Healthcare reform: The dismantling of the affordable care act

Please answer the following Discussion Question. Please be certain to answer the four questions on this week’s DQ and to provide a well-developed and complete answer to receive credit. Also, please ensure to have read the assigned chapters for the current week.

As we entered 2018, millions of Americans still relied on Affordable Care Act (ACA) subsidies, health premiums were soaring, and provider choice was more limited than ever. There was, however, momentum for reform. Health care was identified as the country’s leading priority for Democrats (54%) and the second highest priority for Republicans (42%) at the close of 2017. A group of registered nurses debates the issue of health care reform.

1. Explain the ethical and legal aspects of healthcare reform

2. What were the 10 essential benefits guaranteed by insurance plans in the ACA Health Care Marketplace?

3. What are the successes of the ACA?

4. What are the failures of the ACA?

 

 

 

Ethics & Legal Aspects in Nursing

 

 

 

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Ethics & Legal Aspects in Nursing

Healthcare Reform: The Dismantling of the Affordable Care Act

As nursing involves the care and well-being of individuals, it is imperative to examine the ethical and legal aspects that guide and govern nursing practice. Ethics and legal aspects are essential components of nursing practice that govern the conduct and responsibilities of nurses (Suhonen et al., 2018). Ethics concerns the principles and values that guide nursing practice and decision-making, such as beneficence, non-maleficence, autonomy, and justice. Nurses must uphold ethical principles in their interactions with patients, colleagues, and the healthcare system to ensure safe and effective care. Legal aspects, on the other hand, refer to the laws and regulations that govern nursing practice, including licensure, liability, and scope of practice (Balestra, 2018). Nurses must adhere to legal requirements to avoid legal sanctions and protect patients’ rights. Thus, nurses must integrate ethical and legal principles into their practice to promote quality and ethical care while complying with the law.

Healthcare reform is a highly debated and contentious topic in the United States, with proponents and opponents often fiercely advocating for their positions. One of the most significant developments in recent years was the Affordable Care Act (ACA), which aimed to increase healthcare access for millions of previously uninsured or underinsured (Glied et al., 2020). However, in recent years, there have been efforts to dismantle the ACA, which has resulted in a range of impacts on the healthcare system. Some argue that dismantling the ACA could lead to decreased access to care for vulnerable populations, increased costs for individuals and the government, and decreased overall health outcomes. On the other hand, some argue that the ACA was a flawed policy that did not adequately address the root causes of healthcare issues in the United States and that dismantling it will allow for more effective solutions to be developed (Chin et al., 2018). The debate over healthcare reform and the dismantling of the ACA will likely continue for some time, with significant implications for the health and well-being of millions of Americans. This essay will explore the ethical and legal aspects of healthcare reform, the ten essential benefits guaranteed by insurance plans in the ACA Health Care Marketplace, and the successes and failures of the ACA.

The Ethical and Legal Aspects of Healthcare Reform

Healthcare reform is a complex and multifaceted process that involves ethical and legal considerations. Healthcare reform aims to improve access to healthcare, reduce healthcare costs, and improve the quality of care (Yip et al., 2019). However, implementing healthcare reform raises ethical and legal issues that must be addressed. One of the ethical considerations of healthcare reform is the principle of distributive justice. This principle requires that healthcare resources are allocated fairly and equitably (Liu et al., 2020). Healthcare reform ensures that all individuals have access to healthcare, regardless of income or social status. However, implementing healthcare reform can be challenging because it involves allocating limited resources. Therefore, policymakers must balance the need to provide healthcare to all individuals with the need to allocate resources fairly and equitably. Another ethical consideration of healthcare reform is the principle of autonomy (Layman, 2020). Autonomy refers to an individual’s right to make decisions about their healthcare. Healthcare reform seeks to empower individuals to make informed decisions about their healthcare. However, implementing healthcare reform can be challenging because it requires individuals to have access to accurate and reliable healthcare information. Therefore, policymakers must ensure that individuals have access to the information they need to make informed decisions about their healthcare.

In addition to ethical considerations, healthcare reform raises legal issues that must be addressed. One legal issue of healthcare reform is the constitutionality of healthcare reform (Wang et al., 2020). The constitutionality of healthcare reform has been challenged in court, with opponents arguing that the individual mandate, which requires individuals to have health insurance, is unconstitutional. Therefore, policymakers must ensure that healthcare reform complies with the Constitution. Another legal issue of healthcare reform is the implementation of healthcare reform (Kojima et al., 2019). Implementing healthcare reform requires the cooperation of multiple stakeholders, including healthcare providers, insurance companies, and government agencies. Therefore, policymakers must ensure that healthcare reform is implemented in a manner that is consistent with existing laws and regulations. Healthcare reform is a complex, multifaceted process that raises ethical and legal issues. Policymakers must balance the need to provide healthcare to all individuals and allocate resources fairly and equitably. Additionally, policymakers must ensure that healthcare reform is implemented in a manner that is consistent with existing laws and regulations.

