Despite the significant developments in the U.S healthcare sector, many people lack adequate access to quality healthcare services. Over the past few years, expenditure for health care, health research, and health items has increased significantly, resulting in large figure per capita (Lazar et al., 2018). Resultantly, the issue of cost and quality of healthcare service affects many U.S citizens today. Most people have a private or public health insurance coverage, with only 16% of the U.S population being uninsured. However, the 16% who are uninsured translates to 50 million Americans, 8 million of which are children (Lazar et al., 2018). Lack of health insurance has dire consequences; the uninsured individuals are less likely to receive preventive health care and care for various medical conditions and diseases. These people are also less likely to receive medical checkups, which increases the prevalence and death associated with terminal diseases that would have been treated if it were detected earlier. Furthermore, approximately 45,000 people die every year due to the lack of health insurance (Lazer et al., 2018). Therefore, health care services are currently not equally accessible to every American, with the poor and low-income families being the most affected.
To address the challenges of cost and unequal access to health care, the U.S government, both federal and state, has developed policies and legislation over the years. The Affordable Care Act (ACA) and Medicaid was introduced to help increase health insurance coverage among Americans. While there are still challenges in the U.S healthcare sector, government funding through these programs has helped alleviate the condition of the healthcare sector
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Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act was introduced in 2010, with its full implementation achieved in 2014 (Center et al., 2017). The primary objective of the Act is to attain a near-universal health coverage by adopting collaborative responsibility national and state government, people, and employers (Gaffney et al., 2017). Aside from that, ACA was enacted with the target of bettering the quality and cost aspects of health insurance coverage. The first two aims of the Act will help with the achievement of the third objective, which is to improve health-care value, quality, and efficiency, ensuring that the health care sector becomes more accountable to the diverse patient population (Gaffney et al., 2017). The adoption of Act has helped improve access to quality health care services through coverage expansion, health insurance market reforms, and cost and affordability plans.
By strengthening existing health insurance coverage programs while introduced new and improved health insurance coverage programs, ACA expanded coverage. The dependent coverage provision for people up to the age of 26 years in family insurance plans, and the expansion of Medicaid to cover more adults ensured that a significant part of the previously uninsured population gained coverage (Gaffney et al., 2017). Coverage expansion was also gained through individual and employer mandates. Based on the Act, any person without a coverage was expected to buy a private plan or pay a tax (Gaffney et al., 2017). On the other hand, any employer with at least 50 employees must offer coverage that meet the cost and affordability requirements of ACA. Resultantly, the number of uninsured Americans has reduced significantly.
The health insurance market reforms along with cost and affordability criteria of ACA has helped to make insurance coverage more affordable. The Act introduced online marketplace for the sale of insurance plan to individuals and businesses (Gaffney et al., 2017). Aside from these plans covering the ten primary health benefit, they were also eligible for premium and cost-sharing subsidies, which made it more affordable and accessible to the public. Additional changes, such as the guaranteed issue of plan without basing them on pre-existing conditions, prohibition of annual or lifetime limits on benefits, and the provision of specified health care services without cost sharing ensured that the coverage was less expensive and more viable for most people who could not previously afford coverage (Center et al., 2017). The cost and affordability criteria set up for employer-sponsored plans and marketplace plans also ensures that the interests of patients are covered.
Therefore, through the aforementioned reforms, ACA has shown great importance in solving the social welfare issues envisaged in the U.S healthcare sector. The regulation of the content and design of coverage has helped improved healthcare outcome. The Act makes insurance coverage more affordable, pushes employers to take up workplace wellness programs to boost and incentivize health outcomes, and facilitates improved health-care quality, efficiency, and accountability, which culminate in better health outcome for patients (Gaffney et al., 2017). The Act has particularly been beneficial to the approximately 60 million medically underserved individuals by eradicating the potential health risks and shortage of primary health-care professionals.
