Uninsured and Underinsured in America

Uninsured and Underinsured in America Essay Sample

The uninsured and under-insured population in America “poses an alarming threat to the US health care system, and is a major target of the Obama health reform”. (Qin, X., & Liu, G. G. (2013). In this paper we will take a look at the impact of the uninsured and underinsured population and explore what has been done to alleviate the problems so far. I will provide you with the history of health insurance in the United States and compare our health care systems to that of other countries. I will explore how all the stake holders can be involved in lowering the costs of health care and give you my recommendations on how to provide access to affordable insurance to all Americans. The U.S. health care system faces significant challenges that clearly indicate the urgent need for reform. There are over 47 million Americans who are uninsured and millions more that are underinsured.

Many insured Americans are facing rapid increases in premiums and out-of-pocket costs that will soon add them to the ranks of the uninsured or underinsured. The Patient Protection and Affordable Care Act (PPAC) signed into law in 2010 by President Barack Obama is an attempt provide all Americans with affordable access to health care and control America’s out of control and rising health care costs. Inadequate coverage and the resulting impact on access to medical care have been issues for citizens across the United States for many years. As a result of the escalating cost of health care the numbers of uninsured and underinsured Americans have risen to historic levels. What will Obama Care mean for the millions of American without adequate insurance? How do we expand access to medical care? We will take a look at how we got here and where to go now to fix the problem. History of Insurance:

To understand our current healthcare crisis we need to go back to the beginning. Before 1920 most Americans did not have any insurance, it was not needed, medical cost were relatively low. Then there was the war and the great depression. These were hard times for Americans. Most people struggled just to put food on the table there was nothing left for health care. To help ease the healthcare problem a system was developed that helped Americans with medical bills. By the late 30s insurance was common place. Then advancement in medical science and new technologies started driving medical prices up. With the success of the early insurance models private insurance entered the market. At this time other industrialized countries were adopting nationalized health care but Americans did not want to put health care in the hands of the government. With private insurance companies entering the market, premiums rose. Employers were encouraged to provide health insurance with government incentives. Unions got in the picture and employment based insurance got its foot hold.

The problem was that self-employed and unemployed people had no insurance. If you had a pre-existing condition insurance companies would not insure you. There were no insurance programs available to take care of medical bills when you retired. By the1960s health care cost had rose significantly, there was talk about following other countries and adopting a national health care system. That was again met with strong opposition. The President decided that we needed to start small and Medicare and Medicaid were enacted. These programs provided health care to the recently retired, the elderly, and the poor. The bill was passed in 1965 and consisted of two parts. Since then, Medicare has evolved. Medicare is still provided by the government and Medicare Advantage which was added to provide insurance to seniors by private insurance companies contracted with the government. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States.

It has been four decades and little has changed with Medicare and Medicaid. Through the years a number of factors have combined to drive health care costs way up. Advances in medical technology which can save lives are out of reach for over 50 million Americans. We can all agree that our health care system is in need of reform. Now we need to agree on how to rebuild our health care system. Patient Protection and Affordable Care Act (PPAC) signed into law in 2010 by President Barack Obama is meant to provide all Americans with affordable access to health care and control America’s out of control and rising health care costs. Government, the private sector, individuals and the groups that represent them each must share in the responsibility for finding an affordable solution. Other wealthy nations like Japan, Australia, Canada, and rich European nations spend between 8 to 11% of their GDP on health care and enjoy superior service and universal coverage.

America is the only rich country that does not provide universal health care coverage to its population. Millions of Americans go without healthcare due to cost. Americans without health insurance often put off getting medical care or go without it entirely. If they must seek care they can face enormous financial burdens from medical bills. The underinsured have insurance coverage that doesn’t provide adequate protection against health care costs and even with insurance they still are faced with the dilemma of not being able to afford health care. This is not the case for citizens in other countries. In Canada, our closes neighbor to the north, every citizen is insured by a single payer system, their government. They do not have co-pays or deductibles, they only need to make the appointment and show their medical card to get all necessary medical care.

