Abstract
This paper dwells upon the major ethical issues associated with the recent changes in the healthcare system, namely its passage from Obamacare to Trumpcare. The primary focus of the present healthcare reform is the reduction of taxes associated with the American Health Care Act (AHCA) and the services provided to people. Therefore, one of the central ethical issues related to the upcoming changes in the increase in inequality as fewer people will have access to high-quality healthcare services.
The most vulnerable groups (women, the elderly, and children) will be most affected. Another ethical issue is the absence of a detailed plan that could ensure the sustainable development of the US healthcare system. Opponents of the Trumpcare call the reform irresponsible and unethical due to this lack of detail. Nursing practitioners will also face various ethical issues. For instance, they may face ethical conflicts related to their patients’ access to resources and services.
Nursing professionals are trained to provide care to people, but this will be difficult or impossible in many cases. At that, nursing practitioners have certain guidelines that can help them address some ethical conflicts. These guidelines are the code of conduct of their healthcare facilities and nursing organizations’ codes. It is noteworthy that nurses can and should contribute to the development of solutions to the arising ethical conflicts.
This can be done through the launch of discussions of the issues on different levels including their healthcare facilities, the community, healthcare organizations, and so on. Nurses need to communicate with patients and their caregivers to identify their needs and the problems they encounter. The patients having no access to healthcare services still have some options such as state subsidies, charitable projects, addressing policy-makers.
Introduction
The Affordable Care Act (ACA) is regarded as one of the major accomplishments of Democrats that have made American society better. Republicans’ opposition to this healthcare policy has been intense, and the start of Trump’s presidency was marked by the discussion of repeals and immediate changes to the ACA (Zurcher, 2017). The American Nurses Association, as well as numerous nursing organizations, has opposed the repeal of the ACA revealing the flaws of the new Republican policies.
The opponents of the so-called Trumpcare address different aspects of the new policy. This paper includes a discussion of the major ethical issues associated with the new healthcare reform. Some views on the role nurses can play in this process are highlighted.
Main Discussion
First, it is necessary to summarize basic changes the Trumpcare will bring. The central change is the significant decrease in the population who will have health insurance. The new healthcare policy will not imply any tax penalties for those who will not have health insurance. Large companies will not be required to pay the penalty if they have uninsured employees. However, it turns out that Republicans are not ready to repeal Obamacare completely due to various reasons including political, economic, ethical, and so on (Zurcher, 2017).
As a result, approximately 90% of the taxes imposed to maintain the ACA will be sustained. States will be allowed to end the coverage of some health conditions or allow waivers to establish a maximum sum they will pay. According to the Trumpcare, states are allowed to revisit the provision concerning the pre-existing health conditions. States are allowed to repeal the coverage of maternity care and contraceptives. The new healthcare policy also allows states to charge older Americans more.
Finally, the Republican’s healthcare reform allows states to develop their subsidy plans instead of the use of Obamacare’s refundable tax credits provided to low-income individuals. It is noteworthy that the reform is not as dramatic as it was expected to be. Republicans have different views on the matter, and many provisions of Obamacare are still used due to the lack of agreement within the Republican party (Kelly, 2017). The debate concerning the future of the healthcare system and the process of policy-making is still ongoing.
The described changes are associated with several ethical issues. For example, the major ethical concern is related to the decrease in the number of insured people (Fornili, 2017). The inequality within the American society is likely to increase if the Trumpcare is implemented and all Trump’s promises are brought to life. Such vulnerable groups as low-income individuals, older adults, women, and children will have limited access to high-quality services. The reform is likely to make the gap between the rich and the poor even bigger. The major ethical concern for nurses will be their inability to provide the care their patients need due to the limitations of their insurance plans.
Obama (2017) stresses that Republicans are making a huge mistake trying to repeal Obamacare. They do not have a specific plan for the development of the healthcare system as the Trumpcare presupposes certain repeals of the existing policy. In simple words, the country will have no sound plan as to the development of the healthcare system. Some changes are already criticized and called inconsistent with the directions chosen by Republicans themselves (Kelly, 2017).
This peculiarity of the policy is associated with another ethical issue. The healthcare reform has long been a matter of political games while people need a specific plan that will ensure their access to high-quality healthcare services (Jones, 2017). Nursing professionals can and should be the practitioners who will make the reform more clinical rather than political. Nurses can bring to the fore particular issues they face every day. The reform cannot be a sum of repeals but should be a relevant plan addressing the needs of the stakeholders.
Furthermore, nurses will have to address numerous ethical issues as their commitment to providing care to everyone irrespective of any aspects of their identities will be challenged. Nurses will be unable to provide a full set of the necessary healthcare services to those who have basic insurance plans or have no insurance at all (Fornili, 2017). Importantly, any healthcare system, and especially reforms, tend to be related to certain ethical challenges for nursing professionals.
The major reason for that is the peculiarity of human nature. All people have different views so nurses may support different approaches to the provision of health care. For instance, some nurses can be devout Republicans and welcome the upcoming changes while many nurses are likely to support the Democrats’ views on the matter and oppose the Trumpcare. Both groups have to provide high-quality services and complete assigned tasks.
