Nursing Paper on Conflicts Between Ethics and Healthcare Reform

Conflicts Between Ethics and Healthcare Reform

The Patient Protection and Affordable Care Act (ACA), famously known as Obamacare, is a United States federal statute enacted by the 111th U.S Congress. On March 23, 2010, President Barrack Obama signed the federal statute into law. The statute majorly focused on healthcare reforms and covered eight basic consumer protections. The consumer protections were inclusive of extended coverage for young adults, no lifetime and annual caps on coverage, no gender discrimination, no cost-sharing for preventive care, no exorbitant deductibles, no dropping of coverage when one becomes seriously ill, guaranteed insurance renewal so long as premiums are paid, and no discrimination of people with pre-existing conditions. President Donald Trump later enacted the Trumpcare that replaced the Obamacare. There exist conflicts between ethics and health care reform in the form of Obamacare and Trumpcare.

Conflicts Between Ethics and Healthcare Reform

In recent years, healthcare coverage for Americans has reduced significantly under the Trumpcare. This is contrary to Obamacare that advocated for an increase in healthcare coverage. According to Congressional Budget Office (CBO) statistics, approximately 24 million people in the U.S. are set to lose health care coverage under Trumpcare over the next decade. There is the perception that Trumpcare has dismantled and prevented the expansion of the Medicaid program that has been of significance to the large working population across the U.S. Also, under the healthcare reforms, states can get a waiver from insurance companies that are obliged to cover all essential health care services (McNees, 2018). States use the money for an individual or small group plans benefits. For instance, states such as Ohio and Arkansas have made healthcare coverage programs such as Medicaid meaningless. These states have been using the money to purchase exchange policies thus cutting off health care benefits for people such as access to quality and effective health care services as well as reduced costs of care delivery. Under Obamacare, effective consumer protection on people with pre-existing conditions was majorly emphasized (Morden, 2017). The situation is different under Trumpcare that has jeopardized Medicaid program turning it into a block grant for the states. As such, people with pre-existing conditions are not well protected as their chances of attaining better and improved healthcare services are threatened.

How Nurses Should Negotiate Such Conflicts

To intervene in the conflicts between ethics and health care reform, nurses should focus on three critical issues including reform of the private insurance market, expanding the Medicaid program, and changing of medical decisions. Concerning the reform of the private insurance market, nurses should advocate precisely on the insurance companies to accept more health risk and offer comparable policies at favorable and constant rates. As a result, many people will get premiums to ensure access to better healthcare services (Field, 2015). Furthermore, competition among insurance companies will be encountered thus triggering a reduction in premiums, and a large percentage of the population will benefit. Additionally, nurses should emphasize the expansion of the Medicaid program (Silvers, 2013). A large population of Americans will access healthcare services easily and improve their livelihoods and health status. Nurses should negotiate to bring changes to medical decision-making processes. They should advocate for the federal government’s adoption of new and better medical practices such as compensation for new systems of health care (telemedicine and nurse-driven clinics) and adopting alternative organizational arrangements such as medical homes (Salmond & Echevarria, 2017). As a result, a value-based benefit will be witnessed in the healthcare service delivery across the U.S.

The conflicts between ethics and health care reform brought upon the execution of Obamacare and Trumpcare cannot be ignored. The disputes, some of which are mentioned above, could affect health care service delivery. Nurses have a role to play in preventing such conflicts and their adverse effects on healthcare service delivery to citizens.




Field, R. I. (2015). The Ethics of Expanding Health Coverage through the Private Market. AMA journal of ethics17(7), 665. Retrieved from

McNees, P. (2018, October 16). Dying, Surviving, Or Aging with Grace. Retrieved from

Morden, S. (2017). The Ethical Right to Healthcare in the Affordable Care Act. Retrieved from

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing36(1), 12. Retrieved from

Silvers, J. B. (2013). The Affordable Care Act: objectives and likely results in an imperfect world. The Annals of Family Medicine11(5), 402-405. Retrieved from