Ethical Challenges in the Era If Health Care Reform
Ethics, Law, and Policy
Vicki D. Lachman
Ethical Challenges in the Era
Of Health Care Reform n truth, the United States is at the beginning of a long overdue and a much needed health care reform. We have seen the dismal statistics about our high cost health care system and some of the less than stellar outcomes (e.g., infant mortality)
(Callahan, 2011; World Health Organization [WHO],
2011)). The purpose of this article is not to complain about the current health care system, but instead to focus on existing reform efforts — The Patient Protection and the Affordable Care Act (ACA), the ethical justifications for its creation, and ethical challenges it brings.
I
Key Features of the Law
ACA offers new ways for consumers and providers to hold insurance companies accountable. The most important parts of the law are features described in the following discussion. Because of space limitation, I will highlight some elements of the law that are enacted through
2014 and clearly impact nursing. These selected features include insurance choices, insurance costs, rights and protection, and people age 65 and older.
Insurance Choices
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, 2012a). Citizens will have a choice of private insurance, employer-paid insurance, Medicaid,
Medicare, or state-based insurance exchanges.
Affordable Insurance Exchanges. Individuals and small businesses can purchase coverage through these exchanges, with premium and cost-sharing credits available to individuals and families with income between
133%-400% of the federal poverty guideline (in 2011, the poverty guideline was $18,530 for a family of three)
(Werhane & Tieman, 2011).
Businesses with 50 or more employees need to make coverage available, and businesses with less than 25 employees will qualify for tax credits to
Vicki D. Lachman
Ethical Challenges in the Era
Of Health Care Reform n truth, the United States is at the beginning of a long overdue and a much needed health care reform. We have seen the dismal statistics about our high cost health care system and some of the less than stellar outcomes (e.g., infant mortality)
(Callahan, 2011; World Health Organization [WHO],
2011)). The purpose of this article is not to complain about the current health care system, but instead to focus on existing reform efforts — The Patient Protection and the Affordable Care Act (ACA), the ethical justifications for its creation, and ethical challenges it brings.
I
Key Features of the Law
ACA offers new ways for consumers and providers to hold insurance companies accountable. The most important parts of the law are features described in the following discussion. Because of space limitation, I will highlight some elements of the law that are enacted through
2014 and clearly impact nursing. These selected features include insurance choices, insurance costs, rights and protection, and people age 65 and older.
Insurance Choices
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, 2012a). Citizens will have a choice of private insurance, employer-paid insurance, Medicaid,
Medicare, or state-based insurance exchanges.
Affordable Insurance Exchanges. Individuals and small businesses can purchase coverage through these exchanges, with premium and cost-sharing credits available to individuals and families with income between
133%-400% of the federal poverty guideline (in 2011, the poverty guideline was $18,530 for a family of three)
(Werhane & Tieman, 2011).
Businesses with 50 or more employees need to make coverage available, and businesses with less than 25 employees will qualify for tax credits to
References: (ANA, 2001, p. 7). Brody, J.E. (2009). End-of-life issues need to be addressed. Retrieved from http://www.nytimes.com/2009/08/18/health/18brod.html Callahan, D. (2011). Health care reform: Can a communitarian perspective be salvaged? Theoretical Medicine and Bioethics, 32(5), 351-362. CMS.gov. (2012). Emergency Medical Treatment & Labor Act (EMTALA). Crowley, M. (2009). Connecting American values with health care reform. Hamel, R., & Nairn, T. (2011). The individual mandate: A rancorous moral matter HealthCare.gov. (2012a). Affordable Care Act. Retrieved from http://www. Noddings, N. (2003). Caring: A feminine approach to ethics and moral education. Berkeley, CA: University of California Press. Pariser, D.M. (2012). Ethical considerations in health care reform: Pros and cons of the affordable care act ProCon.org. (2012). Right to healthcare: Did you know? Retrieved from http://healthcare.procon.org/ Sade, R.M. (2007). Ethical foundations of health care system reform. Annuals of Thoracic Surgery, 84(5), 1429-1431. Trotter, G. (2011). The moral basis for healthcare reform in the United States. Werhane, P., & Tieman, J. (2011). Clearing the brush: Myths surround the Affordable Care Act World Health Organization (WHO). (2011). World health statistics 2011.