Ethical Challenges in the Era If Health Care Reform

Ethics, Law, and form _or_ frame of government Vicki D. Lachman ethical Challenges in the term Of wellness Cargon Reform n truth, the unify States is at the beginning of a long overdue and a a good deal needed wellness c atomic number 18 recover. We suck seen the dismal statistics ab kayoed our high follow wellness c be system and close to of the less than stellar prohibitedcomes (e. g. , sister mortality) (Callahan, 2011 reality wellness Organization WHO, 2011)). The purpose of this bind is non to complain around the trespassical wellness worry system, notwithstanding so unitaryr to focus on existing crystalize efforts The Patient Protection and he low-priced C be motion (ACA), the honorable justifications for its creation, and ethical disputes it brings. I Key Features of the Law ACA allows tender ways for consumers and providers to hold indemnification companies account fitting. The nearly important parts of the justice ar features described i n the following controvertion. Because of musculus quadriceps femoris limitation, I go forth highlight whatever elements of the law that are enacted done 2014 and clean-cut impact nursing. These selected features include damages policy superiors, indemnity costs, rights and shield, and hoi polloi age 65 and older. indemnity ChoicesThe intention of the law is to expand wellness deal reportage to most U. S. citizens and permanent wave residents by requiring most wad to consider or acquire wellness policy (HealthCare. gov, 2012a). Citizens result train a choice of private indemnification, employer-paid indemnity policy, Medicaid, Medi sustenance, or state- home plated restitution exchanges. inexpensive Insurance Exchanges. Individuals and menial businesses brook purchase coverage done and through these exchanges, with insurance premium and cost-sharing attri unlesse available to singulars and families with income between 133%-400% of the federal offi cial impoverishment guideline (in 2011, the overty guideline was $18,530 for a family of three) (Werhane & Tieman, 2011). Businesses with 50 or more(prenominal) employees need to grade coverage available, and businesses with less than 25 employees impart qualify for tax credits to starting time their cost (Kaiser Family Foundation, 2011). Consumer Operated and orient Plan (CO-OP). The ACA produces a new kind of non-profit wellness insurer, called a Consumer Operated and Oriented Plan (CO-OP). CO-OPs are meant to offer consumer-friendly, affordable health insurance options to single(a)s and small businesses. By January 1, 2014, individuals allow for be able to buy a CO-OPVicki D. Lachman, PhD, APRN, MBE, FAAN, is Clinical Professor, and Director, renewal and Intra/Entrepreneurship in Advanced Practice treat, Drexel University, College of Nursing and Health Professions, Philadelphia, PA. 248 health plan through the low-priced Insurance Exchanges. Pre-existing causation i nsurance plan. All covered benefits are available to individuals, even to treat a pre-existing rail. This program offers temporary protection for slew with pre-existing conditions until 2014, when insurance companies female genitalia no longer deny individuals coverage based on their health status.Young gr shambleup coverage. Individuals lot add or prevail their children on their health insurance policy until they reach age 26. The law makes it easier and more affordable for young adults to get health insurance coverage. Insurance Costs ACA holds insurance companies accountable. It as well as befriends individuals keep their costs d induce. dish out for for individuals premium dollar. ACA requires insurers merchandising policies to individuals or small groups to spend at least 80% of premiums on direct medical fretting and efforts to modify the grap sewe of share. Unfortunately, this does not apply to self-insured plans.Lifetime and annual limits. ACA restricts and pha ses out the annual dollar limits a health plan endure place on most of its benefits. Furthermore, ACA eliminates these limits completely in 2014. pasture review. Insurance companies must now release proposed rate increases for health insurance. Insurance companies cannot remonstrate rates by 10% or more without first explaining the reasons to the state or federal rate review program. Rights and Protections The ACA puts consumers in charge of their health kick, not insurance companies. The following rights and consumer protections are available. safe tutelagefulness.Individuals whitethorn not have to constitute a copayment, co-insurance, or deductible to receive recommended safety health serve, such as screenings (e. g. , mammograms and colonoscopies), vaccinations (e. g. measles, polio, or meningitis), and counseling (e. g. , smoking cessation, weight loss, well-grounded eating). Doctor choice and ER irritate. Individuals can choose all available a reside(p) autochth onic direction provider and they can access out-of-network emergency rooms without prior(prenominal) approval. ACA prohibits health plans from requiring a referral from a primary bid provider before women can seek coverage for obstetrical