The 10 Essential Benefits Guaranteed by Insurance Plans in the ACA Health Care Marketplace

The Affordable Care Act (ACA) Health Care Marketplace ensures that all health insurance plans offer ten essential benefits to their enrollees. These benefits aim to provide comprehensive coverage for various medical services and treatments. Firstly, ambulatory patient services are an essential benefit of health insurance plans in the ACA Health Care Marketplace (Kates et al., 2021). This includes services provided in a doctor’s office, outpatient clinic, or another setting. It covers preventive services, diagnostic tests, and other medical services that do not require admission to a hospital. Secondly, emergency services are another essential benefit. It includes care for medical conditions that require immediate attention, such as a heart attack or stroke. Insurance plans must cover emergency services, regardless of whether the healthcare provider is in or out of the plan’s network. Thirdly, hospitalization is an essential benefit that covers the cost of inpatient care, including room and board and other necessary medical services (Yabroff et al., 2019). This benefit also includes surgery, anesthesia, and other treatments that require hospital admission. Fourthly, maternity and newborn care is a benefit that provides coverage for prenatal care, childbirth, and postpartum care. This benefit also covers newborn care, such as routine newborn screening tests and preventive services. Fifthly, mental health and substance use disorder services are essential benefits that provide coverage for mental health treatment and substance use disorder treatment. This includes counselling, psychotherapy, and medication-assisted treatment for substance use disorders.

Sixthly, prescription drugs are an essential benefit that covers the cost of prescription drugs, including those used to treat chronic conditions. Insurance plans must cover at least one medication in each drug category, and the formulary must include drugs considered essential for treating common conditions. Seventhly, rehabilitative and habilitative services and devices are essential benefits that provide coverage for services and devices that help individuals recover from injuries or illnesses (Jones et al., 2020). This includes physical therapy, occupational therapy, and speech therapy. Eighthly, laboratory services are an essential benefit that covers the cost of lab tests, including blood tests, urine tests, and other diagnostic tests. Ninthly, preventive and wellness services and chronic disease management are essential benefits that provide coverage for preventive care, such as annual check-ups, vaccinations, and cancer screenings (Jiang et al., 2018). It also includes chronic disease management for conditions such as diabetes and asthma. Lastly, pediatric services, including oral and vision care, are essential benefits that provide coverage for preventive and routine care for children. This includes dental and vision care, immunizations, and other preventive services. The ACA Health Care Marketplace ensures that all health insurance plans offer these ten essential benefits. These benefits provide comprehensive coverage for various medical services and treatments and ensure that individuals can access the care they need to maintain their health and well-being.

Successes of the Affordable Care Act (ACA)

Increased Access to Healthcare Coverage

One of the primary successes of the Affordable Care Act (ACA) is that it has significantly increased access to healthcare coverage for millions of Americans. Before the ACA, many individuals could not obtain health insurance due to pre-existing conditions, high costs, or simply not having access to employer-sponsored coverage (Rice et al., 2018). The ACA addressed these issues by establishing state-based health insurance marketplaces where individuals can purchase affordable health insurance plans that meet their needs. Additionally, the ACA expanded Medicaid coverage to include more individuals and families, providing them access to preventive care, doctor visits, and prescription drugs. As a result, millions of previously uninsured Americans can now access the healthcare they need to maintain their health and well-being.

Lowered Uninsured Rates

Another significant success of the ACA is the significant reduction in uninsured rates. Before the ACA, millions of Americans were uninsured, leaving them vulnerable to catastrophic healthcare costs and unable to access essential healthcare services (Blumenthal et al., 2020). With the implementation of the ACA, the uninsured rate in the United States has dropped to historic lows. This is primarily due to Medicaid’s expansion and the health insurance marketplaces’ establishment. By providing affordable health insurance options to those who previously could not afford coverage, the ACA has helped to ensure that more Americans can access the care they need to stay healthy and productive.

Protection of Individuals with Pre-Existing Conditions

The ACA protects individuals with pre-existing conditions like cancer, diabetes, or heart disease. Before the ACA, these individuals often struggled to obtain affordable health insurance or were denied coverage altogether (Hampton & Lenhart, 2019). With the ACA, insurers are prohibited from denying coverage to individuals with pre-existing conditions, ensuring they have access to the care they need without fear of being denied coverage or charged exorbitant premiums. This provision of the ACA has helped to ensure that individuals with pre-existing conditions are not discriminated against and can access the care they need to manage their health conditions.

