Introduction and Problem Statement.
The Kaiser Commission on Medicaid and the Uninsured, led by James R. Tallon, Jr., is a bipartisan team that offers advisory services and comprises of 17 nationwide leaders and specialists in public policy and health care. The commision, conceptualized in 1991, has grew to be the biggest working project of the Kaiser Family Foundation. Also, it functions as an essential asset for legislators, the media, and associations looking for data on health insurance for the low-income faction of the US and the Medicaid program. The Commission's work is directed by Foundation staff in Washington, DC. The Commission's responsibilities concentrates on the fundamental health strategy concerns at the federal and state level, comprising of Medicaid and health, access to care, and financing of health services for the economically disadvantaged population. The Commission gives important and reliable data and analysis on human health cover and access as well as the Children's Health Insurance Program, and scope of the uncovered to inform policy discourses. Based on the Commission’s gathered and analyzed information at both the state and federal level, many Americans are still uninsured- a situation that affects access to health care in particular among the low-income population. Many African-American do not have any health cover. The blacks community provides an illustration of how public health insurance is limited in the US. As a result, approximately 25% of uninsured adults go without the needed care in a year (The Kaiser Commission on Medicaid and The Uninsured, 2013).
Literature Review
The Kaiser Commission on Medicaid and The Uninsured, (2013) explains that a fundamental goal of the Affordable Care Act is to enlarge access to Healthcare. The Act extends Medicaid coverage to those in the low-income category of the populace in states and gives Marketplace subsidies to people beneath 400% the poverty line. The real coverage provisions of ACA's became active in January 2014 and prompted significant gains in coverage. As at the end of 2015, the quantity of uncovered nonelderly Americans remained at 28.5 million, translating into a reduction of about 13 million since 2013. Collins, Rasmussen, and Doty, (2014) explains that the absence of health insurance takes a colossal toll on the uninsured who suffer profoundly of stoppable deaths every year.
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As per the increasing research, being uninsured also has other economic outcomes. The uninsured individuals normally experience poorer quality of health as well as low productivity and more reduced personal satisfaction. Additionally, for organizations, their workers miss work or take an early retirement due to health complications. Moreover, for the health care system, they are often overburdened by the insufficiency of funds to cater for the uninsured patients in addition to the inadequacy of equipment. On the other hand, the general community loses the productive benefit of a healthy population (Popescu, 2014). The Institute of Medicine estimates the number of deaths resulting from insurance to be approximately 18,000 every year (Popescu, 2014). This figure is huge making it the sixth cause of deaths in the US. It further suggests that the deaths due to lack of insurance have a significant cost on the populace as it takes more lives than HIV and Aids (Popescu, 2014). The uninsured are less likely to receive quality care, preventive care, therefore, often do not benefit from early detection or prevention of diseases.
Description of the Case/Situation/Conditions Explained From a Theoretical Perspective
As of 2012, approximately 47 million Americans were uninsured (Collins, Rasmussen, and Doty, 2014). The population comprised of only non-Adults. However, the primary cause of the high level of health uninsurance is as a result of the high cost of coverage. It, therefore, implies that only a few individuals can afford to purchase the health insurance on their own. Most of the Americans who have insurance have obtained the same from their employers although not all workers get the employers package. Additionally, not all who are offered the employer coverage can afford the premiums (Popescu, 2014). Children from low-income households are covered by the Medicaid Health Insurance Cover. However, cases of eligibility on parents without dependable children are often limited locking out many parents from the affordable coverage. The majority of the uninsured population agree to the fact that cost is their major impediment towards getting coverage. Also, most of the uninsured comprise of the self-employed and meager earners who are not offered coverage at their place of work. From 2003 - 2013, the costs of premiums have risen by 80% making the insurance cover very expensive (The Kaiser Commission on Medicaid and The Uninsured, 2013). The employers also have a huge budget to spend on their workers, hence, discouraging them from participating in the employee coverage. Despite the expansion of Medicaid for children, the eligibility of disabled and pregnant women plus parents of children with disability remain much limited.
The Kaiser Commission on Medicaid and The Uninsured (2013) explains that the lack of coverage has had various effects on both the nation and the uninsured population. Due to the decreasing employer coverage of the insurance cost, the number of the uninsured in the US has witnessed a steady increase over time. For example, in 2008 – 2010, the recent recession resulted in a sharp increase in the uninsured due to loss of jobs (Popescu, 2014). The trend in uninsured also reflects on the state’s economic condition. In 2012, employment rates progressed steadily resulting in an increase in the insured population due to increase in the stability of the employer-sponsored coverage. Conversely, in recent years, due to the weakening economy, the share of Medicaid cover of the insured population has also witnessed a decrease (Popescu, 2014).