No Canadian citizen has to choose whether they buy groceries or take their medication. Everything is paid out of taxes set aside for insurance. “Funding for the healthcare is provided from a combination of a flat tax for every citizen and through general provincial revenues”. (LeBien, 1996).The drawbacks with Canada’s health care it that there are longer wait times than in the United States. But Canadians are healthier than Americans. The United States rations health care by ability to pay and some people never get the care needed. Comparing the United States to England we again are behind in quality to access of care. England uses the National Health Service and any person who has a European residence Card has complete access to health care. Health care is publicly financed. Most funding comes from general taxation, a smaller percent from national insurance or a payroll tax.

The National Health Service also receives income from co- payments, those using NHS services as private patients. There is again more of wait time to get treatments but they have set in place maximum wait times on any treatment that could affect a person prognosis. There is a strict policy in place to make sure standards of care are met by all agencies providing health care. The citizens have complete medical care including mental health, dental and long term care, prescription drugs with minimal out of pocket expense. Like every other developed country England ranks above the U.S. in most health measurements. People have a longer life expectancy and lower infant mortality, and the country has more acute-care hospital beds per capita and fewer deaths related to surgical or medical mishaps. England achieves these results while spending proportionally less on health care than the United States about $2,500 per person in England, compared with $6,000 in the U.S. Thailand is one of the first developing countries to make major progress towards universal health coverage.

“After the student revolt against the military government in 1973 and their first democratic elections in 1975, the new government made health services available free of charge to the poor”. (Fleck, F. (2014). Although the country was facing an economic crisis the government elected to focus on health care and has been successful in providing insurance to all there citizens. In 1975 zero percent had health insurance now in 2014 every citizen has basic essential coverage. It is apparent that the Health care system in the United States is in need of a makeover. The Canadian universal healthcare system has shown that a single-payer system dramatically reduces administrative overhead and there is proven success in containing healthcare costs. This is shown again and again with other industrialized countries doing way better that the United State in most health care areas. “Efforts to broaden access to health coverage in the twentieth century have repeatedly ended in failure.

In addition to Bill Clinton’s unsuccessful attempt in 1993-1994, other presidents-including Franklin D. Roosevelt, Harry Truman, John F. Kennedy, Richard Nixon, and Jimmy Carter-have sought and failed to achieve meaningful coverage expansions. The lone exception is Lyndon Johnson, who, after an electoral landslide that was accompanied by overwhelming Democratic majorities in both chambers of Congress, succeeded in enacting Medicare and Medicaid in 1965”. (Kahn,Charles N., I.,II, & Pollack, R. F. (2001). This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state.

The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare”. (Quadagno, J. (2004). Private insurance companies do not want a single payer system when they are getting rich on our broken outdated health care system. They are allowed to set premiums and pick and choose who they insure. This leaves millions of Americans uninsured or underinsured, and it leaves others at risk of losing insurance if they get sick, such as cancer or traumatic injury because they exceed the lifetime limits of their coverage and they have no way of reacquiring insurance because they now have a preexisting condition. The uninsured are sicker, receive inferior care, and are more likely to die prematurely (Institute of Medicine 2004). The fundamental premise of solving the American Health Care Crisis is that most American decision makers are in a state of denial.

Many of them consistently claim that the United States has the greatest health care system in the world. That claim is hard to support when America spends over 16% of its gross domestic product (GDP) on health care, while more than 47 million Americans have no health insurance and millions more are under-insured. The Patient Protection and Affordable Care Act (PPACA) specifically address’s access to health care for the millions of Americans that do not have health insurance. People that already have insurance through their employment will not lose coverage. The PPACA will however make coverage more affordable and you will no longer have to worry about losing insurance due to meeting life time coverage caps. If you get a new job, you cannot be denied coverage with their insurance do to pre-existing conditions.