Cost Control Measures

One of the ACA’s goals was to reduce healthcare costs in the United States. To achieve this goal, the ACA includes several cost control measures, including the establishment of accountable care organizations, which focus on providing coordinated and efficient care to patients, and the implementation of payment reforms that incentivize providers to focus on the quality of care rather than quantity of services (Brockett et al., 2018). The ACA also includes provisions that encourage preventive care and wellness programs, which can help reduce the need for expensive medical treatments and hospitalizations. While the full impact of these cost control measures is still being evaluated, early evidence suggests that the ACA has helped to slow the growth of healthcare costs and make healthcare more affordable for millions of Americans.

Improvement in Healthcare Quality

The ACA includes several provisions to improve healthcare quality in the United States. For example, the ACA established the Center for Medicare and Medicaid Innovation, tasked with developing and testing innovative payment and service delivery models that can improve the quality of care while reducing costs (Giullian et al., 2022). Additionally, the ACA includes provisions that encourage using electronic health records and other health information technology, which can improve care coordination and reduce medical errors. The ACA also includes provisions supporting research on effective healthcare interventions and promoting best practices dissemination. Together, these provisions have helped improve healthcare quality in the United States and ensure that patients receive the best possible care.

Failures of the Affordable Care Act (ACA)

Rising Healthcare Premiums

One of the major criticisms of the Affordable Care Act (ACA) has been the increase in healthcare premiums. The ACA aimed to expand access to affordable healthcare, but many individuals have experienced rising premiums in the individual market (Davidoff et al., 2018). The ACA attempted to address this by introducing subsidies and cost-sharing reductions for low-income individuals, but rising premiums have particularly affected middle-income families. Some reasons for this include the cost of covering individuals with pre-existing conditions and the requirement that insurance companies cover certain essential health benefits. Additionally, the ACA created an age rating system that limits the variation in premiums based on age, which has resulted in younger and healthier individuals paying more to help offset the costs of older and sicker individuals.

Limited Provider Choice

Another issue with the ACA has been the limited provider choice for individuals who purchase insurance through the marketplace. In order to keep costs down, insurance companies have narrowed their networks of healthcare providers, meaning that individuals may not be able to see the doctor of their choice or receive care from certain hospitals (Boone, 2019). This has particularly affected individuals with complex medical conditions who require specialized care. Additionally, some insurers have dropped out of specific marketplaces altogether, leaving individuals with even fewer options for healthcare coverage.

Political Controversy and Division

The ACA has been a source of political controversy and division since its inception. A Democratic-controlled Congress passed the law without any Republican support, which created a sense of animosity toward the law from some Republicans (Grogan & park, 2018). Additionally, the Supreme Court upheld the constitutionality of the ACA in 2012, but there have been numerous attempts to repeal or undermine the law through legal challenges and budget cuts. This has created uncertainty and instability in the healthcare system, making it difficult for individuals and healthcare providers to plan for the future.

Increased Administrative Costs

The ACA has also been criticized for increasing administrative costs in the healthcare system. The law introduced new reporting requirements for insurance companies, hospitals, and other healthcare providers, which has resulted in increased paperwork and administrative burdens (Crowley et al., 2021). Creating new marketplaces and insurance regulations have also required significant resources from both public and private entities. Some critics argue that the administrative costs associated with the ACA have resulted in higher healthcare costs overall.

Inadequate Coverage for Some Individuals

Despite the ACA’s goal of expanding access to healthcare coverage, some individuals still face inadequate coverage. For example, some individuals who purchase insurance through the marketplace may have high deductibles or out-of-pocket costs, making it difficult to afford healthcare services (Hall et al., 2019). Additionally, the ACA did not address the issue of healthcare access in states that chose not to expand Medicaid eligibility, leaving many low-income individuals without access to affordable healthcare coverage. The ACA also did not address the issue of healthcare access for undocumented immigrants, who are not eligible for marketplace coverage or Medicaid.

Conclusion

In conclusion, the ethical and legal aspects of healthcare reform, specifically the dismantling of the Affordable Care Act, have been a source of significant debate and concern. The ACA’s ten essential benefits guarantee that individuals can access essential healthcare services, such as emergency care, prescription drugs, and mental health services. While the ACA has had its successes, such as increasing access to healthcare and improving health outcomes, it has also faced criticism for its high cost and limited consumer options. The ongoing debate over healthcare reform highlights the complex interplay between ethics, law, and policy in the healthcare system. As healthcare evolves, it is essential to consider the ethical implications of policy decisions and their impact on patients’ health and well-being.

 

 

 

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