The majority of uninsured in the US comprises the following: the low-income, non-working families and people of color as well as the individuals who live below poverty line. They are mostly at high risk of being uninsured. In fact, the group accounts for approximately 38% of the uninsured population in the US (Popescu, 2014). The uninsured spans the spectrum of age. However, children are less likely to be uninsured due to their coverage by the Medicaid. As for adults, they continue to have high rates of un-insurance due to lack of employment or low-income employment that do not have employer covers (Popescu, 2014).
Lack of insurance on the affected population affects their health care access. According to Collins, Rasmussen, and Doty, (2014), each year, 25% of the uninsured go without health care. They are less likely to gain access to preventive care or early disease detection. The lack of insurance also contributes towards their baggage of stress and depression. It is only in emergency centers that the law allows for screening and stabilizing of all individuals indiscriminately. However, all other health care facilities can choose not to attend to those without insurance. The situation shows how the uninsured faction of the population is dire need of salvation regarding healthcare. They are people that need screening even more than the insured since they hardly access it. In the cases where they are screened and found with chronic conditions like cancer or diabetes, they are often unlikely to receive follow-up treatment compounding their health problems (Christopher, McCormick, Woolhandler, Himmelstein, Bor, & Wilper, 2016). They are subjected to unaffordable bills when they are diagnosed during the care. The costs further translate to massive medical debts owing to the fact that they majorly comprise the non-working or low-income individuals. Such individuals rarely have savings given their low-income status.
Discussion That Includes a Detailed Explanation of the Synthesized Literature Findings
From the assessment of the report, the uninsured suffer a huge deal when it comes to access to health care. The uninsured live a poor quality of life and their productivity in the society is also lowered. They are most likely to die when attacked by life-threatening diseases not to forget that they are mostly stressed or depressed due to lack of the insurance cover. The uninsured have low earnings due to reduced workforce participation and low productivity. To their employers, the situation leads into incurring of costs. When their workers fail to show up at work due to sickness, the productivity is lowered. Also, when they lose employees to early retirement due to health reasons, they often suffer the loss of skills and experience labor requiring them to hire new workers who need training that involves costs.
The uninsured population is also a huge cost to the health system. The adults who lack coverage make use of the health system inefficiently since they mostly rely on the costly emergency rooms. It is because they rarely seek medical screening and often show up when emergency situations arise. The emergency rooms pose enormous costs to the health care facilities. When the uninsured work for fewer hours due to their illnesses, they subject other taxpayers to financing their medical covers since they do not contribute much tax to the government. When individuals work for fewer hours, their pay is reduced, and so is the tax payable to the government to meet their medical emergency care. It follows that those who are insured and work full time are subjected to paying for medical bills of the uninsured through the taxes the government collects.
To the American public, the uninsured population has a hidden cost. When they suffer a contagious disease, the uninsured hardly access health care services to ensure that they are adequately treated. Consequently, they remain a danger to the wider public concerning their likelihood to spread certain contagious diseases to the broader population as they interact with them. Additionally, when they turn into the health care facilities during an emergency and occupy, the emergency areas become overcrowded making health care facility to refer some insured patients who might need such service to other locations.
Summary of the Case
The main reason for the high number of uninsured population in the US is due to the high cost of insurance. In these cases, therefore, the low-income individuals are mostly at risk of being uninsured. Additionally, the people of color are highly likely to lack health insurances. The uninsured trend changes with the adjustments in the economy. Consequently, during economic downturns, the number of uninsured rises while the reverse is true. It is because there is often loss of jobs when the economic conditions are harsh and vice versa. Such a situation causes many adults to remain uninsured.
Notably, the low-income individuals constitute the majority of the uninsured. The high rate of the uninsured population results in adverse effects on the health care sector. Studies indicate that the uninsured have a small probability of accessing the preventive care as well as services for chronic illnesses (McCormick, Woolhandler, Himmelstein, Bor, & Wilper, 2016). The uninsured face huge medical bills when they access the health care facility leading them into medical debt. Since they hardly have any savings and very little or no income, they are greatly affected by such bills causing stress and depression among this faction. However, the Affordable Care Act still has an enormous potential of expanding the medical coverage to millions of the uninsured population following the enactment of Health Insurance Market Places in 2014 as well as the expansion of the Medical Eligibility. The Act further makes private insurance affordable to the public to increase insurance.
Proposed Solutions to Remedy Gaps, Inefficiencies, or Other Issues from a Theoretical Approach
Jost and Pollack (2015) identifies some of the gaps in ACA and explains them as follows. On the lack of accessibility to health care coverage for low and modest income families in the US, the remedies include fixing the family glitch. The legislative drafting ambiguity that leads to the exclusion of the working families from marketplace tax credits should be discredited. By doing that up to 4.7 million individuals will have admission to health care coverage. Secondly, the complexity of the tax credit program should be reduced so that approximately 4.8 million individuals who receive overpayments in advanced premium tax credits can be protected as taxpayers. Third is to increase credit for low and moderate income families. It can be done by the Congress increasing both size and scope of the Advanced Premium Tax Credit program. When that is implemented, the coverage for families who are receiving little Affordable Care Act (ACA) assistance will have an expanded coverage.
