Definition of the Problem:
Health care is not something that should be treated as an incentive or something that you should have to earn or work for. Receiving adequate health care and making sure that all needs are met in order to live a healthy life span is a necessity and should be treated as one. The problem is that According to the U.S. Census Bureau (2012) there were 48.6 million people in America that were uninsured of those 48.6 million people seven million were children. (census.gov). There are some individuals that have health insurance but still lack proper health care due to outrageously high copayments. Even though there is help available through assistance programs it is not just handed to you. Contemporary Scope of the Problem:
Despite all of the efforts made to provide adequate health care to the majority of Americans we still have millions of people that lack health insurance. Not receiving the proper health care that is needed can lead to a burden of issues for an individual. For example, a person with a mental health disease that is not insured and not receiving the proper care or medication to stabilize their condition is not just a personal problem. This issue is a problem for society as a whole that can potentially be in harm due to the lack of proper treatment for the individual that is suffering. Financially, we are paying for these individuals to be incarcerated instead of being treated. According to Easley (2009)
The development of psychotropic drugs in the 1960s led to efforts across the country to deinstitutionalize the care of people with mental illness, but there was a subsequent failure to provide adequate community mental health resources to meet their needs. This resulted in many of the mentally ill living homelessly, often self-medicating with illicit drugs, and experiencing a revolving door from prison to street. Currently, 15 percent to 24 percent of U.S. prison inmates have a severe mental illness, with one half of them — numbering 1 million — having at least one mental health problem (p. 17) Costly health care is one obvious reason why millions of Americans are suffering from inadequate health care. “The increased cost of health insurance is a central fact in any discussion of health policy and health delivery. As annual premiums surge beyond $15,000 for an average family, costs are blamed for rising uninsured and “under-insurance.” (ncsl.org) Families that have a low income level can obviously not afford the cost of health insurance. This is where government assistance programs are beneficial to those who qualify. However, if you are not making enough to afford health insurance on your own or your income exceeds the required amount set to receive Medicare you are left uninsured. Although many jobs offer health benefits you must also meet the criterion of working full time and in most cases you have to maintain the job for a required period of time before you are able to receive those benefits. Vulnerable Populations:
It is no surprise that the poor and the unemployed are most affected population due to lack of health proper health care. As we learned this semester society tends to ignore the issue of poor individuals and pretend as if it doesn’t exist. If we are not personally affected by it we ignore it. According to Robinson (2007)
Racial and ethnic minorities are more likely to lack health insurance, and much of this disparity extends from the fact that roughly 60% of Americans today receive health-care coverage as a benefit of employment. Racial and ethnic minorities are disproportionately employed in sectors of the economy where wages are lower and benefits more limited. Blacks and Hispanics face considerably higher rates of unemployment (p. 531) Significant Programs Created
When the Social Security Act of 1935 was reformed and titles were added two major programs were created to insure millions of Americans who qualify. Medicaid funded by the government was enacted to provide health care for individuals in the low income bracket. According to Medicaid.gov “Medicaid and CHIP provide health coverage to nearly 60 million Americans” (p. eligibility) Medicare provides health coverage for people over the age of 65 or people with certain disabilities, and individuals who suffer from End-Stage Renal Disease. In 1997, the CHIP program was enacted to provide coverage for uninsured children if their family did not qualify for Medicaid. In 2003, the Medicare Modernization Act was enacted; its purpose is to provide lower costs for prescription drugs for individuals receiving Medicare. Gaps or Limitations within Policy:
“Although Medicare is the main provider of medical care for the elderly and disabled, it does not cover all medical costs. In particular, it covers only a limited amount of long-term care expenses (for example, nursing home expenses) (De Nardi, French, Jones, & Gooptu, 2012 p. 17) The result of lack of full health coverage for the elderly who can no longer work and afford to pay high health care costs means they are “dual eligible” meaning they can receive both Medicare and Medicaid. The Medicare Modernization Act (MMA) negatively affects recipients who are considered “dual eligible”. “A unintended consequence includes the fact that individuals receiving both Medicaid and Medicare are being excluded to qualify for a prescription drug plan allowing them to take advantage of lower prescription drugs at all causing gaps of coverage for many Americans” (James, 2013 p.5).
