Identify and discuss any conflicts that exist between ethics and healthcare reform that has been brought upon the execution of the affordable care act aka Obamacare/Trumpcare. Also, explain how nurses should negotiate such conflicts. Consider how nurses have historically handled conflicts between ethics and their profession in a time where health care reform was obsolete. What happens to those patients that still don’t have insurance?
Word Length: 1500-2000 words
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he pitchforks are changing hands. In 2009, it was Democratic members of Congress supporting health-care reform who were set upon by outraged constituents. When they passed the Affordable Care Act anyway, it cost their party control of Congress in the 2010 midterm elections. House Republicans subsequently voted more than fifty times to repeal or cripple the A.C.A. Nineteen Republican-led states spurned the offer of federal funds to expand Medicaid coverage. In January, Donald Trump’s first act as President was to order government agencies to avoid implementing, as much as is legally possible, what has become known as Obamacare.

But Obamacare, it turns out, has done a lot of good. It guarantees that people with preëxisting health conditions cannot be rejected by insurers or charged more than others. It has reduced the number of uninsured people by twenty million. It has increased access to primary care, specialty care, surgery, medicines, and treatment for chronic conditions. Patients are less likely to skip needed care because of the cost. As a result, according to studies conducted at Harvard, the A.C.A. is saving tens of thousands of lives each year.Obamacare/Trumpcare” And Healthcare Reform Essay

Now Republicans in Congress are facing the wrath of constituents who don’t want to lose those gains. Conservatives have had to back off from their plan to repeal Obamacare now and worry about replacement later. Instead, they must grapple with what they have tried to ignore: the complexities of our health-care system, especially in the four vital areas of employer-sponsored coverage, Medicaid, the individual insurance market, and taxes.

Half of Americans get their health coverage through their employer. For them, the A.C.A. brought such popular changes as uncapped coverage, inclusion of children up to the age of twenty-six, and requirements that insurers cover not only primary care but also pediatric dental and vision care, mental-health care, and, with no co-payments, preventive care. The Republicans probably won’t risk eliminating these provisions—except for contraceptive coverage—but they dislike the measures that have kept employers providing health benefits: tax penalties for big companies that don’t; tax credits for small businesses that do.Obamacare/Trumpcare” And Healthcare Reform Essay

It was Obamacare’s dramatic expansion of Medicaid, in participating states, to all Americans living near the official poverty line that produced the largest reductions in the uninsured. Many Republicans have vowed to cut back the program’s funding, and to send the money to states as a lump sum, or “block grant.” This approach, however, is apt to throw millions out of coverage and many states into fiscal crisis, and key Republican governors and senators are opposing it.

Republicans are also divided on what to do about the roughly ten per cent of Americans—freelancers, independent contractors, and the like—who aren’t covered by an employer, don’t qualify for Medicare or Medicaid, and must rely on the individual health-insurance market. Before the A.C.A., these people were the most vulnerable in the system; twenty-seven per cent of non-elderly adults have a preëxisting condition that makes them effectively uninsurable without the law’s protections. Now they can sign up through online exchanges for plans that are priced without regard to health history and are subsidized based on income.Obamacare/Trumpcare” And Healthcare Reform Essay

Republicans claim that the program is in a death spiral. It isn’t; enrollment has held constant. But there is a need to draw in younger, healthier people to offset the costs of older, sicker people and keep the premiums steady. Doing so depends on promoting HealthCare.gov widely and enforcing the tax penalty for people who don’t sign up. The President, however, has issued a raft of contradictory directives that ultimately instruct the government to do neither. As a result, more and more insurers are saying that they will pull out of the exchanges, risking the collapse of the individual market.

