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The Ethical Right to Healthcare in the Affordable Care Act Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Spring 1-1-2017 The thicE al Right to Healthcare in the Affordable Care Act Stella Morden Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Morden, S. (2017). The thicalE Right to Healthcare in the Affordable Care Act (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/141 This Worldwide Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. THE ETHICAL RIGHT TO HEALTHCARE IN THE AFFORDABLE CARE ACT A Dissertation Submitted to the McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Stella Morden, MSN, NP-C May 2017 Copyright by Stella Morden 2017 THE ETHICAL RIGHT TO HEALTHCARE IN THE AFFORDABLE CARE ACT By Stella Morden, MSN, NP-C Approved on March 28, 2017 _________________________ ___________________________ Gerard Magill, PhD Henk ten Have, MD, PhD Vernon F. Gallagher Chair Professor, Center for Healthcare Ethics Professor, Center for Healthcare Ethics (Committee Member) (Dissertation Chair) _________________________ ___________________________ Joris Gielen, PhD Henk ten Have, MD, PhD Assistant Professor Director, Center for Healthcare Ethics Center for Healthcare Ethics (Center Director) (Committee Member) _________________________ James Swindal, PhD Professor and Dean, McAnulty College and Graduate School of Liberal Arts iii ABSTRACT THE ETHICAL RIGHT TO HEALTHCARE IN THE AFFORDABLE CARE ACT By Stella Morden, MSN, NP-C May 2017 Dissertation supervised by Dr. Gerard Magill Since the passage of the Affordable Care Act, It has been questioned whether the right to healthcare in it can be ethically justified. The objection to a right to healthcare in general has been prominent over many decades in the U.S. The concern over higher personal taxes, quality care, and national debt steered the opposition. Responding to these concerns has a direct effect on each individual in society. In particular, the lack of healthcare is very significant. The idea of a comprehensive national healthcare in the United States caught the attention of the public in the 1970s. It was inspired by the positive results of the Medicare and Medicaid programs which were passed and signed into law in the 1960s. The public would see the benefit of access to healthcare, which led to acquiring the expansion of it. Most people were wiling to accept and agree on providing free healthcare to the elderly and the poor. There was, however, a iv strong opposition to a system of a national healthcare. The opposition did not dishearten proponents to advocate for the right to healthcare in subsequent decades. After a vigorous congressional debate, the Affordable Care Act (ACA) was passed and signed into law in 2010. This dissertation engages the four standard ethical principles (known as principlism) to justify the right to healthcare that is provided in the Affordable Care Act. In addition, theories of distributive justice and normal functioning are used to argue and justify the provision of Affordable Care Act. v ACKNOWLEDGEMENT I thank God for the initial inspiration to enter the PhD program. I dedicated my dissertation defense to my father. My father, and he alone, called me by a masculine name at birth. The name carried the meaning of “to be a scholar”. Sadly, he did not live to see me receive my PhD degree. He was an example of a scholar. I thank my mother for always being supportive and encouraging. She has always allowed me to choose my path and take on new challenges. Her love is amazing! I thank my husband, John, for his understanding and support during the entire academic process. His love and patience were noted in his tireless help. I thank my children (Joshua, Jannah, Jonathan, Justin, Jesselyn, Jedidiah, Joanna-Praise, and Jamie-Ophelia) for always demonstrating their support and excitement about my pursuit of a doctorate degree. Their laughter and loving teasing have always warmed my heart. Their love for me is seen in their understanding of the time I needed for school work. I thank Dr. Gerard Magill, my chair, for his guidance and teaching. He taught me to be a better writer, thinker, and researcher. His help during the writing process demonstrated the meaning of humanity and a Christian. I could not have reached my academic goal without his teaching and insight. I deeply appreciate his help. I thank the department of Healthcare Ethics for understanding my situations during difficult life events. The department has always been loving and caring. vi TABLE OF CONTENTS Chapter One: Section One. Introduction Section Two. The Affordable Care Act (ACA): Patients, Populations, & Organizations 1. ACA Overview: Key Features of Affordable Care Act a. Ten Titles of the Affordable Care Act b. Expanding Insurance Coverage i. Setting the Priority ii. Removing Obstacles to Obtain Health Insurance 2. Patients and Populations a. Emphasis on Preventive Care for All i. Free Preventive