A Background of Modern Day Health Insurance in the US and the Ethical Consequences of Recent Policy Changes

A Background of Modern Day Health Insurance in the US and the Ethical Consequences of Recent Policy Changes

One of the most divisive topics in this day and age is the issue of health insurance. The first question that comes to mind for many is whether medical treatment in this country should be a right or privilege. The next consideration is how to determine the amount that different individuals must pay in order to gain access to adequate health care. For example, many states continue to struggle with deciding what income level should serve as the cutoff for Medicaid eligibility. This is where forces like price ceilings, state regulations, political agendas, government subsidies, and insurance pricing models come into play [5]. With this in mind, it is no surprise that the last decade has been full of legislative changes aiming to influence the state of health insurance in this country.

Upon entering office, President Barack Obama vowed to improve the United States healthcare system. On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law [6]. His primary motivations were to make affordable health insurance available to more people, to expand the Medicaid program, and to lower health care costs [1]. This bill forced all employers to offer health insurance, raised the requirements of what qualifies as essential coverage,  and banned insurance companies from denying coverage based on pre-existing conditions [6]. This had an enormous impact on the medical landscape in the US, as prior to the bill nearly one in seven Americans were denied health coverage due to pre-existing conditions [8]. Ever since Donald Trump was sworn in as the 45th President of the United States, there has been great uncertainty about what will happen with our healthcare system. This is because his presidential campaign included a promise to repeal and replace Obamacare [6].

Up to this date, the Trump administration has taken many steps to weaken the ACA without officially repealing it. For starters, President Trump has repealed the Obamacare tax on individuals who do not have health insurance for at least nine months of the calendar year [2]. This rule was named the “individual mandate” [7]. The purpose of this tax was to incentivize every member of society, including those who are most healthy, to subscribe to some form of health insurance. This was meant to encourage a greater proportion of the population to have coverage in the case of injury or sickness. This also had the effect of lowering insurance premiums for the sickest members of society, since insurance companies now had a greater number of healthy individuals also enrolled in their plans [2]. Without the fear of a tax penalty, healthier individuals are now more likely to refrain from enrolling in any form of health insurance at all. Thus, with mainly sicker individuals with chronic conditions choosing to enroll in insurance plans, premiums will undoubtedly skyrocket for those who need health coverage the most [4].

Another major change made by President Trump is to allow for certain insurance policies to cover less than the level that the ACA previously deemed “minimum essential coverage” [3].  Under Obamacare, every single health insurance plan in the United States was required to guarantee a certain level of baseline coverage [7]. Recent policy changes now allow insurers to sell short term health coverage that is less comprehensive than what was allowed under President Obama [3]. Although this allows individuals to enroll in health coverage at a lower cost, it could have disastrous effects. Firstly, this rule change could lead to healthier individuals migrating away from more traditional plans, which would undoubtedly raise premiums that sicker individuals must pay. Secondly, individuals enrolled in these new, cheaper plans are more likely to be uninformed about what exactly is covered by their policies. This could lead to many individuals falling into medical debt after receiving treatment and care that is not covered by these “barebone” plans.

These healthcare reforms have the potential to raise many ethical questions. For starters, is it right for the government to use tax penalties to incentivize individuals to enroll in health insurance? It is also important to think about whether or not Congress has the right to enforce a minimum level of coverage that every insurance policy must offer. The answers to these questions will also have great consequences on how expensive health insurance becomes for US citizens, particularly those with chronic conditions. As a result, it is imperative for society to stay educated about current and future legislative changes that will influence healthcare.


1. Affordable Care Act (ACA) - HealthCare.gov Glossary. (n.d.).

2. Amadeo, K. (n.d.). How Trump's Health Care Policies Will Raise Premium Prices for You.

3. Coombs, B. (2018, August 01). Trump administration clears way for cheap short-term health

plans to compete with Obamacare.

4. Demko, P., Cancryn, A., Gerstein, J., Shafer, J., Carter, A., & Blau, M. (2018, June 19).

Trump's new health insurance rules expected to hurt Obamacare.

5. Fitzgerald, J. (2017, December 02). Why Is Health Insurance So Complicated?

6. Griffin, J. (2017, March 7). The History of Healthcare in America.

7. Obamacare: Minimum Essential Coverage & 10 Essential Benefits. (2018, March 01).

8. Wang, M. (2010). Insurers Denied Health Coverage to 1 in 7 People, Citing Pre-Existing Conditions.

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