Having promised to get rid of the insurance mandate, Republicans are considering alternatives, but so far they are all inadequate. A requirement for people to maintain “continuous coverage”—to take an example supported by the new Secretary of Health and Human Services, Tom Price, and Speaker of the House Paul Ryan—would mean that people who lose their insurance temporarily, because they, say, change jobs or suffer a financial setback, would also lose their preëxisting-condition protections. For these people and for others left behind, Price and Ryan advocate state-run “high-risk pools.” But, in the thirty-five states that offered high-risk pools to the uninsurable before the A.C.A., inadequate funding delivered terrible coverage, with extremely high premiums and deductibles, and annual limits as low as seventy-five thousand dollars. Hardly anyone signed up.Obamacare/Trumpcare” And Healthcare Reform Essay

For orthodox Republicans, the central issue is, of course, taxes. Obamacare increased them, particularly for high-income individuals and for industries that profit from the expansion of coverage, to pay for the costs of reform. (The A.C.A. actually reduces the deficit.) Many Republicans have made cutting those taxes their top priority; others see preserving coverage as the imperative. Each side thinks the other is committing political suicide. But, with so many Americans beginning to recognize how much they stand to lose, the political equations are shifting.

Governance is forcing Republicans to confront the reality that repeal without replacement is untenable. In a stalemate, Congress would likely need to delay repeal and, to reassure skittish insurers, focus on small-scale repairs, such as affirming that subsidies will continue to be funded, and either enforcing the existing mandate or revising it so that more young and healthy people sign on. (For instance, healthy people could be charged an extra ten per cent on premiums if they forgo insurance for a year, the same as the penalty for elderly people who refuse Medicare Part B.) In addition, the states that sat out the Medicaid expansion in order to thwart President Obama would be free to join in under a Republican Administration, as many would like to. “Insurance for everybody,” Trump has vowed. A Trumpcare compromise could yet bring us a step closer to it.Obamacare/Trumpcare” And Healthcare Reform Essay

But legislators have no time to waste. Insurers must decide by April whether to offer a plan for the exchanges in 2018, and at what price. That requires certainty about the future. Pitchforks have their uses, but crafting health-care policy calls for more delicate instruments. The basic functioning of the health-care system is at stake. So are American lives.

Obamacare has a lot of benefits that most people don’t know about. That’s possibly because spending on negative messages about Obamacare has exceeded spending on positive messages by 15 to 1.1 Three years after it was approved, 54% of Americans opposed the Act.2 Donald Trump took actions to weaken it and Congress made failed replacement plans. In December 2017, the Tax Cuts and Jobs Act repealed the tax on those who don’t get insurance effective December 31, 2018.3

Here’s a list of advantages and disadvantages of the Patient Protection and Affordable Care Act of 2010.Obamacare/Trumpcare” And Healthcare Reform Essay

Hugo Lin © The Balance 2019
The biggest benefit of the ACA is that it slows the rise of health care costs.4 It does this partly providing insurance for millions and making preventive care free.5 This means people receive treatment before they need expensive emergency room services. Between 2012 and 2017, health care costs increased about 1.3% per year, and the Centers for Medicare and Medicaid Services (CMS) believes it’ll grow at about 2.5% per year over the next decade.6
It requires all insurance plans to cover 10 essential health benefits.7 These include treatment for mental health, addiction, and chronic diseases. Without these services, many patients wind up in the emergency room. Those costs are passed onto Medicaid and therefore the taxpayer.8


Insurance companies can no longer deny anyone coverage for pre-existing conditions.9 They can’t drop them or raise premiums if beneficiaries get sick.Obamacare/Trumpcare” And Healthcare Reform Essay
It eliminates lifetime and annual coverage limits.10 Insurance companies used this to contain costs to $1 million per year. Beneficiaries who exceeded that limit had to pay 100% of costs.11
Children can stay on their parents’ health insurance plans up to age 26.10 As of 2012, more than 3 million previously uninsured young people were added.12 This increased profit for insurance companies. They receive more premiums from these healthy individuals.
States must set up insurance exchanges or use the federal government’s exchange.13 Either method makes it easier to shop for plans.
The middle class (earning up to 400% of the poverty level) receive tax credits on their premiums.14 It expands Medicaid to 138% of the federal poverty level.1516 It provides this coverage to adults without children for the first time.
It eliminates the Medicare “doughnut hole” gap in coverage by 2020.1718
Businesses with more than 50 employees must offer health insurance.1920 They receive tax credits to help with the costs.

