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The Affordable Care Act: Healthcare and Ethics


Any substantial government reforms, even those that are generally beneficial for the people, create certain ethical conflicts and discourses. The Affordable Care Act (ACA), also known as Obamacare, has sought to expand health care access by increasing state health expenditures to provide more coverage to vulnerable populations, while at the same time lowering health care costs over time (Amadeo, 2017).

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The majority of states have already adopted the ACA, and while the program provides a lot of health benefits for the people, its implementation has also raised certain ethical conflicts that medical professionals have to negotiate. As part of their daily duties, nurses spend more time with the patients than doctors do; they are also entitled to make certain treatment decisions, administer medication, and more, which makes them responsible for negotiating ethical conflicts, including those caused by the ACA. This paper aims to outline the main conflicts between health care and ethics that arose due to the ACA, as well as to suggest ways in which the nurses could negotiate such conflicts efficiently.


One of the most serious implications of the ACA is the change from a fee for service model to that of bundled payments, which means that the hospitals and medical professionals would receive a fixed amount of money for treating a patient, regardless of the costs implied (Hiseh, 2014). This could cause hospitals to cut down on the services provided to patients or the quality of treatment in order to maximize the financial benefit (Hiseh, 2014). This creates a serious ethical dilemma due to the conflict of interests implied.

The cheaper treatment may not be as effective as the most expensive one, or the patient may need a costly diagnostic procedure such as MRI, which costs more to the hospital than the money it would receive for the patient. One of the primary duties of nurses, as well as other medical professionals, is to ensure that the person receives effective treatment, so the implication here is that the hospitals should still provide the best quality of care to the patient, even if it is not cost-effective. However, the profits are also important to hospitals as they can be spent on modernizing the technologies used, improving the facilities, and hiring more staff, which would lead to a better quality of service in the long-run. Nurses will have to address this ethical conflict in choosing treatment and diagnostic options.

Physician Shortages

Pariser (2012) states that another problem of the ACA is the projected increase in physician shortage. Indeed, a recent report from the AAMC (2017) confirms that the growing shortage of physicians and projects further increase, tying it to the implementation of the ACA. Due to the decrease in funding, many hospitals would opt for dismissing highly-qualified expensive doctors and hire more nurses, practitioners, and physician assistants to fill the gaps (Pariser, 2012). While the nurses have extensive knowledge regarding diagnostics and treatment, there are two different ethical conflicts in nursing that may arise due to the physician shortage.

First, the growing number of duties and requirements will increase the pressure on all hospital workers, including nurses. This may lead to burnout and medical errors, which will negatively affect the quality of service and treatment outcomes. Secondly, the nurses may not be experienced or qualified enough to diagnose and handle certain diseases or conditions, which leads to a risk of treatment mistakes or incorrect diagnoses. The hospitals may not be able to reassign the patient to a physician due to the low availability, and the nurse will have to determine the right course of action for the particular patient. Apart from being a major ethical conflict, this scenario also increases the nurses’ accountability and, thus, the pressure to provide the best treatment possible.


Moffit (2016) argues that another significant failing of the ACA is the fact that some of the increased spendings may end up funding abortions. Despite President Obama’s claims that the prohibition on using federal taxpayer money for abortions will remain intact after the introduction of the ACA, “the ACA authorizes federal funding of abortion in its ‘qualified’ health plans, a sharp break from the previous law” (Moffit, 2016, p. 10). The multi-state health plans, administered by the OPM, on the other hand, requires the government to contract with at least two national health plans, one of which must offer abortion coverage in the ACA exchange (Moffit, 2016). For hospitals, this may mean an increase in the number of patients signing up for abortions due to their lower costs.

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The nurses may have to care for the patient and support them before or after abortion, which creates a significant ethical conflict if the nurse’s beliefs about abortions contradict the patient’s needs. The nurse may not be able to provide the patient with the necessary support and care if she judges the patient or despises her decision, and it may take a lot of energy and effort for the nurse to overcome her feelings and provide equal treatment and care to all patients regardless of his or her beliefs.


By lowering the costs of health care and health insurance, the ACA enabled access to medical care for more people from low-income backgrounds. Despite the fact that the ACA does not cover undocumented immigrants, the size of ethnic communities that pass the eligibility criteria is quite large. This leads to growing diversity among the patients that nurses care for and treat.

Treating patients from various ethnic, cultural, and religious backgrounds may pose an ethical challenge for the nurse, as the patient’s beliefs regarding treatment, care, and death may be different from the nurses. Some cultures require people to avoid certain medication components, causing the patients to refuse the treatment. Other cultures have rules regarding the interaction between men and women, or adults and children. Failure to adhere to the traditions of the patient’s culture may cause emotional distress, which will impair the results of care and treatment.

Conclusion: Negotiating Ethical Conflicts

Overall, the ACA has caused several large ethical conflicts for the nurses to negotiate, which can sometimes prove to be a difficult task. There is no specific framework that could be used by the nurses to negotiate every ethical conflict in their practice, but there are certain suggestions that should be followed to ensure satisfactory outcomes. First, it is crucial to determine the possible actions that can be taken and evaluate them, outlining the benefits and disadvantages that may result from them. Next, the nurse should consider the patient’s interests.

Patient-oriented care is the key to managing ethical conflicts; however, it is crucial to remember that patient’s physical health is not the only concern and that it is also essential to evaluate emotional harm that a certain decision may cause. To prevent medical errors, the nurses should focus on building their knowledge about diagnostics and treatment – for instance, by participating in conferences, or completing additional courses. Finally, in caring for a diverse community of patients, the nurses should learn to set their inner feelings and beliefs aside if they impair the quality of care. These recommendations would help nurses to negotiate ethical conflicts in a way that ensures a positive outcome for all sides.


Association of Americal Medical Colleges (AAMC). (2017, March 14). New research reaffirms physician shortage. AAMC News.

Amadeo, K. (2017, May 24). Benefits of Obamacare: Advantages of the ACA. The Balance.

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Hiseh, P. (2014, January 28). How Obamacare creates ethical conflicts for physicians and how patients can protect themselves. Forbes.

Moffit, R. (2016, April 1). Year six of the Affordable Care Act: Obamacare’s mounting problems. The Heritage Foundation.

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.

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