallup.com. 26 July 2016.
Web. 18 October 2017.

Gale, Cengage Learning. “Health Care Issues,
Opposing Viewpoints Online Collection.” 2017. galegroup.com.
Document. 19 October 2017.

Goodman, John. NCPA.org. 6 July 2011. 1
November 2017.

HealthCare.gov. 2012a. 3 November 2017.

HealthCare.gov. 2012b. 2 November 2017.

Lachman, V.D. Ethical Challenges in Healthcare:
Developing Your Moral Compass. New York: Springer, 2009. Print.

ProCon.org. Healthcare.procon.org. 2012. 9
November 2017.

Sade, Robert M. www.ncbi.nlm.nih.gov/pmc/articles/PMC4486288/.
23 May 2012. 2 November 2017.

Sayles, Nanette B. and Gordon, Leslie L. “Health
Information Management Technology, An Applied Approach Fifth Edition.”
Chicago: AHIMA Press , 2016. Print.

Sorrell, J. “Ethics: The Patient Protection and
Affordable Care Act: Ethical Perspectives in 21st Century Health Care.” OJIN:
The Online Journal of Issues in Nursing Vol. 18 No. 1 9 November 2012.

Stone, Dr. Judy. Forbes.com. 5 January 2017.
Web. 14 October 2017.