The Ethical Implications of ACA

Introduction

As the United States continues to reform the health care system, the ethical implications of such reforms remain the greatest concern. The reforms have been characterized by high health care costs as well as not so stellar outcomes thus affecting the people whose lives should be improved. The initial purpose of the ACA was to provide Americans with the access to health care (Loyola University, 2015). However, it has brought to the forefront of nursing many ethical implications. This paper will look at these ethical implications as well as what is being done by the federal government to combat them.

Ethical Issues Related to ACA

The first challenge has been the requirement that people have to purchase health insurance. The argument has been that this requirement goes against the clause 3 of the eighth section of the Article 1 of the United Sates’ Constitution. Having given the Congress the power as far as the collection of imports, taxes, excises, and duties is concerned, the clause requires it to provide for the US’ general welfare. The act contravenes this provision by making it compulsory for citizens to buy the health care services. Initially, it was only the working population that was required to make payment towards Medicare and Social Security. Thus, the act raised an ethical question of whether the government should force people to take insurance (Lachman, 2012).

To deal with this argument, the government has insisted that the services fall under its mandate and programs. The article also requires all people driving cars to take insurance policies as well as insurance against flood for all its citizens living in the places which can be affected by the disaster. It has been argued that making insurance a legal requirement will help the country to avoid putting the cost of the individuals who are paying for insurance on the moral community. In fact, since the passage of ACA, the federal government has been enjoying the authority to fine any citizen who fails to acquire insurance.

Another aspect is that the act, in its projection, aimed at ensuring that at least 30 million Americans are insured through the Healthwise. However, increasing the number of people with insurance cover and expanding the actual care are two different things. The country has had to struggle trying to train more health-related professionals. Though more nursing professional have been graduating yearly, patients still have to wait for a long time and access providers with difficulties because of high demand. Equally, nurses have had to limit the amount of time they spend with their patients. Finally, most of the patients have gone through frustrations due to the poor delivery and high cost of health care services (Anderson, 2014).

Therefore, even though the act had good intentions, its ethical soundness is in question due to the resulting expanded healthcare delivery’s sheer logistics, personnel shortages, as well as limited resources. The nurses and their care provision abilities’ have been negatively affected. Ethically, the changes have come with the increased regulatory burdens, workloads, penalties, and reduced payments while disregarding the values and preferences of nurses. This is worsened by the fact that the act has over-relied on the model of free preventive care and Patient Centered Medical Home. The models can never be effective without the required number of primary care providers ensuring that the delivery of services is efficient and effective (Anderson, 2014).

It has also been argued that ACA has come with additional stress that is likely to accelerate the retirement of the elderly health care professionals who had willingly stayed on to help in the delivery of services. The implementation of the act has thus been complicated by this group of health care providers. It was estimated that from 2.8 million nurses who had registered by 2014, it is most likely that a third will retire during the coming decade. Moreover, the more dedicated older nurses are being replaced by the less experienced younger ones. Studies have shown that nurses who have reached the age of 50 years are more hardworking and dedicated compared to their younger counterparts. It means that the rate of nurses’ productivity will reduce with the implementation of the act. With deteriorating efficiency and productivity, the major concern has been whether the country will ever meet the projected demand of its health care related services. Apart from the problem of retiring older nurses, many nurses have continued to consider other opportunities as well as alternative carriers. This is because of the increased stress faced by the health care workforce. Though the government has tried to increase the number of students being trained in nursing, the demand for health care services has also continued to increase (Anderson, 2014).

The implementation of the act has also remained a major contributor to nurses’ stress based on its massive and complex nature. The health care providers have had to contend with a delicate balance of meeting the newly introduced legal requirements and fulfilling their obligations as stated in their professional ethics. For instance, it is proved impossible for the nurses to ensure high performance in their delivery of patient care. There is also the issue of penalties against and various incentives given to doctors being determined by one’s quality as well as performance irrespective of the diminishing workforce. This has made it hard for the nurses to keep up to the expected ratio for quality care. The result is fatigue-related medical errors, death of patients, and poor outcomes (Anderson, 2014).

With heavy workloads, there has also been an increasing disparity especially affecting the African-Americans and the elderly in the society. The Act has led to an increase in the number of patients being admitted with complex medical issues requiring the few available nurses to ensure the provision of services. This has encouraged disparities in healthcare. As a measure to reduce inequality in the provision of health care services, the act provided for forgiveness and repayment of loans. It also ensured workforce planning funding, scholarships as well as increased funds towards public care. However, the programs have only realized minor successes. Ethics is concerned, because the programs provided by the act remain the only initiatives meant to help in addressing inequality in the distribution of health care related services. As a result, there has been an increase in mortality as well as morbidity among the rural Americans. To be able to solve this problem, the government has been trying to shift its approach to the practices related to education admission. It has also been recruiting the additional number of personnel who have experience in the rural life. The government has also tried to reform its payment systems in both private and public sectors. Finally, it has been trying to ensure that health care professionals are provided with a friendlier environment when it comes to regulations (Anderson, 2014).

Another issue closely related to inequality is a penalty problem. The act heavily relies on reimbursements of bonus, mandates, and penalties against the institutions and professionals who have not complied with its numerous regulatory standards. The effect of this act can be seen in the many (2,225) hospitals that suffered in the year 2013 under HRRP part of the act’s regulation. The government collected up to over 227 million dollars. What makes it an ethical issue is the fact that most of the affected hospitals were from the regions that are hardly hit by poverty. It means that the low-income patients from such areas have been negatively impacted. Equally, with the reduction in the payment of Medicaid DSH, such health care institutions are struggling to improve the quality of the services they provide due to the increased cut in revenue. It has seen most nurses being retrenched with those in the private sector having to contend with low wages. However, the government has been trying to ensure improvement in the nurses’ working environment by providing incentives and reducing federal taxes on them (Anderson, 2014).

The second points of the act that has ethical implications is its requirement for health care providers to maintain their medical records electronically. This requirement has raised a contentious debate with regard to the confidentiality and privacy of the information given by patients. However, the government has insisted that the new advancement has helped in transforming rural health care via tele-homecare and tele-health. Thus, it ensures that relevant expertises are brought to patients to facilitate the appropriate choices of treatment. Irrespective of its advantages, keeping electronical records makes it challenging to ensure confidentiality and consent.

Ironically, the act has also led to the increased volumes of paper work taking much of the nurse’s time. The law came with 109 new regulations. Nurses and their organizations have had to spend much time as well as efforts trying to ensure that they are complying with the set rules as well as regulations. It is estimated that 190 million hours are lost by the healthcare industry in paperwork every year. Reading nearly 13,000 pages in the form of regulations has drastically impacted the amount of time that nurses are able to take attending to their patients. Thus, the act puts unnecessary burden on the nurses and health care institutions. It also aggravates the problem of the healthcare workforce shortage. Though the government has tried to train its nurses on the regulations, not all the nurses have been reached (Anderson, 2014).

Conclusion

In conclusion, a lot needs to be done by the government if the Affordable Care Act is going to improve the work of nurses in the U.S. The government needs to plan for more of training, assessments, and implementation analysis to identify the negative impacts of the act and the best approaches to address them.