Problem Identification
The health sector has experienced steady growth in health care and practice standards and a concurrent rise in healthcare costs. A majority of American people are insured both in public and private insurance plans. Medical insurance brokers are continually changing the insured customers' medical programs due to shifting medical care (Teiltelbaum & Wilensky, 2016). However, the problem lies in the high number of uninsured Americans who consist of the low-income earners, the disabled: the aged population, and the marginalized. However, the most shocking is that although about 88% of Americans are insured, only half have comprehensive medical coverage (Wisk et al., 2020). The rest are underinsured with phony insurance plans that can barely cover their medical expenses.
Background
In the United States, the Affordable Care Act was passed into law by then-president Barrack Obama (Gaffry et al., 2019). The act is meant to ensure that every American citizen has access to affordable medical care, including having an insurance plan that covers the primary treatment, all cancer screening, and the approved contraceptives procedures by the Food and Drug Agency (FDA) (Teitelbaum &Wilensky, 2016). However, insurance companies are gradually shifting the burden of paying for medical coverage entirely to the clients. As a result, individuals have to dig deep into their pockets to afford medical care. Hospitals and other health care facilities do not tend to patients who either cannot pay or do not have insurance coverage.
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Consequently, the patients use either primary health care at a price that plunges them into bad debts or treats them for free. The latter might seem like a noble idea until the consumers start feeling the pinch of cost-sharing (Teitelbaum &Wilensky, 2016) Every time a patient is treated for free, the cost is transferred to individuals with comprehensive insurance cover to offset, which drives healthcare costs high.
There is an ever-increasing number of uninsured people in the U.S. While the Affordable Health Care Act has stepped in to provide medical coverage for the disadvantaged, statistics show that about 23% of Americans are uninsured, and 25% are on Medicare and Medicaid plans (Buchmueller & Lary, 2020). However, the number increases with increasing young adults who have just entered the job market and need medical coverage. The study further indicates that most Americans are surviving on inadequate insurance plans courtesy of unaffordable health care . Although the Affordable Care Act has a provision that employers pay for its employees' premium insurance fees, this does not always happen. Insurance providers are reluctant to pay the full amount of insurance cover due to the rising healthcare cost. Some medical procedures are too expensive to be covered in a basic insurance plan, which means that some Americans cannot afford to pay for significant surgeries involving organ transplants and intense chemotherapy.
Landscape
With the changing job market structure, some Americans have been rendered unemployed. Job loss has increased the number of uninsured and underinsured people in the United States. For instance, the Covid-19 pandemic has led to massive job loss, which means that former employers can no longer pay for former employees' insurance plans. Consequently, the percentage is still rising. Some factors leading to high numbers of uninsured people include; insurance coverage limitation, age, education level, employment, and low income (Carmona & Rosenberg, 2020). On average, 57% of Americans are gainfully employed. However, only half of this number can guarantee that their profession can afford adequate insurance coverage. The premiums are too high, and the income comparatively low (Teitelbaum & Wilensky, 2016). As a result, such people settle for smaller insurance packages. Insurance companies are in the business to make a profit. Therefore, if some people cannot afford the premium plans, the insurer limits the services available for such a customer. It is no surprise that most Americans cannot afford critical and complicated procedures such as high-dose chemotherapy, bone marrow transplant, and organs transplant (Cormona & Rosenberg, 2010). The insurer is unwilling to cover such complex procedures due to the uncertainties and risks involved. Also, parents' insurance coverage ceases to work on the children when they are officially regarded as adults. The young adults have to struggle to afford basic health care plans.
Options
There are outstanding issues that can only be solved through consultation between stakeholders. The medical practitioners, insurers, the federal government, and pharmaceutical companies. Primarily, all the stakeholders work together towards achieving the common goals of better health care and happy living. To achieve this goal, some hard bargains have to be addressed (Teitelbaum & Wilensky, 2016). For instance, the federal government might have to inject more funding into achieving universal insurance coverage. While the committee on budget and planning may dismiss this move, it is essential for the federal government to fully roll out the Affordable Care Act, ensuring all Americans are covered under a form of medical coverage, be it Medicaid or Medicare. The goal is to ensure that the congressional budget committee remembers that the act is the law, and the funding is paramount for the hospitals to enroll the patients (Gaffry et al., 2019). Also, there is the consideration of lowering the prices of pharmaceutical products. While these companies maintain that the federal government has no power inside the firms' boardrooms, it can institute checks and balances through legislation to ensure that the pharmaceutical companies comply with the expected code.
Moreover, the number of uninsured can be regulated by creating community centers that extend community care to patients. One of the advantages is that the nurse's in-charge of the community clinics can advise the patients on obtaining cheaper medication and treatment at more affordable hospitals (Wisk et al., 2020). The clinics will extend medical care to the uninsured for a while before a permanent solution can be reached between the insurers and the customer.
Insurers believe that any form of government influence could threaten the future relationship between the different stakeholders. It is only through legislation or an act that the federal government can influence others into agreeing to its point of view. For instance, the government cannot instruct the hospitals to lower their prices or the insurer to give lower premiums while still providing the same services (Teitelbaum & Wilensky, 2016). The rationale is that if the government can help the other stakeholders combat the high cost of health care, they can consider reducing their customers' debt. With manageable respect, the insurers can charge fair premiums for their services. At the same time, hospitals can treat the uninsured and bill the services rendered to the federal government's Medicaid and Medicare plans.
Recommendations
It is, therefore, recorded that all stakeholders in the health sector undertake consultative planning. The goal is to agree on how to solve the national problem of uninsured people and underinsured ones. If the burden is shared, it is possible to arrive at a consensus that could solve the issue at hand (Buchmueller & Lary, 2020). Also, it is advisable to vouch for reduced prices of medicines. Sometimes, it is not the unwillingness to go to a health care provider that is difficult but how to offset the medical bill. It is also sensible to ensure adequate research to document the severity of the need to revise the current insurance plans. Citizens ought to enjoy the health care they have paid for through hefty insurance premiums. Also, while the stakeholders work to develop policies and frameworks, it is prudent to remember that timeliness, cost, cost-benefit analysis, and health implications to nurses and patients should be used as the focal points for evaluating the suggested policies' effectiveness. Therefore, it is possible to provide solutions to the issue of uninsured and underinsured through mutual collaboration.
References
Buchmueller, T. C., & Levy, H. G. (2020). The ACA's Impact On Racial And Ethnic Disparities In Health Insurance Coverage And Access To Care: An examination of how the insurance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. Health Affairs , 39 (3), 395-402.
Carmona, R., Jones, T. A., & Rosenberg, J. (2020). Barriers to Accessing Medical Care for Hispanic Individuals With Craniofacial Conditions. Plastic Surgical Nursing , 40 (2), 73-80.
Gaffney, A., McCormick, D., Bor, D., Woolhandler, S., & Himmelstein, D. (2019). Coverage expansions and utilization of physician care: evidence from the 2014 Affordable Care Act and 1966 Medicare/Medicaid expansions. American Journal of Public Health , 109 (12), 1694-1701.
Teitelbaum, J. B., & Wilensky, S. E. (2016). Essentials of health policy and law . Jones & Bartlett Publishers.
Wisk, L. E., Peltz, A., & Galbraith, A. A. (2020). Changes in Health Care–Related Financial Burden for U.S. Families With Children Associated With the Affordable Care Act. JAMA pediatrics .
