November 1, 2012 | Posted By Paul Burcher, MD, PhD

When former President Bill Clinton spoke at the Democratic National Convention, he argued that we must put aside ideologies to “get things done.’”  The implementation of the Affordable Healthcare Act (ACA) is challenging Republican governors on exactly this point, and their responses are not uniform.  Jan Brewer, governor of Arizona outspoken critic of President Obama and the ACA, has begun planning for, and implementing the healthcare exchanges that states must create under the rules of the legislation.  States that fail to plan for exchanges will have exchanges created for them by the federal government. Six states with Republican governors have decided not to create exchanges, and may also not accept additional money from the federal government to expand Medicaid coverage along the lines set out by the ACA.

Is this just politics as usual, or is there an ethical dimension to this partisan debate?  I would argue that to fight against Obamacare to the detriment of the health of a state’s citizens—the poorest of the states citizens—is a violation of a politician’s duty to beneficence.  Uninsured patients suffer a preventable harm from the lack of access to healthcare, a harm that is now being remediated by the ACA, but only if only states will fully implement its policies.

We elect public officials not only to represent us, but also to make choices in the interest of the people of the city, state, or nation.  Given that the costs of the ACA if fully implemented will be distributed throughout the fifty states, only the purest form of partisan blindness would allow a governor to have the state’s citizens pay into the program without reaping its benefits.

Although this point is quite clear in regards to whether Republican governors should accept Medicaid monies to expand Medicaid coverage in their states, it is equally true for the establishment of exchanges.  It is a Republican principle that states can do a better job at providing services for their citizens than the federal government, and this may be very true in terms of local insurance environments and negotiating best terms.  To abdicate this responsibility to the federal government is contrary to Republican beliefs, and probably to best administrative practices, and can only be seen as placing partisan politics over the needs of the people, or politics over ethics.

It can only be hope that after the heat of the election season subsides that politicians remember that their first duty is toward the citizens of their states, and not their party’s ideologies.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
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