Also, there exist a gap while making the health care sector more affordable, and therefore, the following remedies are applicable: the government should increase minimum employer requirement and reduce the out of pocket limits through amending the Affordable Care Act (ACA) (Blumenthal & Collins, 2014). When that is done, the affordability of coverage will increase leading to the more insured American population. Secondly, the health savings account use needs to be improved through ACA alignment so that millions of low-income families can find the care more affordable.
Another gap is consumer marketplace experience. There is a need for users to be actively guided in selecting their coverage. Therefore, the market tools should be able to provide assistance to the public on the suitable plans depending on their ability so that they can enroll only in programs that best suit their needs and ability. There should also be an improved network as well as a transparency formula. The marketplace regulators should demand the stakeholders in the industry to provide a better understanding of methods and ensure transparency when dealing with the public. This approach will ensure the Americans access appropriate care which will see an increase in coverage (Blumenthal & Collins, 2014). Also, there is a need for standardization of the marketplace to increase competition that will facilitate improved consumers choice.
Regarding the lack of Medicaid for low-income families, the government needs to assume the entire cost of expanding Medicaid to cover low-income families. Also, the government should eliminate estate recovery on Medicaid so that individuals may not have any fear of their families being compelled to pay their medical bills in the event they die. The Medicaid payment rates should also be increased by the Medical Department so that the health insurance can be sufficient to elicit participation even private providers. Individuals should also be granted the option of purchasing a medical cover from the state marketplace.
Identification of a Research Instrument to Evaluate the Proposed Solution Along With a Description of How the Instrument Could Be Evaluated
The research instruments to be used in the evaluation of the proposed solutions include the following: first is surveys. The study will involve designing questionnaires to conduct a survey that seeks to collect responses from the sampled population. For instance, in evaluating how the government’s policies have on the increase minimum employer requirement or reduction of the out of pocket limits through amending the ACA act as a solution, a survey can be conducted to assess the impact of the resolution on the employees in accessing the health care insurance. The results can be evaluated using numerically rated items in a quantitative study (Bowling, 2014). The outcome of the data analyzed can thus be projected to the entire population (Bowling, 2014). In administering the surveys, it can be done either via online platforms or paper surveys. Either way, the data can be collated for analysis although the online surveys are easier when it comes to data collating since the system already collects it.
Conclusion
One of the social policy issues that the U.S faces today is the large American population that has no health insurance. The lack of health insurance affects accessibility to health care services among the American population. This report has found out that based on the Commission’s gathered and analyzed information at both the state and federal level, many Americans are uninsured. It is a situation that affects access to health care, in particular among the low-income population. The main reason for the high number of uninsured people in the US is due to the high cost of insurance. The people of color are highly likely to lack health care. Such a situation renders many adults inaccessible to health care. Notably, the low-income individuals constitute the majority of the uninsured. The situation has significant effects on the health care sector. The uninsured are less likely to access the preventive care as well as services for chronic illnesses. The uninsured face huge medical bills when they access the health care facility leading augmented medical debts. Since they have no savings or income, they are hugely affected by these bills leading to stress and depression. However, the Affordable Care Act still has an enormous potential of expanding the coverage to millions of the uninsured population following the enactment of Health Insurance Market Places in 2014 as well as the expansion of the Medical Eligibility. The report has proposed various solutions to the problem. They include the need to correcting the family glitch; reducing the intricacy in the tax credit plans; increasing minimum employer requirement, and reduce the out of pocket limits through amending the ACA act among other solutions.
References
Blumenthal, D., & Collins, S. R. (2014). Health care coverage under the Affordable Care Act—a progress report. New England Journal of Medicine , 371 (3), 275-281.
Bowling, A. (2014). Research methods in health: investigating health and health services . London: McGraw-Hill Education.
Christopher, A. S., McCormick, D., Woolhandler, S., Himmelstein, D. U., Bor, D. H., & Wilper, A. P. (2016). Access to care and chronic disease outcomes among Medicaid-insured persons versus the uninsured. American journal of public health , 106 (1), 63-69.
Collins, S. R., Rasmussen, P. W., & Doty, M. M. (2014). Gaining ground: Americans' health insurance coverage and access to care after the Affordable Care Act's first open enrollment period. Issue brief (Commonwealth Fund) , 16 , 1-23.
Pollack, H., & Jost T. S. (2015). Key Proposals to Strengthen the Affordable Care Act . The Century Foundation. Retrieved from https://tcf.org/content/report/key-proposals-to-strengthen-the-aca/.
Popescu, G. H. (2014). Economic aspects influencing the rising costs of health care in the United States. American Journal of Medical Research , 1 (1), 47-47.
The Kaiser Commission on Medicaid and The Uninsured. (2013). Key Facts about the Uninsured Population. Kaiser Family Foundation . Retrieved from http://files.kff.org/attachment/fact-sheet-key-facts-about-the-uninsured-population.
