Week 6 Discussion Response- Law and Ethics in Healthcare

Law and Ethics in Healthcare

Week 6 Discussion Response

Colleague 1- Tia Sturdevant

Health reform in the United States is often evaluated by examining whether more people have health insurance. While expanded coverage is an important outcome, I believe the more significant transformation has been the shift in organizational accountability. Modern reform efforts have gradually redefined healthcare organizations from entities that primarily deliver medical services to organizations that are expected to demonstrate measurable improvements in patient outcomes, quality, and fiscal stewardship. Examining both the Social Security Amendments of 1965 (Medicare and Medicaid) and the Affordable Care Act (ACA) of 2010 illustrates how federal policy has progressively changed not only for who receives care but also how healthcare organizations are evaluated and governed.

Gruber and Sommers (2019) found that the ACA substantially reduced the uninsured population while increasing access to preventive services and financial protection. However, one of the article's more meaningful contributions is its discussion of payment reform. The ACA accelerated the transition from fee-for-service reimbursement toward value-based purchasing, creating incentives for hospitals and physicians to improve care coordination, reduce preventable hospital readmissions, and measure patient outcomes rather than simply increase service volume. In this respect, the ACA represented not merely an insurance expansion but a structural redesign of healthcare accountability.                           

Similarly, McIntyre and Song (2022) argued that Medicare and Medicaid continue to provide the foundation for healthcare access among older adults, individuals with disabilities, and economically vulnerable populations. Yet the evolution of these programs extends beyond insurance coverage. Medicare, in particular, has become one of the nation's most influential drivers of quality improvement through reimbursement policies tied to patient safety indicators, quality reporting, and performance benchmarks. Consequently, healthcare organizations increasingly design clinical operations around federal quality expectations because reimbursement is directly linked to measurable outcomes.

When evaluated across the four dimensions of healthcare reform- safety, cost, quality, and access- progress has been uneven but meaningful. Patient safety has improved through standardized quality reporting systems, evidence-based clinical guidelines, and financial incentives that reward reductions in hospital-acquired conditions and avoidable readmissions. Healthcare quality has advanced through greater transparency, public reporting, and coordinated care models such as Accountable Care Organizations. Access has improved considerably as millions of Americans gained insurance through Medicaid expansion and Marketplace coverage (Gruber & Sommers, 2019).

Cost remains the area where reform has produced the most complex results. Although the ACA slowed spending growth in certain sectors and reduced uncompensated care, overall healthcare expenditures continue to increase due to chronic disease prevalence, pharmaceutical pricing, workforce shortages, and demographic changes. This suggests that expanding insurance coverage alone cannot solve the broader challenge of healthcare affordability. Sustainable reform will likely require greater attention to prevention, population health management, administrative simplification, and payment innovation (Wilensky & Teitelbaum, 2023).

Another aspect of reform that deserves greater attention is the role of administrative agencies in translating legislation into operational policy. Congress establishes statutory authority, but agencies such as the Centers for Medicare & Medicaid Services (CMS) determine how reforms are implemented through regulations, reimbursement methodologies, quality metrics, and compliance requirements. The Department of Health and Human Services (HHS) oversees these activities while coordinating implementation across federal programs. The Internal Revenue Service also administers important ACA tax provisions. As Pozgar (2024) notes, agency rulemaking carries the force of law when exercised within delegated authority, making administrative agencies central participants in healthcare reform rather than simply regulatory overseers.

One observation from both the literature and my professional experience is that health reform has fundamentally changed organizational culture. Healthcare organizations now devote significant resources to compliance, quality improvement, data analytics, risk management, and interdisciplinary collaboration because reimbursement increasingly depends upon measurable performance rather than service volume. While patients often associate reform with insurance coverage, healthcare administrators experience reform as an ongoing expectation to continuously demonstrate value, transparency, and accountability. This evolution reflects a broader understanding that successful healthcare reform depends not only on expanding access but also on creating systems capable of delivering consistently safe, high-quality, and financially responsible care.