Despite the apparent benefits of ACA, the Act has been criticized for disrupting insurance coverage that existed before its enactment, by making some of the existing insurance policies non-compliant. Also, there is an argument that the adoption of ACA has resulted in increased premium and reduced affordability (Center et al., 2017). While a significant part of the population either moved to Medicaid or received a highly subsidized coverage, the people with incomes over 400% of the Federal Poverty Level saw their premium almost doubled and their out-of-pocket expenses increase. Besides, a significant population of the newly covered Americans enrolled in Medicaid; despite the reduction in the number of uninsured people, ACA resulted in an estimated 17 million increase in the number of individuals covered by Medicaid and CHIP, thus straining the state budget due to the contribution that is expected of them (Center et al., 2017). In summary, there is an opposing view that ACA has only increased insurance for many people but coverage for few.
Medicaid
Despite its introduction in 1965, Medicaid is still a relevant policy for addressing the social welfare issues inherent in the U.S healthcare sector. Congress enacted Title XIX of the Social Security Act in 1965 to introduce the Medicaid program (Katch, 2017). The program gives states the opportunity to offer health coverage to the eligible population, that includes low-income families, children, pregnant women, senior citizens, and persons with disability (Katch, 2017). States are however required to administer the program as per the federal government requirements. The Act identified various categories of medical services that will be eligible for federal reimbursement. State governments have the obligation of covering services categorized under mandatory services. Aside from the mandatory services, states are also expected to choose and incorporate additional services from the thirty-four optional services in its state plan.
The program only covers people who meet its eligibility criteria. The minimum income criterium is one of the guidelines used to determine eligible individuals. The program accepts low-income expectant women and children under the age of 6 with 133% of the Federal Poverty Guideline (Katch, 2017). In addition, low-income parents and guardians of children may be considered in the program. Other persons that are eligible for the program, include people that benefits from SSI due to disability or being 65 years or older, children in foster care, and medically needy individual who have incomes greater that the required limit, but paid adequate medical funds to allow them to qualify for the “spend down” test.
Medicaid works to increase health coverage and thus access to quality health care by covering millions of individuals. Medicaid has been proven to improve health; it increases the number of people with personal doctors and the number of people who receive annual checkup (Katch, 2017). Its expansion resulted in the reduction of the uninsured population. The increased access to healthcare for people who would otherwise not have any has resulted in better and improved health outcome. Medicaid offers access to care that is parallel to that offered by private insurance, meaning the poor and low-income families can have access to providers and high-quality care.
Although Medicaid has ensured coverage for a significant part of the previously uninsured population, there are people who still find themselves locked out of the program due to the difference in guidelines set up by different states. It is possible to have low-income individuals who are not eligible for the program (Katch, 2017). Even when a person is eligible, he or she may be forced to endure low quality treatment in cases of emergency because they are on Medicaid. Beneficiaries of the Medicaid programs tend to be targets of discrimination, especially the elderly in nursing homes (Katch, 2017). Also, the recent expansion of Medicaid to cover more adults has increased the financial burden of funding the program on States.
While the introduction of ACA and Medicaid has significantly improved coverage and access to healthcare services, these policies have issues that makes solving the social welfare issue discussed therein difficult. Due to these issues, there are still many people who are uninsured in the United States, and thus increasing their health risks. A couple of changes can be made on the two legislation to help improve coverage while minimizing its negative effect on other members of the population. These policies can be amended to be beneficial to more members of the community. All in all, ACA and Medicaid have had relatively more positive outcomes compared to their shortcomings.
References
Center, H., Woods, C. A., Manchikanti, L., & Purdue Pharma, L. P. (2017). A critical analysis of Obamacare: affordable care or insurance for many and coverage for few. Pain Physician , 20 , 111-138.
Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity. The Lancet , 389 (10077), 1442-1452.
Katch, H. (2017). Medicaid Works: Millions Benefit from Medicaid’s Effective, Efficient Coverage. Washington, DC, Center on Budget and Policy Priorities .
Lazar, M., & Davenport, L. (2018). Barriers to health care access for low income families: a review of literature. Journal of community health nursing , 35 (1), 28-37.
