The cost of health insurance in America remains one of the greatest hindrances to healthcare. Without insurance, patients have to spend money from their pockets, which means they are more likely to pay more for treatment and sometimes even fail to afford the cost. McIntyre and Song (2019) argue that before the Affordable Care Act (ACA), 15% of uninsured families spent approximately 20% of their income on healthcare, a reality that affected the ability to live a comfortable life. Uninsured persons also have limited access to healthcare since priority is offered to persons who can cater to their cost and not leave institutions in debt. Such also translates to the possibility of receiving poor quality health that limits access to preventative care and services for chronic ailments that could prove fatal.
If left unchecked, we risk the inevitable possibility of having low-income earners spend more on healthcare, which affects sustainability. For the underprivileged, spending money they cannot afford means more economical and clinical vulnerability. For persons living in poor neighborhoods, they could become susceptible to poor health and unmet health needs. Indeed, in such communities, it also means that people, including the elderly, the disabled, and the mentally ill, cannot access the standard healthcare services that cater to their varying health problems. For example, adequate health services should ensure that every patient gets sufficient time with their practitioner to examine the situation. However, when access to insurance coverage is not available, it limits examination time and medication access.
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However, through the ACA, Medicaid expansion caters to a broad spectrum of income earners. These include the disadvantaged, persons with disabilities, and children.
Through Medicaid, better health services, access, and diagnosis of ailments such as cancer, mental illness, and substance disorders have saved lives that would otherwise be lost. Although the Supreme Court made the expansion optional to states, many states have adopted the development, which has increased the number of persons with health coverage.
Through the ACA, medical underwriting is minimized, thus protecting patients with pre-existing conditions. Before the act, insurance companies had the upper hand in deciding who could access health status benefits. The elderly who have underlying conditions such as diabetes, heart, or lung diseases meant that they were denied coverage and benefits. However, ACA reforms such as the rating rules prohibit the companies from setting premiums by considering health status and gender. Hence, given that most of the elderly have the ailments, the insurers are limited in varying premiums by age.
Innovatively, there are new payment initiative reforms and tax credits aimed at improving effectiveness and lowering cost. Such include value-based payment programs constituting the ambulatory care payment programs and global budgeting in Maryland for rural areas. Still, tax credit continues to provide financial assistance for persons living below the poverty line (Emanuel, 2014). These create a sense of value-based care through reduced costs and payment models.
There is a need to shift towards a value-based system that promotes quality access and reduces cost for mitigation. These would include valuing the patient at the center of healthcare, which could see insurers compensated based on the standards and effectiveness of services offered. Also, Medicare should have the upper hand in negotiating with the pharmaceuticals on the cost of drugs.
Improving subsidies would also help reduce the cost of care for low-income earners. Providing premium subsidies means more people will seek insurance covers for those below the poverty line. With premiums lower than what most would pay in the market place, clients are encouraged to enroll in Medicaid. Ideally, those who register with financial assistance tend to spend less on care and increase the pool of insurance funds, leading to reduced sticker price premiums.
References
Emanuel, E. (2014). Reinventing American health care: how the affordable care act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly inefficient, error prone system . Public Affairs.
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade.