References

American College of Healthcare Executives. (2023). Code of ethics.  https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics

Center on Budget and Policy Priorities. (2021). ACA survives legal challenge, protecting coverage for tens of millions.  https://www.cbpp.org/research/health/suit-challenging-aca-legally-suspect-but-threatens-loss-of-coverage-for-millions

Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act's effects on patients, providers, and the economy: What we've learned so far. Journal of Policy Analysis and Management, 38(4), 1028–1052.  https://doi.org/10.1002/pam.22158

KFF. (2011). Timeline: History of health reform in the U.S.  https://www.kff.org/wp-content/uploads/2011/03/5-02-13-history-of-health-reform.pdf

McIntyre, A., & Song, Z. (2022). The US health care system after Medicare and Medicaid: Progress and remaining challenges. JAMA, 327(1), 19–20.

Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

Wilensky, S. E., & Teitelbaum, J. B. (2023). Essentials of health policy and law (5th ed.). Jones & Bartlett Learning.

Colleague 2- Ketsia Amize

Week 6 Discussion 

Health reform in the United States has developed gradually, often in response to public concerns about access, affordability, quality, and fairness. Two major reform efforts that reflect this evolution are the Affordable Care Act (ACA) of 2010 and the 21st Century Cures Act of 2016. Both reforms attempted to improve the healthcare system, but they addressed different problems. Together, they show that the ACA focused mainly on expanding insurance coverage and consumer protections, while the 21st Century Cures Act emphasized innovation, interoperability, patient access to health information, and modernization of healthcare delivery.

Baten and Lee (2024) examined the impact of the ACA Medicaid expansion on healthcare access among adults aged 45–64. Their findings showed that Medicaid expansion was associated with improved access to care, especially for adults at risk of becoming uninsured before the ACA. These findings support the idea that the ACA has made progress in improving access, a long-standing weakness of the U.S. healthcare system. Similarly, Gruber and Sommers (2019) found that the ACA increased insurance coverage, improved access to preventive and outpatient services, and reduced financial barriers for many patients. From my own observations in healthcare and social services, having insurance does not solve every problem, but it often determines whether patients seek early or delay care until their conditions become more serious.

The 21st Century Cures Act also represents an important reform effort. Arvisais-Anhalt et al. (2022) explained that the Cures Act Final Rule expanded patients' access to their electronic health information and addressed information blocking. As a result, this reform supports quality and safety by helping patients become more informed participants in their care. When patients can review lab results, medication lists, and provider notes, they are better positioned to ask questions, identify errors, and follow treatment plans. However, the article also noted challenges, especially when multiple users access patient portals, such as caregivers, parents, or family members. This shows that transparency must be balanced with privacy, security, and ethical concerns.

When considering safety, cost, quality, and access, the ACA has been most successful in improving access and financial protection. Medicaid expansion, marketplace coverage, dependent coverage up to age 26, and protections for people with preexisting conditions helped many individuals obtain coverage. Even so, cost remains a major concern. Many families still struggle with premiums, deductibles, copayments, and limited provider networks. Therefore, the ACA has improved access to insurance, but access to affordable and timely care is still uneven.

The 21st Century Cures Act has contributed more directly to quality, safety, and patient engagement. Requiring better access to electronic health information encourages transparency and care coordination. In turn, this can reduce duplication, improve communication among providers, and help patients understand their own health status. At the same time, technology alone does not guarantee better care. Patients may feel overwhelmed by complex medical information, and providers must help interpret results in an understandable, compassionate way.

Several federal agencies play important roles in implementing these reforms. For the ACA, the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Internal Revenue Service are central to rulemaking and enforcement. CMS oversees Medicaid expansion, marketplace regulations, Medicare reforms, and quality initiatives. The IRS has been involved in tax-related provisions, including premium tax credits and employer responsibilities. For the 21st Century Cures Act, the Office of the National Coordinator for Health Information Technology plays a major role in health information technology standards, interoperability, and information blocking rules. Together, these agencies translate broad laws passed by Congress into detailed regulations that healthcare organizations must follow.

Overall, health reform has progressively improved the U.S. healthcare system, but it has not fully met public expectations. The ACA expanded coverage and reduced some barriers to care, while the 21st Century Cures Act strengthened patient access to information and promoted interoperability. Still, more work is needed to control costs, reduce disparities, simplify care navigation, and ensure that quality care is available to all communities. The main lesson from health reform is that policy must continue to evolve. Healthcare needs, technology, and patient expectations change. Effective reform must not only expand coverage but also make care safer, more affordable, more coordinated, and more respectful of the people being served.