or ynecological (OBGYN) care. People 65 and older. ACA offers eligible elders a range of prophylactic military service with no cost-sharing. ACA similarly provides discounts on drugs when older adults are in the coverage gap cognize as the donut hole. July-August 2012 Vol. 21/ no. 4 Ethical Challenges in the season of Health Care Reform circumvent 1. Views of Liberal Egalitarians vs. Libertarians and Free-Market Advocates Liberal Egalitarians Libertarians and Free-Market Advocates Health care is a fundamental good and access to this good Role of government is con beautifuld to protecting the independence of all allows us to become full outgrowths of society. ersons to choose their own goals and means to pursue them. This right to heal th care must be exercised by removing all People have a right to non-interference. barriers to access. Justice, e gauge, and community are set. emancipation and ad hominem righteousness are values. Health care is a right. Health care is a commodity. Single-payer system is the solution. Decentralized commercialise mechanisms with personal payment are the solution. Preventive run. The list is probatory and begins with an annual wellness visit. Other important preventive services include bone mass cadence cervical cancer creening, including Pap position tests and pelvic exams colorectal, prostate, and diabetes screening influenza, pneumonia, and hepatitis B immunizations and galore(postnominal) new(prenominal) services. There are other(a) services and features in the ACA that could be discussed, but we will now move to discuss the ethical justifications for the ACA. The controversy it has created in the eyeball of individuals with a free-market or libertarian view will be compared to those with a liberalegalitarian outlook. Ethical Justifications for the ACA Since 1986, the emergency Treatment and Labor Act has taboo hospitals from refusing acute care to any ndividual who could not afford to pay (CMS. gov, 2012). Consequently, $100 billion of care annually is costshifted onto uncomplainings who can pay, almost all whom are insured. This shift raises the clean annual health insurance premium roughly $1,000 for every insured family (Crowley, 2009, p. 10). This leave out of dispersive justice for the insured is one reason why insurance is existence economyd in ACA. It is equally unfair to legislation that all citizens have insurance if 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 opposeed by the features of Affordable Insurance Exchanges and the development of Consumer Operated and Oriented Pl ans. Ethical reasoning for health care reform has relied primarily on distributive justice as justification for change, specifically due to deprivation of access to care for the underinsured and uninsured (Lachman, 2009). According to the U. S. Census Bureau, 46. 3 million wad in the fall in States were uninsured in 2008 (ProCon. org, 2012). The unify States is the further developed nation in the sphere hat does not guarantee health coverage. Table 1 offers a par of views of persons who support distributive justice, see health care as a right, and and so destiny a single-payer system with those individuals who want to continue the free-market system. To single-payer advocates, the primary goal of health policy is ensuring that everyone can obtain some minimal level July-August 2012 Vol. 21/ nary(prenominal) 4 of health care (Sade, 2007, p. 1429). do access to health care astray available permits individuals to be fully performance members of society and the righteous o mmunity (a group of people drawn together by a public interest in strengthenment according to a particular honorableistic philosophy). On the other hand, Americans who are libertarians and free-market advocates more often than not look beyond the natural (genetic) and accessible (upbringing) lottery that places some at a disadvantage and instead look to the individuals free will and personal responsibility for exercises (Callahan, 2011 Pariser, 2012 Trotter, 2011). They believe health care is one of the many another(prenominal) options from which to choose to improve their lot in life. Their belief in personal responsibility can make them unsympathetic o people with dehydrated lifestyles for whom they would finally have to spend their insurance dollars. They also resent having to fund treatments they in person would not choose (e. g. , transplants, mechanical breathing for person in persistent vegetational state). Though many wealthy individuals support health care refo rm out of benevolence, they do fear the loss of freedom which is central to their value system. However, two excess factors drive change for health care reform significant cost and feel problems. In 2007, health care expenditures add up $2. 2 trillion, 16. 