Americans who do not meet the specific requirements set for any of the programs intended to insure the uninsured will remain uninsured and with very little options. To qualify for Medicare you must be 65 or disabled to be considered. To receive Medicaid benefits you must meet the income requirements. Even if there is no possible way for an individual to afford health insurance on their own they are still told no if they make more than the budget that has been set to be determined eligible. Relevant Social Services:
As mentioned previously the social services provided for American’s who lack health care insurance are Medicaid, Medicare, and the CHIP program specifically designed for children. Medicare covers the elderly and disabled but does not have a long term care benefits. You must be 65 or older or have a certain disability to qualify. Medicaid and CHIP are both government funded programs that provide health care to individuals with low income. Medicaid does offer long term care and is usually available to those already receiving Medicare. However, with the MMA, dual eligible recipients will not be able to take full advantage of lower prescription drug costs. CHIP provides health insurance for children only. “In the absence of health insurance coverage expansions, subsidizing the direct provision of services
to uninsured such as through Community Health Centers (CHC) and other safety net providers is one of the few alternatives policy makers can use to improve access to care for the uninsured” (Cunningham, Hadley, Kenney, & Davidoff, 2007).Many Americans who lack insurance may use a local urgent care center or a community health center for low cost medical services. Levels of Effectiveness in Addressing Problem:
The level of effectiveness in addressing lack of health care has come a long way. Despite the fact that nearly 49 million American’s remain uninsured, the social welfare policies that have been put in place over the years have provided many American’s with adequate health care. In just a one year span you can see the difference in numbers of American’s who are insured due to Medicaid and CHIP or Medicare. According to the U.S. Census Data (2012) on Health Insurance in the U.S., in 2011 •The percentage of people without health insurance decreased to 15.7 percent from 16.3 percent in 2010. The number of uninsured people also decreased, to 48.6 million, down from 50.0 million in 2010. •The percentage and number of people covered by Medicaid in 2011 increased to 16.5 percent and 50.8 million, up from 15.8 percent and 48.5 million. The percentage and number of people covered by Medicare increased in 2011 to 15.2 percent and 46.9 million from 14.6 percent and 44.9 million. (census.gov) This shows that these programs are very effective with providing millions of Americans with health coverage. As I stated previously in the early 1900’s Americans who did not have adequate health care were ignored. We can now see more Americans qualifying for assistance programs that provide health care benefits. Current State of the Social Problem
As of right now there are several different policies that are enacted that focus primarily on providing adequate health care to the uninsured. However, we are still faced with this large number of uninsured individuals. Medicare and Medicaid insure over millions of Americans which is better than the past. However, with limitations and a stigma attached many Americans do not have the opportunity to receive the help that is out there. Medicare and Medicaid were both added titles in 1965 to the Social Security Act of 1935. The impact of these services are tremendously effective to those who
qualify, as of 2011, according to census.gov (2011) there are about 100 million Americans enrolled to receive some type of government health insurance. The Medicare Modernization Act of 2003 was enacted primarily for lowering prescription drug costs for low income individuals receiving Medicare. However, many individuals receiving Medicare also receive Medicaid to pick up the tab of expenses not entirely covered by Medicaid. This act prohibited recipients enrolled in both services to receive lower prescription drug costs. Individuals who receive Medicaid alone greatly benefited from this act. The Patient Protection and Affordable Care Act of 2010 “introduces many new mechanisms into the insurance marketplace that significantly impact business as usual. Many changes have already been implemented (e.g., 100% preventive care services and dependent coverage until the age of 26), while many are set to begin in 2014” (Mehmud, & Neiman, 2013). As I mentioned previously there are various changes that will take place in the beginning of next year.