References

Arvisais-Anhalt, S., Lau, M., Lehmann, C. U., Holmgren, A. J., Medford, R. J., Ramirez, C. M., & Mandl, K. D. (2022). The 21st Century Cures Act and multiuser electronic health record access: Potential pitfalls of information release. Journal of Medical Internet Research, 24(2), e34085. https://doi.org/10.2196/34085

Baten, R. B. A., & Lee, J. S. (2024). Affordable Care Act Medicaid expansion, access to health care, and health care experience among adults aged 45–64. BMC Health Services Research, 24, Article 1240. https://doi.org/10.1186/s12913-024-11730-5

Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act’s effects on patients, providers, and the economy: What we’ve learned so far. Journal of Policy Analysis and Management, 38(4), 1028–1052. https://doi.org/10.1002/pam.22158

Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

Wilensky, S. E., & Teitelbaum, J. B. (2023). Essentials of health policy and law (5th ed.). Jones & Bartlett Learning.

Law and Ethic in Healthcare

Health reform has influenced the U.S. healthcare system through the Medicare and Medicaid Act of 1965 and the Patient Protection and Affordable Care Act (ACA) of 2010. Gruber and Sommers (2019) found that ACA dramatically reduced the number of uninsured Americans, increased access to preventive services and enhanced financial protection for patients. Further, the authors pointed out that the law brought positive economic consequences for providers and consumers and reinforced the healthcare system through increasing healthcare coverage. Hayes et al. (2025) also suggest a better alignment of Medicaid eligibility criteria before and after age 65, and access to unbiased Medicare enrollment guidance facilitate a smoother transition between these programs. Likewise, Roberts et al. (2025) reported that Medicare-Medicaid Plans (MMPs) create greater coordination between Medicare and Medicaid and increase Medicare beneficiaries or their retention of Medicaid coverage among those who are eligible to enroll.

These efforts towards reform have helped to make safety, cost, quality, and access better, but there are still challenges. The ACA advanced patient safety by encouraging preventative care and improving the reimbursement structure for payment that is based on quality and not service volume. Medicare and Medicaid improved access to essential health care services to vulnerable populations, as well as eliminated cost barriers to health services. Notwithstanding these advances, the high cost of health care persists due to the price of insurance premiums, prescription drugs and workforce shortages on affordability and timely access. Based on the literature and my observations, health reform has improved healthcare quality and expanded access for millions of Americans, but additional efforts are still needed to control costs while maintaining high-quality care.

These changes are largely dependent upon the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS). The agencies develop regulations, oversee compliance, administer federal healthcare programs, and translate legislation into operational policies. CMS also tracks quality indicators and reimbursement mechanisms to incentivize better health outcomes for patients from improved healthcare systems. Their rulemaking functions help to ensure that healthcare facilities meet federal requirements, safeguard patient privacy, and foster fair access to healthcare services. Ongoing cooperation between these agencies is crucial for the advancement of healthcare reform and addressing future challenges.

References

Gruber, J., & Sommers, B. D. (2019, June).  The affordable care act’s effects on patients, providers, and the economy: What we’ve learned so farLinks to an external site..  Journal of Policy Analysis and Management,  38(4), 1028–1052. https://doi.org/10.1002/pam.22158

Hayes, S. L., Byrnes, M. E., Furst, W., Beathard, E., & Tipirneni, R. (2025). Moving from Medicaid Expansion Coverage to Medicare Can Be a Burdensome Transition: A Qualitative Study. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-025-09789-9

Roberts, E. T., Macneal, E., Johnston, K. J., & Figueroa, J. F. (2025). Effects of Dual-Eligible Integrated Care Plans on Medicaid Enrollment and Retention: Evidence From the Implementation of Medicare-Medicaid Plans. Medical Care Research and Review, 83(1), 10775587251372267-10775587251372267. https://doi.org/10.1177/10775587251372267

Law and Ethics in Healthcare

Week 6 Discussion Response

Colleague 1- Tia Sturdevant

Health reform in the United States is often evaluated by examining whether more people have health insurance. While expanded coverage is an important outcome, I believe the more significant transformation has been the shift in organizational accountability. Modern reform efforts have gradually redefined healthcare organizations from entities that primarily deliver medical services to organizations that are expected to demonstrate measurable improvements in patient outcomes, quality, and fiscal stewardship. Examining both the Social Security Amendments of 1965 (Medicare and Medicaid) and the Affordable Care Act (ACA) of 2010 illustrates how federal policy has progressively changed not only for who receives care but also how healthcare organizations are evaluated and governed.