Another important role a good nurse has to perform is the role of an educator. Nurses can help patients find various solutions to access healthcare services. Nursing practitioners should have the necessary knowledge as to options available in their healthcare facility and state (as well as other states across the country).
Finally, nurses may face certain ethical issues related to the role of an advocate. The reform that is shaping the US healthcare system discourages practitioners from advocating for vulnerable groups. The global economy is facing financial constraints, and almost every healthcare facility has reduced budgets, healthcare professionals are overwhelmed with tasks and responsibilities. These circumstances make many nurses reluctant to become advocates for any group. Therefore, nursing practitioners should also solve the conflict between their responsibility to advocate and other responsibilities. In many cases, nurses choose to focus on clinical tasks and neglect other roles.
It is necessary to note that the ANA has a specific ethical code that helps nurses address their daily challenges. When the healthcare reform was obsolete, such guidelines were specifically helpful as nursing professionals could stick to the norms that existed within the field (Morley & Jackson, 2017). However, even such codes could not be applied to all situations. Nurses have employed three strategies to address the conflicts between their profession and ethics: leaving the field, trying to get used to certain circumstances, try to change the situation or the entire system. The first strategy is quite common, which is associated with the low popularity of the profession (Morley & Jackson, 2017). Many nurses change their values and personal codes to handle the conflict. Many nursing practitioners choose to fight and seek changes.
Numerous strategies to negotiate the mentioned conflicts exist. First, the nurse can initiate a discussion of a particular situation or conflict, which can lead to the development of some guidelines in the healthcare facility. These codes can help the nurse and other practitioners cope with certain ethical issues. Nurses can also address nursing organizations and associations with the initiative to develop guidelines or codes.
Morley and Jackson (2017) stress that advocating is one of the roles performed by a good nurse. Hence, nurses can and should affect the changes that occur within the system. The ANA has been one of the major critics of the Trumpcare and advocates of the most vulnerable groups (Fornili, 2017). The organization can have a more significant impact on policies as compared to individuals. However, individuals within such organizations initiate discussions and action plans aimed at changing the norms that conflict with good nursing practice. The continuous discussion of the existing problems can make policymakers develop systems and frameworks that will help address the issues effectively.
It is important to add that nurses’ actions will be shaped by their daily practice and communication with patients and their caregivers (Morley & Jackson, 2017). The completion of clinical tasks is not the only area where ethical issues arise. The interactions between nurses and patients often unveil the gaps to be addressed. Nurses communicate with patients and learn about their needs and concerns. This information is employed to develop programs, policies, guidelines, and so on. Effective communication with patients, their caregivers, and other stakeholders is essential for the implementation of any changes.
As for the individuals who are still uninsured, these people have several possible solutions. They can simply pay for each healthcare service out of their pocket once they need some services. However, this solution is not affordable for many people who remain uninsured due to financial constraints. In many states, vulnerable groups will still be able to apply to receive certain subsidies (Zurcher, 2017). The last resort is to address organizations and individuals.
Those who have no insurance but need healthcare services can address a healthcare facility’s administration. If the facility has sufficient funds, the services are provided free of charge or at reduced prices. Such people can address individuals or charities, which can also be useful. Finally, they have their right to fight and make their representatives bring their issues to the fore. Uninsured people should negotiate with healthcare professionals, politicians, and policymakers, etc.
Conclusion
In conclusion, the changes taking place within the US healthcare system are related to numerous ethical challenges healthcare professionals have to address. One of the central nurses’ functions will be jeopardized as millions of people will have no access to high-quality healthcare services. Nurses will have to handle various ethical conflicts every day. Apart from the challenges mentioned above, nursing professionals still have to align their values with the existing codes and guidelines associated with the good practice.
One of the ways to address the problem and solve at least some ethical issues is to focus on advocacy. Nurses should be active advocates for the most vulnerable groups. These healthcare professionals should educate and guide patients and their caregivers to help in accessing high-quality healthcare services. Nurses can draw policy-makers’ attention to the gaps and controversies within the system or reform, which can have positive effects in the long run. Such organizations as ANA can become the centers of this advocacy and the overall changes.
References
Fornili, K. (2017). Socialized risk and privatized profit. Journal of Addictions Nursing, 28(3), 157-165.
Jones, D. K. (2017). The Democrats’ dilemma. The Milbank Quarterly, 95(2), 241-244.
Kelly, A. (2017). Health reform in the Trump era: Will politics unmake policy? The Forum, 15(2), 345-362.
Morley, G., & Jackson, J. (2017). Is the art of nursing dying? A call for political action. Journal of Research in Nursing, 22(5), 342-351.
Obama, B. (2017). Repealing the ACA without a replacement — The risks to American health care. New England Journal of Medicine, 376(4), 297-299.
Zurcher, A. (2017). Obamacare v Republican plan compared. BBC. Web.