Services. ii. Three Levels of Preventive Care. b. Increased Benefit for Target Populations i. The Poor and the Uninsured. ii. The Old and the Weak 3. Organizations and New Mandates a. Insurance Provision with Inclusion of Contraception i. Making Health Insurance a Priority ii. Women’s Preventive Services Including Contraception. b. Quality of Care i. Taking Care of the Vulnerable Populations ii. Improving Quality of Patient Care Section Three. Patients: Autonomy and the Right to Health Care 1. Autonomy & Human Rights a. Human Dignity & Sanctity i. The Intrinsic Value of Every Human Being ii. Life is Sacred b. Personal Autonomy i. The Right to Make Choices. ii. Self-governance 2. Beneficence & Non-Maleficence a. Right to Treatment i. The Obligatory Action to Give Benefit ii. Health Services for All Americans b. Right to Forgo Treatment i. Medical Wishes ii. ACA Includes End-of-Life Services 3. Patient Protection and Affordable Care Act a. Right to Basic Health Care vii i. The Right to Health ii. Minimum Coverage for Evidence-based-Services b. Balancing Right and Responsibility i. Benefiting from Health Care ii. Changing Practice Section Four. Population Health: Vulnerability, Justice, & Entitlement Programs in the ACA 1. Vulnerability a. Physical Limitation i. Disease ii. Physical and Mental Disability b. Financial Limitation i. Unemployment and Health ii. Poverty and Beyond Working Years 2. Justice a. Theories of Justice i. Distribution of Health Care as Social Goods ii. Two Positions on Justice b. Needs & Fairness i. The Principle of Need ii. Justice as Fairness in Health Care 3. Entitlement Programs in the ACA a. Medicare i. Opportunity for Every Stage of Life ii. Medicare for the Elderly b. Medicaid i. Equal Resources for the Disadvantaged Population ii. Medicaid for the Low Income Section Five. Organizations: The HHS Contraceptive Mandate in the ACA 1. Right to Preventive Care a. The Conflict between Government Mandate and Religious Conviction i. Health and Human Services (HHS) Announcement ii. A Compromise b. Needing More Provision of Women’s Health Services i. IOM Recommendations ii. Women’s Health Concerns 2. Protecting the Religious Identity of Organizations. a. The Reaction Regarding the Contraceptives Mandate i. Contraceptives Mandate Violates Religious Liberty ii. Upholding the Catholic Faith b. Permitting Abortion i. Catholic Faith in the Secular World ii. Voting for Laws that Support Forbidden Practices 3. The Principle of Cooperation viii a. Categories of the Principle of Cooperation i. Settling the Conflict ii. Distinctions of Cooperation b. Cooperation Justifies Health Policies that Provide Forbidden Services i. Support without Violation ii. Considering the Greater Good Section Six. Conclusion Chapter Two Section One. Introduction Section Two. ACA Overview: Key Features of Affordable Care Act a. Ten Titles of the Affordable Care Act b. Expanding Insurance Coverage i. Setting the Priority 1. Extending Health Coverage to Young Adults 2. Medicaid Expansion 3. Improve Medicare Benefits ii. Removing Obstacles to Obtain Health Insurance 1. A Chance to Get Care 2. “I can’t afford health insurance.” 3. Coverage for Pre-existing Condition Section Three. Patients and Populations a. Emphasis on Preventive Care for All i. Free Preventive Services. 1. Emphasis on Prevention 2. Wellness Programs 3. Lifestyle Modification ii. Three Levels of Preventive Care. 1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention b. Increased Benefit for Target Populations i. The Poor and the Uninsured. 1. Low-income Population 2. Minority Groups 3. Uninsured Population ii. The Old and the Weak 1. Medicare Recipients 2. Improving Quality in Hospital and Skilled Facility Section Four. Organizations and New Mandates a. Insurance Provision with Inclusion of Contraception i. Making Health Insurance a Priority 1. Working but no Health Insurance 2. Employers’ Responsibility Under ACA ix ii. Women’s Preventive Services Including Contraception. 1. Seeking Better Health for Women 2. Contraceptive Measures b. Quality of Care i. Taking Care of the Vulnerable Population. 1. Health Homes Services and Medical Homes Services 2. Community-based Care Transitions Program ii. Improving Quality of Patient Care 1. Quality Health Care for Americans 2. Comprehensive Primary Care Initiative Summary Chapter Three Section One. Introduction Section Two. Autonomy and Human Rights a. Human Dignity & Sanctity i. The Intrinsic Value of Every Human Being 1. Religious View on Human Dignity 2. Philosophical View on Human Dignity 3. Historical View on Human Dignity ii. Life is Sacred 1. Theological View on the Origin of Life 2. Selective Reproduction b. Personal Autonomy i. The right to Make Choices 1. Respect for Autonomy 2. Choosing Healthcare ii. Self-governance 1. Moral Authority to Self-Rule 2. Choosing Personal Integrity Section Three. Beneficence & Non-Maleficence a. Right to Treatment i.
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