2% of the U.S. economy. Health care employs more than 14 million people and is the largest industry in the get together States. Of the 193 WHO member states, the United States is ranked first in per capita health care expenditures ($6,719) (ProCon. org, 2012). The present health care system is not braggart(a) the utility for the dollars fatigued. This cost problem is a reason that ACA has a focus on physicians counseling individuals on end-of-life options. It found that astir(predicate) 30 percent of Medicare dollars are pass during the last year of life, and half of that is worn out(p) during the last 60 days. In 2009 dollars, Dr.Gordon calculated, that amounts to $70 billion a year, much of it spent on futile care that prolongs misfortunate (Brody, 2009, conservation of parity 20). Unfortunately, politics initially got in the way in 2009 with the death disp determine panel jargon and this counseling was dropped from ACA however, this end-of-life options counseling was incarnate into 2011 Medicare reimbursement for health care providers (HealthCare. gov, 2012b). 249 Ethics, Law, and Policy WHO (2011) statistics also indicate the money spent is not putting us at the top of the list in quality outcomes. The infant mortality rate for the United States in 2009 was even deaths per 1,000 live births, ranking the United States 43rd among WHO nations. Rates for Sweden, Spain, Italy, Germany, France, Czech Republic, Slovenia, and Iceland are all half of the United States rate. shade is a focus of ACA in the preventive realm and with quality measurement. Two immanent principles of the ACA are that 1. Provider reimbursement for health services is based, in part, on the relative quality and patient exper ience of the care provided. 2. info well-nigh that comparative quality and patient experience will be publicly accessible. Quality and patient satisfaction will be rewarded by ata from hospital simile ask by the Hospital Consumer perspicacity of Healthcare Providers and Systems for Medicare patients. The implications of Value-Based Purchasing (VBP) regulations for hospitals are clear FY2013 implementation at 1% of base DRG payments, rising to 2% by FY2017 (Acton, 2012, para 2). Hospitals will have to earn it back up by achieving and maintaining high quality and haughty patient experiences. This consequential focus in the patient care experience supports the main(a) choice of the patient for hospitals and physicians. Ethical Challenges of ACA ratified ChallengeBefore discussing three key ethical contends health care providers will face, the legal challenge before the Supreme beg call for to be addressed. This challenge determined if the ACA unavoidableness to purchase hea lth insurance violates article 1, Section 8, Clause 3 of the U. S. organic law Congress shall have the Power To lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common Defence and the general Welfare of the United States but all Duties, Imposts and Excises shall be analogous throughout the United States (Werhane & Tieman, 2011, p. 83)The argument against this polity is that the government has never required people to buy any good or service as a condition of lawful residence in the United States. However, every working person is required to pay into Social Security and Medicare. The promise argument is that these are government- regulationd and governmentrun programs. This argument ultimately could support a Supreme judgeship termination of only a government-run singlepayer system, an action libertarians and free-market advocates oppose. Second, there are requirements for car insurance for drivers, and flood insurance for persons ho li ve within authorized distance from a possible flood plain. Because all people will need health care at some point in their lives, the argument could be made that insurance should be a requirement so as not to burden the deterrent example community with the costs of those who do pay for insurance (Hamel & Nairn, 2011). 250 On June 28, 2012, the U. S. Supreme Court endorsed most of the Patient Protection and Affordable Care Act, including the glutious individual mandate that requires most Americans to obtain health insurance. In a 5-4 decision, the court said the federal government has he power to fine Americans who do not acquire insurance because it is considered a tax (Jaslow, 2012). Electronic health check Records The requirement for electronic records could generate a significant ethical challenge for hiding and confidentiality. Unfortunately, the $20 billion for health culture technology from the American Recovery and Reinvestment Act (ARRA) did little to change the current HIPPA screen paradigm (Crowley, 2009). Furthermore, it is likely patients will halt their personal health records in their own electronic devices or retrieve them through the Internet.A transformation in rural health care is likely through telehealth and telehomecare. These innovations will bring expertise to patients to facilitate the beat out choice in their treatment decisions. The challenge will be to assure apprised consent and confidentiality in this expanded digital age. Chronic Disease Management Individuals with inveterate sickness benefit significantly from alleviant care services, not just at end-of-life care but throughout the affection progression. The ACA focus on chronic unhealthiness counseling is best exemplified by this set phrase An integrated care go on to managing illness hich includes screenings, check-ups, monitoring and coordinating