Gruber and Sommers (2019) found that the ACA substantially reduced the uninsured population while increasing access to preventive services and financial protection. However, one of the article's more meaningful contributions is its discussion of payment reform. The ACA accelerated the transition from fee-for-service reimbursement toward value-based purchasing, creating incentives for hospitals and physicians to improve care coordination, reduce preventable hospital readmissions, and measure patient outcomes rather than simply increase service volume. In this respect, the ACA represented not merely an insurance expansion but a structural redesign of healthcare accountability.                           

Similarly, McIntyre and Song (2022) argued that Medicare and Medicaid continue to provide the foundation for healthcare access among older adults, individuals with disabilities, and economically vulnerable populations. Yet the evolution of these programs extends beyond insurance coverage. Medicare, in particular, has become one of the nation's most influential drivers of quality improvement through reimbursement policies tied to patient safety indicators, quality reporting, and performance benchmarks. Consequently, healthcare organizations increasingly design clinical operations around federal quality expectations because reimbursement is directly linked to measurable outcomes.

When evaluated across the four dimensions of healthcare reform- safety, cost, quality, and access- progress has been uneven but meaningful. Patient safety has improved through standardized quality reporting systems, evidence-based clinical guidelines, and financial incentives that reward reductions in hospital-acquired conditions and avoidable readmissions. Healthcare quality has advanced through greater transparency, public reporting, and coordinated care models such as Accountable Care Organizations. Access has improved considerably as millions of Americans gained insurance through Medicaid expansion and Marketplace coverage (Gruber & Sommers, 2019).

Cost remains the area where reform has produced the most complex results. Although the ACA slowed spending growth in certain sectors and reduced uncompensated care, overall healthcare expenditures continue to increase due to chronic disease prevalence, pharmaceutical pricing, workforce shortages, and demographic changes. This suggests that expanding insurance coverage alone cannot solve the broader challenge of healthcare affordability. Sustainable reform will likely require greater attention to prevention, population health management, administrative simplification, and payment innovation (Wilensky & Teitelbaum, 2023).

Another aspect of reform that deserves greater attention is the role of administrative agencies in translating legislation into operational policy. Congress establishes statutory authority, but agencies such as the Centers for Medicare & Medicaid Services (CMS) determine how reforms are implemented through regulations, reimbursement methodologies, quality metrics, and compliance requirements. The Department of Health and Human Services (HHS) oversees these activities while coordinating implementation across federal programs. The Internal Revenue Service also administers important ACA tax provisions. As Pozgar (2024) notes, agency rulemaking carries the force of law when exercised within delegated authority, making administrative agencies central participants in healthcare reform rather than simply regulatory overseers.

One observation from both the literature and my professional experience is that health reform has fundamentally changed organizational culture. Healthcare organizations now devote significant resources to compliance, quality improvement, data analytics, risk management, and interdisciplinary collaboration because reimbursement increasingly depends upon measurable performance rather than service volume. While patients often associate reform with insurance coverage, healthcare administrators experience reform as an ongoing expectation to continuously demonstrate value, transparency, and accountability. This evolution reflects a broader understanding that successful healthcare reform depends not only on expanding access but also on creating systems capable of delivering consistently safe, high-quality, and financially responsible care.

References

American College of Healthcare Executives. (2023). Code of ethics.  https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics

Center on Budget and Policy Priorities. (2021). ACA survives legal challenge, protecting coverage for tens of millions.  https://www.cbpp.org/research/health/suit-challenging-aca-legally-suspect-but-threatens-loss-of-coverage-for-millions

Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act's effects on patients, providers, and the economy: What we've learned so far. Journal of Policy Analysis and Management, 38(4), 1028–1052.  https://doi.org/10.1002/pam.22158

KFF. (2011). Timeline: History of health reform in the U.S.  https://www.kff.org/wp-content/uploads/2011/03/5-02-13-history-of-health-reform.pdf

McIntyre, A., & Song, Z. (2022). The US health care system after Medicare and Medicaid: Progress and remaining challenges. JAMA, 327(1), 19–20.

Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

Wilensky, S. E., & Teitelbaum, J. B. (2023). Essentials of health policy and law (5th ed.). Jones & Bartlett Learning.

