23 Apr 2022


Socialized health care and ACA change

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Academic level: College

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Despite the Affordable Care Act (ACA) aiming to insure everybody it is still surprising that some Americans still do not have health insurance. Most Americans still do not have insurance because insurance is costly and very few people can afford to buy their own (Schoen et al., 2013). Most Americans get their insurance coverage from their employers but low-income workers fall at a risk of being uninsured because they are unlikely to be offered jobs that include insurance cover and because of their low incomes they are not able to afford their share of premiums as compared to people with higher incomes (Hall and Lord, 2014). Again Medicaid may cover for children with parents with low income but the eligibility of the parents to these services are very low and unless they qualify through a disability pathway it will mean that they do not get coverage. Again many people remain uninsured because they are immigrants who might be undocumented and thus are not eligible to access Medicaid or market coverage.

According to the World Health Organization, social health insurance is whereby financing and management of healthcare is based on risk pooling. This scheme pools health risks of individual people on one hand and the contributions of the government, enterprises or households on the other hand. Shi and Singh, (2014) define SHI as a scheme whereby a policy holder is encouraged to get insurance from a third party. Here, ill health is considered a concern of the public and therefore insurance is highly considered as protection against the costs of ill health. Individuals who have a policy in SHI continue to receive benefits that will keep protecting them against sky rocketing costs of having ill health but does not consider personal choice. According to this scheme when an individual gets sick it affects the whole society which will suffer the loss through loss of productivity and loss of time (Shi and Singh, 2014). 

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Schoen et al (2013) suggest that the ACA should raise the range of income levels to at or below 138% so that it can cover more people in the Medicaid scheme. All states should also implement the expanded eligibility for parents in all states and also lower the cost of insurance to accommodate even people who cannot access insurance from their employers.

According to Buettner and Lobo (2012) market justice leaves the fair distribution health care in the hands of market forces in a free economy. It states that all process of medical care and all the benefits that come with it can only be accorded to people who are willing to pay. Social justice on the other hand states that it would be unjust for people to obtain medical services due to their inability to pay because a person’s health is a concern of the who society and not just an individual. Buettner and Lobo (2012) state that both these principles emphasize on the need for individuals to access health and the rights involved therein but they differ in different ways. Market justice is based on self-interest, personal effort, individualism and voluntary behavior whereas social justice stems from concern for communal well-being, shared responsibility and the government as a vehicle for arriving at equality. 


Buettner‐Schmidt, K., & Lobo, M. L. (2012). Social justice: A concept analysis. Journal of advanced nursing , 68 (4), 948-958.

Hall, M. A., & Lord, R. (2014). Obamacare: what the Affordable Care Act means for patients and physicians. Bmj , 349 (7), g5376-g5376.

Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2013). Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Affairs , 32 (12), 2205-2215.

Shi, L., & Singh, D. A. (2014). Delivering health care in America . Jones & Bartlett Learning.

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