Ethical Challenges in the Era Of Health Care Reform

n truth, the United States is at the beginning of a long overdue and a much needed health care reform. We have seen the dismal statistics about our high cost health care system and some of the less than stellar outcomes (e.g., infant mortality) (Callahan, 2011; World Health Organization [WHO], 2011)). The purpose of this article is not to complain about the current health care system, but instead to focus on existing reform efforts — The Patient Protection and the Affordable Care Act (ACA), the ethical justifications for its creation, and ethical challenges it brings. Key Features of the Law ACA offers new ways for consumers and providers to hold insurance companies accountable. The most impor-tant parts of the law are features described in the follow-ing discussion. Because of space limitation, I will high-light some elements of the law that are enacted through 2014 and clearly impact nursing. These selected features include insurance choices, insurance costs, rights and protection, and people age 65 and older. Insurance Choices The intention of the law is to expand health care cov-erage to most U.S. citizens and permanent residents by requiring most people to have or purchase health insur-ance (HealthCare.gov, 2012a). Citizens will have a choice of private insurance, employer-paid insurance, Medicaid, Medicare, or state-based insurance exchanges. Affordable Insurance Exchanges. Individuals and small businesses can purchase coverage through these exchanges, with premium and cost-sharing credits avail-able to individuals and families with income between 133%-400 % of the federal poverty guideline (in 2011, the poverty guideline was $18,530 for a family of three) (Werhane & Tieman, 2011). Businesses with 50 or more employees need to make coverage available, and businesses with less than 25 employees will qualify for tax credits to offset their cos