The Congressional Budget Office originally estimated it would reduce the budget deficit by $143 billion by 2022.21 It would theoretically accomplish this in three ways. First, it reduces the government’s health care costs. Second, it raises taxes on some businesses and higher income families. Third, it shifts cost burdens to health care providers and pharmaceutical companies. The CBO has since revised its  Obamacare/Trumpcare” And Healthcare Reform Essay

Three to 5 million people lost their employment-based health insurance.23 Many businesses found it more cost-effective to pay the penalty and let their employees purchase insurance plans on the exchanges. Other small businesses find they can get better plans through the state-run exchanges.24
Thirty million people never had company plans and relied on private health insurance. Insurance companies canceled many of their plans because their policies didn’t cover the ACA’s 10 essential benefits.25 For those who lost those cut-rate plans, the costs of replacing them can be high.26 The ACA requires services that many people don’t need, like maternity care.
Increased coverage raised overall health care costs in the short term.27 That’s because many people received preventive care and testing for the first time. It was expensive to treat illnesses that had been ignored for decades.
The ACA taxed those who didn’t purchase insurance. But many avoided the tax through an ever-expanding list of exemptions.28
The number of people with health insurance was estimated to decrease by 4 million in 2019, which could cost them millions of dollars. 29
In 2013, the ACA raised the income tax rate for individuals with incomes above $200,000. It also raised taxes for couples filing joint returns on incomes exceeding $250,000. The rate increased from 1.45% to 2.35% on income above the threshold.30 They also pay an additional 3.8% Medicare tax on investment income.31 That applies to the lesser of income from dividends, capital gains, rent and royalties or income above the threshold. Obamacare/Trumpcare” And Healthcare Reform Essay
Starting in 2013, medical device manufacturers and importers paid a 2.3% excise tax.32 Note: This tax was suspended for 2016-2018. Indoor tanning services paid a 10% excise tax.33 This might discourage those businesses from hiring new employees.
Starting in 2013, families could deduct medical expenses that exceeded 10% of income.34 Before, they could deduct any expenses that exceeded 7.5% of income. The Tax Cut and Jobs Act restored the deduction to the 7.5% limit for 2017 and 2018, but it is back up to 10% for the 2019 and 2020 tax years.35
Rebates close the “doughnut hole” in Medicare Part D. However, prices for drugs have continued to increase and for many, out-of-pocket expenses have continued to rise.3637
In 2022, insurance companies will be assessed a 40% excise tax on “Cadillac” health plans. Under current definitions, these are plans with annual premiums exceeding $10,200 for individuals or $27,500 for families.3839 Many of these plans are for people in high-risk pools, such as older workers or those with dangerous jobs.40 Most of the tax will be passed onto the companies and employees, raising premiums and deductibles and potentially lowering wages

Repealing Obamacare: The Reasons Why
Over five million individuals have lost their health insurance since Obamacare has been approved and put into action. The policy of Obamacare states that employers who are providing health insurance to their employees must tack on additional benefits that the companies cannot afford to do. This in turn causes the eventual cancellation of coverage for the employees, leaving them with no options besides signing up for Obamacare. It is the scheme of all schemes. Policy makers are constantly adding revisions to the Affordable Care Act (Obamacare) making it harder and harder for individual businesses and corporations to keep their health plan up to the standards Obamacare has set in place. Obamacare/Trumpcare” And Healthcare Reform Essay
The goal of this paper is to explain the downfalls of Obamacare and share the stories of individuals affected negatively and directly by the approval of the policy. Although Obamacare set out with good intentions, many people are still left without health care coverage because of the constant revisions of the bill. There have been many taxes raised for the approval of this policy, and has caused problems for individuals who do not want coverage under Obamacare but would want coverage under a different company. Obamacare/Trumpcare” And Healthcare Reform Essay

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