Introduction
Speaking about policies and regulations related to healthcare in the United States, it is important to pay attention to special programs that are targeted at low-income citizens who cannot afford expensive treatment due to their limited financial opportunities. The purpose of the paper is to analyze programs that are supposed to reduce healthcare inequality. To better understand the extent to which they meet people’s expectations and solve healthcare problems of economically disadvantaged individuals, it can be important to make a comparison, outlining advantages and things to be improved. The targeted level of policy is the healthcare system. As for the significance of the chosen policy issue (the access of low-income citizens to healthcare service), it can be listed among the key problems of the United States as income inequality in the country has significantly increased since the end of the twentieth century. Accessibility of health services remains one of the factors that impact the happiness of an entire nation, and this is why the issue needs to be discussed. The questions to be addressed relate to the present state of knowledge, stakeholders, and shortcomings of decisions.
Background
The importance of affordable healthcare services is acknowledged by representatives of different social groups due to the detrimental impact of income inequality on the health of the nation. For instance, some researchers prove that growing income inequality is strictly interconnected with worse health, and this is why providing low-income and hardcore poor individuals with healthcare benefits are among the key tasks of any government (Pickett & Wilkinson, 2015). Modern researchers argue that low-income citizens have special healthcare needs and, according to their analysis, healthcare inequality in the United States is still widening. According to Dickman, Himmelstein, and Woolhandler (2017), the average life expectancy of high-income citizens of the United States exceeds that of economically disadvantaged people at least by ten years. The problem of income-related inequality is addressed with varying success; more than years ago, the level of inequality in healthcare decreased. In the context of the levels of poverty, the problem is especially significant because many healthcare programs are only aimed at people on the breadline whereas low-income citizens are considered to be able to pay for healthcare themselves.
Medicaid is a program that was established more than fifty years ago to bridge the gap between low and high-income people in the United States in terms of healthcare and nursing services. The program under consideration is not necessarily aimed at ethnic minorities or other specific groups as the key factor that impacts the decisions is the inability of a person to pay for nursing and healthcare services. Within the frame of the program, the state administers aid to individuals from different age and ethnic groups. Among the key advantages of the discussed program that are often paid attention to is the fact that it is not obligatory to be a citizen of the United States to receive Medicaid benefits. The state aid can also be offered to citizens of other countries who live or work in the United States regularly.
The key strengths of Medicaid include benefits for children from low-income families (they are provided with access to continued care), advantages for healthcare providers (steady client traffic), and a large number of medical expenses covered by the program. Despite that, there are also shortcomings associated with the program. Due to the current reimbursement rates, the cases of discrimination against Medicaid patients have become more common (Han, Call, Pintor, Alarcon-Espinoza, & Simon, 2015). Also, considering that not all types of healthcare services are covered, the importance of some manipulations has to be approved by Medicaid managers. Hypothetically, this delay can impact patient outcomes when it comes to the treatment of unknown effectiveness.
The key stakeholders are presented by healthcare providers and low-income patients. The impact of the program on the former is primarily positive as the program provides a steady income for practitioners. As for the latter, they are impacted both positively and negatively. Even though people receive healthcare services, the program does not eliminate healthcare inequality in the country, and the discrimination against low-income patients still exists.
Analysis
Speaking about alternative policies to mitigate income-based healthcare inequality, it is important to pay attention to LIHP that was implemented in California and the Affordable Care Act. The criteria that can be used to choose the most effective program include the categories of citizens that are impacted by the alternative. Also, the advantages for low-income patients should be taken into account.
LIHP or Low Income Health Program was aimed at helping low-income citizens to receive healthcare services (including childless people). To qualify for benefits under the program, one needs to be between nineteen and sixty-four years old and be either the citizen of the United States or a legal resident with income about sixty-seven percent FPL and lower (Bazzoli, 2016). Also, the program is targeted at those who are not eligible for other programs for low-income citizens. In terms of patient outcomes, the program provided low-income patients with access to PCMH and CCM services; also, the rate of uninsured people has decreased. The policy has helped to improve the situation for many uninsured people in California whose healthcare needs are usually unnoticed (childless people), and this is why its overall impact on the healthcare system is positive. In terms of disadvantages, LIHP is designed as a short-term program that is targeted only at California citizens.
