Wednesday, May 29, 2013


State of the US Healthcare System: Underinsured & Uninsured According to results from a Commonwealth Fund study, the number of those who are uninsured or underinsured in the United States has increased drastically. The US Census Bureau estimates that about 41.2 million individuals or 14.6% of the United States population are uninsured, up from 40.1 million or 14.2% in 2000. Out of those individuals who are not insured are children and the low income minority groups. The other issue is that of the underinsured or partially insured. This is the group of the individuals who have health care insurance that is not sufficient to cater for the high health care expenses (Stroupe, Kinney, & Kniesner, 2000). In general, 91.1 million individuals are underinsured or uninsured. This number is predicted to continue increasing. The number of people with no insurance coverage in the country is one of the main issues for policy makers in the health care sector. Health care reform in the United States has been performed for a long time all aimed at making health care affordable for majority in the country. Health insurance has always been addressed in health care reform as a means of addressing the issue of uninsured and underinsured in the country. The current health care policy in the United States was passed in the year 2010. This was following the passing of two bills. The first bill that was enacted on 23rd March is PPACA (the Patient Protection and Affordable Care Act). The second bill is the Health Care and Education Reconciliation Act that amended the Patient Protection and Affordable Care Act and was enacted on 30th March (Leap, 2011). The health care reform in the United States comprises health-related requirements to be implemented over the following four years. The requirements include expansion of Medicaid eligibility for individuals earning up to 133 percent of the national poverty level, subsidizing covers for individuals earning up to 400 percent of the national poverty level, for their highest “out-of-pocket” fee for yearly premiums to be on the sliding scale from 2 percent to 9.8 percent of revenue, offering incentives for organizations to offer health care coverage, illegalizing denial of insurance policies in the name of pre-existing conditions, creating health insurance exchanges, providing support for research in health care and forbidding insurance companies from creating annual coverage limits (Odier, 2010). Most of the people in the country who would not be able to afford health care insurance cover any other way benefit from federal insurance programs such as Medicare, Medicaid, the WIC program, and State Children Health Insurance Program (SCHIP). The focus of this paper will be on Medicaid. This is the second largest health insurance program after Medicare in the country. The program is funded by jointly by the federal and state governments to cover health care expenses for the elderly, disabled, and low-income individuals in the country. The program serves United States citizens or legal permanent immigrants (Carpenter, 2011). Having limited assets is one of the main requirements for one to be eligible for the program. However, poverty alone is not enough qualification unless the applicant falls under any of the eligibility categories. The Patient Protection and Affordable Care Act of 2010 extended eligibility to the program, a requirement that will start in 2014. From that time, individuals having an income of 133 percent of the poverty line will be eligible for the cover, even adults with no dependent children. Within each of the eligibility categories various requirements exist other than income. The requirements include assets, pregnancy, age, blindness, disability, income and resources, and status as citizen or legal immigrant. Exceptions are made for Emergency Medicaid for the disabled or pregnant, immigration status notwithstanding (Carpenter, 2011). Non-citizens or illegal immigrants are the majority without insurance coverage in the country. Given the fact that citizenship and legal immigration are among the main requirements for eligibility for Medicaid, this program does not cover illegal immigrants. Non-citizens and illegal immigrants have an insured rate of 43.8%. This is because of their status in the country and the possibility of working in low wage jobs that do not provide insurance coverage. Majority of the uninsured in the country are the recent illegal immigrants. Given the fact that health care is a universal human right, it might seem unethical that this group of vulnerable individuals is left out of insurance cover that is developed to provide healthcare for other minorities (Odier, 2010). There are various implications of denying this group access to health care. There is an ethical dilemma in the health care providers failing to provide health care because of not having sufficient coverage or without having coverage at all. On one hand, health care providers have an ethical responsibility to provide care to people who require it. Failure to provide health care because of being uninsured or uninsured can have various serious health outcomes. Various studies have revealed the consequences of insufficient healthcare compared to those who are insured which include: failure to seek important care as frequently as insured individuals; failure to seek preventive care; late diagnosis of malignancies; acute care; higher chances of hospitalization for preventable cases; and higher rates of mortality. This is an ethical problem that affects not only the patient but also his family and the entire community. While the health care providers have the ethical responsibility of avoiding these adverse health outcomes, there is the problem of the resources required to provide care. Health care providers would wish to help everyone regardless of the insurance status but this is not possible due to the high cost of health care (Lurk et al, 2006). There are various policy reforms that can be implemented to address the issue of failure to receive healthcare due to one’s insurance status. It would be beneficial for the policy makers to develop policies that would make it possible for the uninsured to access health care in the country. Extension of eligibility for coverage to more vulnerable groups such as the recent immigrants would help in addressing the problem of poor health care in the country as well as the ethical implications of leaving out some human beings to suffer because of inability to access health care. It would not be ethical for a country like the United States to continue facing the problems of poor medical care for any person within its boundaries. A policy reform that would see majority of people in the country, including most of the vulnerable groups, accessing health care in the country is important (Lurk et al, 2006). References: Carpenter, C. E. (2011). Medicare, Medicaid, and Deficit Reduction. Journal Of Financial Service Professionals, 65(6), 27-30. Leap, T. L. (2011). Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to do about It, Ithaca, NY: Cornell University Press. Lurk JT, DeJong DJ, Woods TM, Knell ME, Carroll CA (2004). Effects of changes in patient cost sharing and drug sample policies on prescription drug costs and utilization in a safety-net-provider setting. Am J Health Syst Pharm 61(3): 267-272. Odier, N. (2010). The US health-care system: A proposal for reform. Journal of Medical Marketing, 10(4), 279-304 Stroupe K.T, Kinney E.D, Kniesner T.J (2000). Does chronic illness affect the adequacy of health insurance coverage? Journal of Health Politics, Policy, and Law; 25 (2): 309 – 341.