Ethical Challenges of Health Care Reform/Obamacare

Discussions about Obamacare or the Affordable Care Act (ACA) are centered on implementation issues such as insurance exchanges and ethical issues that this landmark legislation has raised. President Obama had noted that there was a rising number of Americans being unable to afford health insurance and proposed this healthcare reform in 2010 (Oberlander, 2012). The Act requires that all companies with about 50 or more full-time employees cover them with health insurance to at least 95% of their full-time employees including their dependents up to an age of 26 (Oberlander, 2012). This is making the companies reevaluate the full-time status of the employees.

Many of the critics of this Act are of the view that the requirement on Americans who meet certain criteria to purchase the healthcare insurance is unethical. The cost of implementation is also high, and the act tends to increase the insurance rates for individuals (Oberlander, 2012). Family heads, employers, and medical professionals have a duty of providing a sense of stability, honest services, and reasonable security to those in their charge. However, Obamacare challenges these moral principles. Americans are getting it hard to uphold as they are being coerced to make decisions on healthcare that affect their lives.

Further ethical issues of this include moral foundations, public health, cost containment and access to healthcare. These moral and ethical issues are founded on the concept of distributive justice, particularly due to limited access to health care for the uninsured and the underinsured (Kantarjian, Steensma & Light, 2014). Since resources are limited, they should be allocated in a way that would provide the greatest good for many participants. States have been given an option to decline or accept the Medicaid expansion. Some states now hold that they cannot afford this expansion since it is financially unstable for the taxpayers and that it degrades the present premium health care system. The implementation of this act is therefore split among states with about 11 states not participating and only 19 participating (Carol, 2014).  Others are either undecided or leaning towards participating or not participating.

How Nurses Should Negotiate these Conflicts in Obamacare

Coping with these dilemmas in nursing require nurses to put the needs of the patients first. However, many times it may mean taking care of the needs of many above the needs of the few especially in the cases of practice (Carol, 2014). Nurses who get an opportunity to speak about their views about certain ethical decisions to the members of the team, ethical committee or the administration would be in a better position to cope with these issues whenever they arise. Nurses must understand that ethical challenges are part of nursing practice. There is no way to escape them, and therefore nurses must handle such issues with aplomb and grace. In cases where nurses are struggling to provide effective care due to policy and restrictions, it is important that nurses bring such issues before the advisory committees in a hospital or to the administration so that the issues can be solved in an ethical and moral way (Kantarjian, Steensma & Light, 2014).


Obamacare has presented many ethical challenges to nurses and nurses are finding themselves being unable to provide adequate healthcare to patients. The main dilemmas are centered on how to best provide care to patients where health care policies seem to present a conflict. Nurses must act as advocates for the needs and the rights of patients rather than trying to chicken out whenever a conflict arises. This would be the best intervention that would improve the welfare of a patient.



Carol, M. (2014). Does the Accountable Care Act aim to promote quality, health, and control costs or has it missed the mark? Comment on “Health system reform in the United States”. International Journal of Health Policy and Management, 2(2), 97-99.

Kantarjian, H. M., Steensma, D. P., & Light, D. W. (2014). The Patient Protection and Affordable Care Act: Is it good or bad for oncology? Cancer, 120(11), 1600-1603.

Oberlander, J. (2012). The future of Obamacare. New England Journal of Medicine, 367(23), 2165-2167.



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