Affordable Care Act that was adopted in 2010 was among the key projects aimed at reducing healthcare inequality and improving access to healthcare services among different groups of citizens. The act was adopted to improve the quality of healthcare services, reduce Medicaid spending, and decrease the number of uninsured people in the United States. The primary difference between ACA and Medicaid is that the former focuses not on providing free services to economically disadvantaged people but on making them more affordable and effective. The alternative impacts citizens with different income levels as all people should buy insurance plans.
Also, the alternative would not help to achieve the objective as subsidies are usually given to people who are not qualified as economically disadvantaged. The eligibility for ACA subsidies is defined based on average family income and household size. In terms of the advantages for low-income patients, some of them report an increased quality of healthcare services. Medicaid can still be regarded as the best alternative for citizens whose financial resources do not allow buying insurance plans. The advantages for low-income patients are numerous as it increases access to care without extra costs for taxpayers. The tradeoffs between alternatives aimed at reducing healthcare inequality are based on the interconnection of costs and quality. Taking into account low-income citizens’ needs, the best alternative would be to reduce discrimination against Medicaid patients.
Recommendations
The best alternative to address the issue of healthcare inequality would be improving Medicaid to control and reduce the cases of discrimination against Medicaid patients. Other alternatives were excluded due to additional expenses for low-income people that they include and the advantages of short-term character. Possible improvement strategies include surveying healthcare practitioners to identify the underlying causes of discrimination against low-income patients (economic, social, etc.) and facilitating the process of verification of additional services. Also, it is possible to encourage improvement with the help of special reviewing committees and mystery patients who are to identify potential cases of discrimination. The barriers to implementation include healthcare practitioners’ resistance to change. To evaluate policy implementation, it is possible to measure the extent to which Medicaid patients are satisfied with healthcare services.
Discussion
The analysis and recommendations are focused on the outcomes for the key stakeholders who are impacted by healthcare inequality – low-income citizens. The recommendation to improve Medicaid aligns with the knowledge on health disparities and income inequality growth (Sommeiller, Price, & Wazeter, 2016). Being aimed at improving the healthcare system, the recommendations and analysis are still related to certain limitations as advantages and disadvantages of practices defined by modern researchers are sometimes impacted by their personal opinion and experience. The results can be used to increase social awareness of the problem, guide further research, and develop new policies ensuring equal access to healthcare.
Conclusion
In conclusion, the recommendation to facilitate the work of healthcare practitioners accepting Medicaid and introduce new measures to eliminate discrimination is expected to reduce healthcare inequality. Nevertheless, the paper does not focus on specific groups of low-income citizens (those with disabilities or belonging to ethnic minorities). Further studies can address this research gap and analyze the unmet healthcare needs of these social groups.
References
Bazzoli, G. J. (2016). Effects of expanded California health coverage on hospitals: Implications for ACA Medicaid expansions. Health Services Research, 51(4), 1368-1387.
Dickman, S. L., Himmelstein, D. U., & Woolhandler, S. (2017). Inequality and the health-care system in the USA. The Lancet, 389(10077), 1431-1441.
Han, X., Call, K. T., Pintor, J. K., Alarcon-Espinoza, G., & Simon, A. B. (2015). Reports of insurance-based discrimination in health care and its association with access to care. American Journal of Public Health, 105(S3), S517-S525.
Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: A causal review. Social Science & Medicine, 128, 316-326.
Sommeiller, E., Price, M., & Wazeter, E. (2016). Income inequality in the U.S. by state, metropolitan area, and county. Web.
Appendix A
Decisions and Criteria
Appendix B