Colleague 2- Ketsia Amize

Week 6 Discussion 

Health reform in the United States has developed gradually, often in response to public concerns about access, affordability, quality, and fairness. Two major reform efforts that reflect this evolution are the Affordable Care Act (ACA) of 2010 and the 21st Century Cures Act of 2016. Both reforms attempted to improve the healthcare system, but they addressed different problems. Together, they show that the ACA focused mainly on expanding insurance coverage and consumer protections, while the 21st Century Cures Act emphasized innovation, interoperability, patient access to health information, and modernization of healthcare delivery.

Baten and Lee (2024) examined the impact of the ACA Medicaid expansion on healthcare access among adults aged 45–64. Their findings showed that Medicaid expansion was associated with improved access to care, especially for adults at risk of becoming uninsured before the ACA. These findings support the idea that the ACA has made progress in improving access, a long-standing weakness of the U.S. healthcare system. Similarly, Gruber and Sommers (2019) found that the ACA increased insurance coverage, improved access to preventive and outpatient services, and reduced financial barriers for many patients. From my own observations in healthcare and social services, having insurance does not solve every problem, but it often determines whether patients seek early or delay care until their conditions become more serious.

The 21st Century Cures Act also represents an important reform effort. Arvisais-Anhalt et al. (2022) explained that the Cures Act Final Rule expanded patients' access to their electronic health information and addressed information blocking. As a result, this reform supports quality and safety by helping patients become more informed participants in their care. When patients can review lab results, medication lists, and provider notes, they are better positioned to ask questions, identify errors, and follow treatment plans. However, the article also noted challenges, especially when multiple users access patient portals, such as caregivers, parents, or family members. This shows that transparency must be balanced with privacy, security, and ethical concerns.

When considering safety, cost, quality, and access, the ACA has been most successful in improving access and financial protection. Medicaid expansion, marketplace coverage, dependent coverage up to age 26, and protections for people with preexisting conditions helped many individuals obtain coverage. Even so, cost remains a major concern. Many families still struggle with premiums, deductibles, copayments, and limited provider networks. Therefore, the ACA has improved access to insurance, but access to affordable and timely care is still uneven.

The 21st Century Cures Act has contributed more directly to quality, safety, and patient engagement. Requiring better access to electronic health information encourages transparency and care coordination. In turn, this can reduce duplication, improve communication among providers, and help patients understand their own health status. At the same time, technology alone does not guarantee better care. Patients may feel overwhelmed by complex medical information, and providers must help interpret results in an understandable, compassionate way.

Several federal agencies play important roles in implementing these reforms. For the ACA, the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Internal Revenue Service are central to rulemaking and enforcement. CMS oversees Medicaid expansion, marketplace regulations, Medicare reforms, and quality initiatives. The IRS has been involved in tax-related provisions, including premium tax credits and employer responsibilities. For the 21st Century Cures Act, the Office of the National Coordinator for Health Information Technology plays a major role in health information technology standards, interoperability, and information blocking rules. Together, these agencies translate broad laws passed by Congress into detailed regulations that healthcare organizations must follow.

Overall, health reform has progressively improved the U.S. healthcare system, but it has not fully met public expectations. The ACA expanded coverage and reduced some barriers to care, while the 21st Century Cures Act strengthened patient access to information and promoted interoperability. Still, more work is needed to control costs, reduce disparities, simplify care navigation, and ensure that quality care is available to all communities. The main lesson from health reform is that policy must continue to evolve. Healthcare needs, technology, and patient expectations change. Effective reform must not only expand coverage but also make care safer, more affordable, more coordinated, and more respectful of the people being served.

References

Arvisais-Anhalt, S., Lau, M., Lehmann, C. U., Holmgren, A. J., Medford, R. J., Ramirez, C. M., & Mandl, K. D. (2022). The 21st Century Cures Act and multiuser electronic health record access: Potential pitfalls of information release. Journal of Medical Internet Research, 24(2), e34085. https://doi.org/10.2196/34085

Baten, R. B. A., & Lee, J. S. (2024). Affordable Care Act Medicaid expansion, access to health care, and health care experience among adults aged 45–64. BMC Health Services Research, 24, Article 1240. https://doi.org/10.1186/s12913-024-11730-5

Gruber, J., & Sommers, B. D. (2019). The Affordable Care Act’s effects on patients, providers, and the economy: What we’ve learned so far. Journal of Policy Analysis and Management, 38(4), 1028–1052. https://doi.org/10.1002/pam.22158

Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

Wilensky, S. E., & Teitelbaum, J. B. (2023). Essentials of health policy and law (5th ed.). Jones & Bartlett Learning.