Young adults are now able to stay on their parent’s policy until age 26. By the year 2019 a family of four will save about $2,000 a year on premiums. Obamacare is closing the Medicare doughnut hole and saving people an average of $600 on out of pocket expenses per year. “Small-business owners are getting tax credits to provide coverage for their workers and will soon be able to pool together to leverage better rates, just like big corporations”. (Obama, B. (2012). For the 20 percent of Americans who are either uninsured or underinsure Obamacare will provide access to medical care. “Those that make more than the federal poverty line, but less than four times the poverty line ($94,200 for a family of four), can buy subsidized insurance on the marketplaces. Those making less than 133 percent of the poverty line, and living in a state that has accepted the Medicaid expansion, can get Medicaid”. (Zandi, M. 2014, Jun 25). “More than 8 million people enrolled through healthcare.gov and other state exchanges.

Several million more lower-income households were able to enroll in Medicaid. If everything sticks reasonably to script, by 2016, more than 25 million more Americans will have health insurance than would have otherwise”. (Zandi, M. 2014, Jun 25). Medicaid expansion is financially beneficial for states. Assuming nationwide expansion, federal funding would cover approximately 93% of the cost of insuring new populations, with states responsible for only 7%.1 According to investigators at the RAND Corporation; by 2016 the first 14 states committed to opting out of Medicaid expansion would forego $8.4 billion in federal funding and assume increased liability for uncompensated care to the uninsured. There would be 3.6 million fewer insured people in these states. (Grant, R. 2014).

My recommendations for fixing the problem of uninsured and underinsured in the United States would be very similar to the National Health Service used in Europe. The PPACA is definitely an improvement to what we have had. I would recommend that we expand Medicare to provide basic essential health coverage for all American citizens. The markets would still be available for anyone wishing to purchase additional coverage that would nonessential procedures. It has been proven that a single payer system is much more cost effective than multiple private payers. America is the richest country in the World; we could afford to spend a few extra dollars on GDP to go into health care rather than spending millions of dollars to receive unnecessary procedures while we have millions of citizens without basic health care.

If we were to follow through with providing everyone with health care we would be a much healthier nation. More money would be spent on GDP which would strengthen our economy. The main target of Patient Protection and Affordable Care Act is to provide every American citizen with basic health care and close the gap on uninsured and underinsured population in America. Martin Luther King Jr. stated in one of his speeches, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

References:

LeBien, L. (1996). The Canadian healthcare system: the future of American healthcare?. (Hospital Topic, 74(3), 25-31). Fleck, F. (2014). Thailand’s health ambitions pay off. World Health Organization.Bulletin of the World Health Organization, 92(7), 472-473. Retrieved from http://search.proquest.com/docview/1544530364?accountid=32521 Department of Health (2010a).Review of Access to the NHS by Foreign Nationals. London: Department of Health. Institute of Medicine 2004

http://en.wikipedia.org/wiki/Healthcare_in_England
Kahn,Charles N., I.,II, & Pollack, R. F. (2001). Building a consensus for expanding health coverage. Health Affairs, 20(1), 40-8. Retrieved from http://search.proquest.com/docview/204640118?accountid=3252 Quadagno, J. (2004). Why the united states has no national health insurance: Stakeholder mobilization against the welfare state, 1945-1996*. Journal of Health and Social Behavior, 45, 25-44. Retrieved from http://search.proquest.com/docview/201666326?accountid=3252 Obama, B. (2012). Securing the future of american health care. The New England Journal of Medicine, 367(15), 1377-81. Retrieved from http://search.proquest.com/docview/1097694221?accountid=32521 Grant, R. (2014). The triumph of politics over public health: States opting out of medicaid expansion. American Journal of Public Health, 104(2), 203-205. Retrieved from http://search.proquest.com/docview/1499845232?accountid=32521 Zandi, M. (2014, Jun 25). GUEST COLUMN: Affordable care act may be slowing health-care costs. The Atlanta Journal – Constitution Retrieved from http://search.proquest.com/docview/1539655191?accountid=32521