Ethical Challenges in Healthcare Reform Dominate Era

Healthcare reforms in the United States still remain highly emotive. When the current regime took over from the Obama administration, one of the primary goals was to repeal and replace the Patient Protection and Affordable Care Act, popularly known as the Obamacare (Glied & Adlan, 2017). It was viewed as a piece of legislation that ignored concerns of many stakeholders and unfairly overburdened tax payers in the country. As such, the current administration enacted American Health Care Act of 2017 also known as Trumpcare (Waitzkin, 2018). It was a deliberate effort to address weaknesses and excesses of the Obamacare.

The senate rejected the bill, which meant that the country still had to rely on the Obamacare, which had become unpopular with the current regime. In the current era where healthcare reform dominates, ethical challenges often emerge, especially among practitioners such as doctors and nurses. One of the ethical issues that often face nurses is how to handle patients who cannot afford healthcare without the support of the government but do not qualify for the support as stated by the law. In this paper, the focus is to discuss how nurses can deal with such ethical challenges in a professional and compassionate way.


The attempt by the current administration to replace the Obamacare failed in the senate. However, that did not stop the government from using executive orders and other executive powers to limit the application of this law (McIntyre & Song, 2019).

However, many states are still embracing the Obamacare as the most comprehensive healthcare act that protects all Americans, especially the low-income earners. Since this law came into force and the subsequent amendments that have been made on it, medical practitioners have been facing various challenges. One of these challenges is how to assess when one qualifies for a full government support. Part of this act reads as follows, “All US citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program” (Waitzkin, 2018, p. 56).

The Ethical Dilemma

The ethical concern that medical staff often face is determining whether one is qualified to get the federal support. Sometimes nurses are tasked with determining the qualification of a patient. In many cases, they encounter cases where one is barely below the set threshold. One may be having an income of 135% of the poverty line but the cost of medication may be too high for them to afford through their private insurance policies or payment by cash (McIntyre & Song, 2019). Others may have so many dependants that their income is often barely enough to meet all their basic needs. Such cases are common in the United States, and it sometimes presents a major challenge to those who are assigned the task of screening the patients to determine if they can be granted the federal support.

The dilemma that these nurses face is whether to follow the law and apply it strictly by denying these individuals healthcare services if they cannot pay from their own pockets or to slightly bend the law when faced with cases deserving the federal support. When a nurse fails to report a case where an individual who do not qualify for federal support uses other means to fall within the threshold, legal actions may be taken against them.

On the other hand, applying this law strictly may mean denying a deserving patient the healthcare services that they need. The consequences of denying them the healthcare support may be devastating, including a possible death (Glied & Adlan, 2017). Such an action may be equivalent to passing a death sentence on the patient. The majority of nurses and other practitioners often do not want to find themselves in making such decisions that may either cause the death of a person or compromise their career growth.

How Nurses Should Negotiate Such Conflicts

When trying to determine how to address this problem, it is necessary to consider how nurses have historically handled conflicts between ethics and their profession in a time where health care reform was obsolete. According to Glied and Adlan (2017), the primary role of nurses is to offer patients healthcare services to the best of their capacity. When legal systems breakdown, such as during wars when healthcare reforms are obsolete or inapplicable, this primary role of nurses do not change.

As Waitzkin (2018) observes, during the First and Second World Wars, American nurses offered their services to wounded soldiers irrespective of their allegiance. They ensured that everyone who was brought to them got the best care and their health restored in cases where that was possible. In an era where it was easy for these doctors to ignore or even harm enemy soldiers, they chose to be compassionate because that is what is expected of them. The same principle should be applied when handling patient at a time when healthcare reforms remain controversial in the country.

What Happens to Patients That Still Do Not Have Insurance

It is important to note that some patients still lack any form of health insurance cover. According to McIntyre and Song (2019), the majority of these people are illegal immigrants who lack formal documentation that can allow them to get the medical cover that they need. They are often blue-collar workers employed in the industrial, transport, and agricultural sectors. For nurses, the primary focus should not change.

When these patients are brought to them, they should focus on offering them quality care to help them overcome their condition. After that, it will be the responsibility of the hospital’s management to find ways of recovering the cost through various means available. As Glied and Adlan (2017) insists, nurses should not be involved in the process of screening patients to determine whether they qualify for the federal healthcare support because it may be tormenting for them to deny some of these needy people the help they deserve.


In the current era where healthcare reform dominates public discourse, nurses face various ethical dilemmas in cases where they have to make sensitive decisions when offering their services. Cases often arise where these have to determine whether a patient should get healthcare services based on the threshold set by the law. Denying any patient medical services because they do not qualify based on the existing law may be an emotionally draining decision for any nurse to make. Their primary goal is to always assist all patients in the best ways they can to ensure that their good health is restored. The study recommends that government should ensure that nurses and other medical practitioners are not be subjected to cases where they have to make such decisions.


Atkinson, G., & Giovanis, T. (2015). Impact of the patient protection and affordable care act: Overview. American Journal of Public Health, 105(5), 631-632.

Glied, S., & Adlan, J. (2017). The future of the affordable care act and insurance coverage. American Journal of Public Health, 107(4), 538–540.

McIntyre, & A., Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Med, 16(2), 1-11.

Waitzkin, H. (2018). Health care under the knife: Moving beyond capitalism for our health. Working Group for Health beyond Capitalism.

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