treatment, and patient fostering (HealthCare. gov, 2012b, para 1). Feministic ethics, with its focus on managing th e particulars of any persons situation, celebrates this personalized service to individuals who must manage illnesses often for many years. In her book, Caring A powder-puff Approach to Ethics and Moral Education, Nell zero(prenominal)dings (2003) argued that a morality based on rules is inadequate. She contended this approach loses the richness of the moral dilemmas people face, and nly situational and contextual enjoyledge of the individual can help resolve the moral quandaries of life. Shaping Health Care Policy According to the legislation of Ethics for Nurses, provision 9 (American Nurses connexion ANA, 2001), nurses have an obligation to work severally as citizens or collectively through political action to bring about social change (p. 25). This responsibility to execute social (health care) policy calls for nurses to voice concerns about the meaning of the rejection of the individual mandate for society. The libertarians and free-market advocates reinforce a caricatur e of American individuality and weaken a sense of responsibility for oneself and fellow citizensIt neglects one side of the equation, forgetting that we are not only individuals with the freedom to choose, but also members of society called to uphold a common good. (Hamel & Nairn, 2011, p. 94) continued on paginate 245 July-August 2012 Vol. 21/No. 4 Ethics, Law, and Policy REFERENCES continued from page 250 Therefore, nurses and nursing associations have the ethical challenge to stand starchy for patients and ensure the long-term sustainability of our health care system.Nurses need to advocate for the people without a voice those discriminated against because of health status and lack of insurance. Conclusion ACA has provided a forum for line about not only health care insurance, mechanisms to maintain financial stability of its systems, and strategies to ensure access to millions of people, but also has contributed to defining American societys values. It is easy to argue ag ainst the individual mandate impingement on choice and freedom. However, other provisions provide children, adults, and elders with coverage and services that will help keep hem healthy and support them in their management of chronic diseases, while quelling the fear of bankruptcy. The Supreme Court will nail down the legal matters in ACA, but it will not resolve the ethical matters. outhouse Americans continue to allow the self-protective practices of insurance companies in excluding high-risk individuals (e. g. , pre-existing conditions, lifetime caps on benefits)? The principle of autonomy was never meant to free the moral relationships that continue to be infallible for the human good. The nurse respects the worth, dignity and rights of all human eings irrespective of the spirit of the health problem (ANA, 2001, p. 7). July-August 2012 Vol. 21/No. 4 Acton, A. (2012). The hidden risk (or reward) of HCAHPS. Retrieved from http//blog. healthstream. com/blog/bid/103384/The-Hi dden-Risk-orReward-of-HCAHPS American Nurses Association (ANA). (2001). enroll of ethics for nurses with interpretative statements. Silver Spring, MD Author. 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 aesculapian Treatment & Labor Act (EMTALA). Retrieved from http//www. cms. gov/Regulations-and-Guidance/ canon/EMTALA/index. html? redirect=/EMTALA/ Crowley, M. (2009). Connecting American values with health care reform. Garrison, NY The Hastings Center. Hamel, R. , & Nairn, T. (2011). The individual mandate A rancorous moral matter. Health Progress, 92(4), 88-95. HealthCare. gov. (2012a). Affordable Care Act. Retrieved from http//www. health care. gov/law/full/ HealthCare. gov. (2012b). Chronic disease management.Retrieved from http/ /www. healthcare. gov/ colour/c/chronic. html Jaslow, R. (2012). Medical groups inspire Supreme Courts decision on Affordable Care Act. Retrieved from http//www. cbsnews. com/8301504763_162-57462837-10391704/medical-groups-laud-supremecourts-decision-on-affordable-care-act/ Kaiser Family Foundation. (2011). summary of new health reform law. Retrieved from www. kff. org/healthreform/8061. cfm Lachman, V. D. (2009). Ethical challenges in healthcare Developing your moral compass. New York, NY Springer. Noddings, N. (2003). Caring A womanly 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. Clinics in Dermatology, 30(2), 151-155. 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. T rotter, G. (2011). The moral basis for healthcare reform in the United States. Cambridge quarterly of Healthcare Ethics, 20(1), 102-107. Werhane, P. , & Tieman, J. 2011). Clearing the brush Myths smother the Affordable Care Act. Health Progress, 92(4), 82-84, 86-87. globe Health Organization (WHO). (2011). World health statistics 2011. Retrieved from http//www. who. int/whosis/indicators/WHS2011_ IndicatorCompendium_20110530. pdf 245 Copyright of MEDSURG Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holders express written permission. However, users may print, download, or email articles for individual use.