Health care in America is one that raises many questions and feelings towards the subject. It is an important issue because of the millions of Americans that are affected by the lack of health care. A universal health care system for America would be ideal but is not set to be affective any time soon. According to Rashford (2007)
Universal healthcare coverage is an important subject for all Americans. Millions of Americans are not covered by health insurance plans, many cannot afford to purchase health insurance, and many employers do not offer such coverage due to high costs, especially for small businesses. Part-time workers, seasonal workers, and most if not all undocumented workers do not have any insurance coverage (p.3). This is a problem in America that cannot be overlooked or ignored. Millions are affected by the lack of health care. It is an issue for our society as a whole. Many people file bankruptcies due to medical expenses. The question that lingers remains the same. Why can’t America provide a universal health care system? “The United States is among the wealthiest and most prosperous nations in the world, yet its government is unable, unwilling, or incapable of providing adequate, basic health care to all its citizens” (Rashford, 2007, p.4). Many people believe that health
care is not the government’s responsibility which may be part of the reason America still does not have universal healthcare. According to Rashford (2007) “The money to support a universal healthcare program is available, and yet the United States remains the only industrialized nation that does not provide health care for its citizens” (p.4). The fact that America can provide health care for its citizens means that America should.
As far as recommendations for current services I believe that America as a society lacks the ability to think sociologically. We are only concerned about our individualistic needs ignoring the needs of others. Our social world is not set in stone we have the ability to change inequality. No person should be without adequate healthcare because of our man made idea of social class. The level of income required to be considered eligible for Medicaid benefits should be adjusted. We must take into consideration the high cost of living. Making less than the set number is guaranteed poverty. Americans should not have to be determined as poverty stricken to receive proper health care. More health care community centers should be placed for the uninsured Americans. Every child should be insured regardless of any situation to provide preventative care in order to live a healthier life in the long run.
References
1. Agostinho, J. (2009). Improving Prescription Drug Access for Dual Eligibles After the Medicare Modernization Act. Columbia Journal of Law & Social Problems, 43(2), 183-214. 2. Cunningham, P. J., Hadley, J., Kenney, G., & Davidoff, A. J. (2007). Identifying Affordable Sources of Medical Care among Uninsured Persons. Health Services Research, 42(1P1), 265-285. 3. De Nardi, M., French, E., Jones, J., & Gooptu, A. (2012). Medicaid and the elderly. Economic Perspectives, (1), 17-34. 4. Easley, C. (2009). The incarcerated mentally ill: An invisible, vulnerable population. Nation’s Health, 39(6), 3. 5. Landers, R. M., & Leeman, P. A. (2011). MEDICAID EXPANSION UNDER THE 2010 HEALTH CARE REFORM LEGISLATION: THE CONTINUING EVOLUTION OF MEDICAID’S CENTRAL ROLE IN AMERICAN HEALTH CARE. NAELA Journal, 7(1), 143-164. 6. Mehmud, S. M., & Neiman, D. (2013). The Affordable Care Act in Brief: A Look Into January 2014 Changes. Benefits Quarterly, 29(2),
34-41. 7. Peters, R. (2004). THE SOCIAL SECURITY AMENDMENTS OF 1960: COMPLETING THE FOUNDATION FOR MEDICARE AND MEDICAID. Journal Of Health & Human Services Administration, 26(4), 438-469. 8. Rashford, M. (2007). A Universal Healthcare System: Is It Right for the United States?. Nursing Forum, 9. Robinson, D. E. (2007). US Health and Health Care: Does Political Inequality Make Us Sick?. New Political Science, 29(4), 529-534. 10. Rott, C. J. (2006). THE DEVELOPMENT OF THE U.S. HEALTH CARE SYSTEM AND THE CONTEMPORARY ROLE OF THE PUBLIC HEALTH DEPARTMENT. Journal of Health & Human Services Administration, 29(3), 336-359. 11. Watts, M., Kasper, J., & Lyons, B. (2009). FUTURE CHALLENGES FACING MEDICAID’S ROLE AS A PROVIDER OF LONG-TERM CARE. NAELA Journal, 5(2), 105-122. 12. Wojcik, S. E. (2013). Implementing the Patient Protection and Affordable Care Act: The Time Is Now. Benefits Quarterly, 29(2), 30-33.
Additional Non Peer Reviewed References
1. James, S. (2013). America’s Health Care System: Medicare Modernization Act. Unpublished manuscript, East Stroudsburg University 2. www.pbs.org
3. www.cencus.gov
4. www.cms.hhs.gov
5. http://www.ncsl.org