Investigating Inequalities in The US Healthcare System (Essay Sample)

Inequalities in The US Healthcare System
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Inequalities in The US Healthcare System
Introduction
In the United States, healthcare is a privilege and not a right. There are many who believe that this system of providing healthcare to those willing to work for it is the best way, despite its inconsistencies in quality and availability (Dickman et al., 2017). The Affordable Care Act was arguably America's first step towards universal healthcare coverage for all citizens; however, there are still disparities in care depending on a patient's location or economic status. Some argue that universal healthcare is a must, while others believe that each state should be able to decide its own healthcare policy (Goldman, 2019). In order to determine the best decision, it is important to look at the systems in place currently and their weaknesses. Since the United States is a large country with widely varying economic statuses and living conditions across states, as well as varying access to capital and resources depending on where one resides, there will always be inequalities in healthcare. However, it is possible to develop a system in which the inequalities are lessened and the quality of healthcare is universally high.
The Affordable Care Act
The ACA was signed into law in March 2010 and is considered one of President Barack Obama's most notable accomplishments.  The main goals of the ACA are to expand coverage to many who had been uninsured, streamline benefits, and reduce costs (Carrasquillo & Mueller, 2018).  It accomplishes this by setting up healthcare exchanges for individuals to shop for coverage.  The exchanges offer four tiers of coverage: Bronze, Silver, Gold, and Platinum.  Each tier offers a different quality of coverage, ranging from "lowest" (Bronze) to "highest" (Platinum), with varying premiums and deductibles in between.  The ACA also expands Medicaid eligibility for lower-income families.  As a result, by the end of 2016, it was projected that approximately 24 million uninsured individuals would receive healthcare coverage (Carrasquillo & Mueller, 2018).
The ACA has had other significant impacts on the healthcare system as well.  First, the law establishes that health insurance companies cannot deny or charge different premiums to individuals based on pre-existing conditions.  Additionally, the law bans lifetime and annual limits on coverage in all plans, as well as rescissions - a practice in which insurance companies cancel an individual's coverage after they have filed healthcare claims (Carrasquillo & Mueller, 2018).  The law also requires that all plans cover preventive care at no cost to the insured individual. This includes many types of examinations and screenings (e.g. mammograms, pap tests, and cholesterol screening) as well as certain forms of treatment (e.g. birth control, obesity treatment, and flu shots).  Finally, it requires all insurance companies to pay for the same level of care at the same cost regardless of the plan a person chooses.
Despite the huge steps forward that are being made by the ACA, there are still major disparities in healthcare outcomes between lower-income families and higher-income families. The ACA is designed so that individuals and families living in poverty will qualify for subsidies to offset the cost of insurance (Goldman, 2019).  However, if an individual makes just a little more than the cut-off for subsidies, they are not eligible to receive any help in paying for insurance. These disparities exist in areas such as coverage, access, and cost of service. Other inequalities exist within vulnerable minority groups such as people of color, people living with disabilities and the LGBTQ.
Coverage
News reports have described dramatic increases in healthcare costs for individuals who will receive insurance through the Obamacare exchanges (Antos, & Capretta, 2020).  While these reports have focused on individuals who will be paying the full-premium, they have overshadowed the fact that many individuals will receive care for free or very low cost.  On average, Americans are going to pay considerably more for healthcare because of Obamacare.  However, this should not be seen as a bad thing since it means that millions of people will now receive care that they were previously denied. 
One of the main goals of the ACA is to increase coverage for individuals.  However, it is estimated that approximately 26 million Americans will remain uninsured by 2023.  This may be because many people simply cannot afford the premiums or it may be because they choose not to get coverage at all (Antos & Capretta, 2020).  It is important to note that this number only reflects the number of people who are eligible for coverage through Medicaid or insurance through state exchanges.  It does not include those who are eligible for coverage through an employer or Medicare.
Access
Low-income families have often been left out of the conversation around healthcare access.  Despite the fact that the government pays for most low-income families to receive insurance through Medicaid, many people do not qualify to receive this coverage.  In fact, approximately 11 million people are currently uninsured due to a lack of eligibility for Medicaid coverage and another 3 million are ineligible because they made too much money or did not meet an income requirement in order to qualify (Dickman et al., 2017).  In addition, many low-income families do not qualify for Medicare coverage.  Many lower-income individuals also choose to forgo healthcare due to their cost or lack of knowledge about their options.
One way to address this problem is through a public option, which would allow all citizens in the United States access to insurance regardless of income.  This would make healthcare more affordable for low-income individuals and could increase the number of low-income adults who receive coverage (Volandes & Paasche-Orlow, 2007).  A public option would also encourage health insurance companies to increase coverage for low-income individuals.  This could be accomplished by implementing a public option that would offer a level of care comparable to other health insurance plans but would have premiums set at a rate affordable by non-Medicaid individuals.  This way, individuals on Medicaid and those who cannot afford healthcare could receive coverage through the public option, and health insurance companies would still have individuals for which they could compete for.
Affordability
Healthcare is expensive in the United States, and many individuals struggle to pay their medical bills.  Despite the fact that the ACA has expanded access to care for millions of Americans, there are still millions more who do not have health insurance or are underinsured. About 50% of personal bankruptcies in the U.S. are related to healthcare costs, and this is affecting middle- and low-income families at a much higher rate than it affects higher-income families (Amadeo & Boyle, 2021).  The ACA has made strides towards reducing this problem by expanding coverage for those who were previously uninsured and by increasing Medicaid eligibility for some groups, but there is still a need for affordable healthcare.
The current United States health care system is a mixture of private and public funding, with most people covered through employer-based health insurance or Medicare.  The majority of individuals covered under Medicare are aged 65 years or older, as compared to most other industrialized nations in which this age group represents a much smaller proportion (Amadeo & Boyle, 2021).  The United States does not have a single-payer health care system, so most people obtain their health insurance through their employer.  Health insurance is a benefit offered by an employer to its employees as part of the employee compensation package.  Similar to other benefits such as retirement plans, on-site child care, and paid vacations, health insurance is often part of fringe benefits in the United States (Galvani et al.,2020).
A possible solution to the current problem of health insurance coverage is the creation of a single-payer system in the United States.  Under a single-payer system, private insurance companies would no longer exist and everyone would have access to free or low-cost insurance through a government program (Galvani et al.,2020).  A single-payer system can be difficult to set up because it requires changes in the way hospitals are funded, which affects both Medicare and Medicaid.
Racial Health Disparities
The United States has a history of racial discrimination in the healthcare system, and this is still a problem today.  In the early 1900s, there were more African American doctors than white doctors.  In 1910, there were more white physicians than black physicians nationwide.  There are clear social and economic disparities between races in the U.S., even though most people are covered by insurance.  For example, it is estimated that 29% of African Americans live below the poverty line compared to only 14% of white Americans (Baciu et al., 2017).  In addition, African Americans have health outcomes that are much worse than those of whites, and these disparities have actually increased in recent years (Baciu et al., 2017).  This is due to a variety of factors such as decreas...