Running Head: United States Healthcare Access Disparity 1

Unites State Healthcare Access Disparity:

Will Obamacare Fix the Problem?

Jacob Persily

Rutgers University

United States Healthcare Access Disparity 2

Table of Contents

Abstract 3

Introduction 4

Methodology 5

Findings 6

Discussion/Recommendation 8

Conclusion 10

Appendix 11

References 13

Table of Figures

All figures can be found in the Appendix on Page 13. Figure Credit can be found on page 13.

United States Healthcare Access Disparity 3

Abstract

United States healthcare is the most expensive single industry in the world. Since the

development of Medicare and Medicaid in the 1960s, and the ever-increasing role of technology,

healthcare costs have skyrocketed. Access to healthcare has suffered the most; people simply do

not have, and cannot afford, the access to healthcare that they need. The Affordable Care Act

strives to bridge the gap in access to healthcare, but its full effect on this issue is yet to be seen

due to the infancy of the program. Whether moving toward government-run healthcare, or

placing price cleanings on the cost of care, changes must be made to ensure equal access to

healthcare for all, to improve the health of the people of the United States.

United States Healthcare Access Disparity 4

Introduction

One of the most commonly discussed topics in the public discourse of the United States

today is healthcare. To properly discuss healthcare, it is important first to define the word. To do

so, one must first look at the root of the word, health, and its meaning in society today. The

World Health Organization defines health as “a state of complete physical, mental and social

well-being and not merely the absence of disease or infirmity” (WHO, 2003). It is important to

understand this state of well being when looking at contemporary healthcare, and its effects on

the population.

Cost

Healthcare is the management of the well being of the people of the United States, and it

costs, to say the least, a lot of money. The United States is well known, both in a good and bad

way, for how much the nation spends annually on healthcare. The current reports put the

healthcare spending of the United States at nearly 18% of the gross domestic product of the

country (Howell, 2014). The United States spends more on healthcare, by a wide margin, than

any other developed country in the world, and we are projected to spend 20% of the GDP of the

nation on healthcare by the year 2023, outpacing growth of the overall GDP (Howell, 2014).

Cost, as evident in Figure 1 of the Appendix, is often one of the major issues reported in access

to healthcare in this country. Cost creates more of a barrier to care than in any other major

country in the world.

Legislation:

The most-often discussed piece of legislation, which seeks to solve some of the problems

of the American healthcare system is the Patient Protection and Affordable Care Act (ACA) of

2010, most often referred to as “Obamacare.” The ACA has several components, including the

United States Healthcare Access Disparity 5

expansion of Medicare and Medicaid services to a larger subset of the population, as well as

creating a federal mandate of health insurance. The Act came before the Supreme Court, and was

upheld as constitutional in 2012. The main goal of the ACA was to expand US access to

healthcare. Figure 2, found in the Appendix, shows the levels of primary care, sick visit, and

specialty care accessible to those with government, employer, and no health insurance. The

figure clearly indicates those with no insurance lagging far behind those with insurance in terms

of access to healthcare. This is one of the issues the Affordable Care Act strives to correct about

the United States Healthcare system

Problem/Thesis:

There is a major problem plaguing United States healthcare today, and threatening the

health and well being of the American populace. That major issue is access. Equal access to

healthcare is still lacking, despite the roll out of the Affordable Care Act, because the majority of

states are opposing the subsidies and issues in the development and rollout of the program.

Access to healthcare is essential to maintaining good health; without healthcare access, health

levels begin to decline, and medical issues become exacerbated.

Methodology

Conducting research on healthcare is a personal continuum among my coursework at

Rutgers. As a student in the Healthcare Administration Bachelor’s degree program, it is useful to

look at healthcare, and its continued changes, from a variety of different perspectives. Writing

about healthcare presents an interesting challenge, as the healthcare industry in the United states

is ever changing. The status of the Affordable Care Act appears to be somewhat stable for the

moment, but many potential Republican presidential candidates have already indicated that the

United States Healthcare Access Disparity 6

abolishment of the Affordable Care Act will be one of their first tasks as President. Therefore,

looking at news articles is often more effective than scholarly literature, but both concepts are

included in the below findings.

Finding news items about the United States healthcare system is quite simple, as

healthcare is in the news for one reason nearly every day, and the system is ever-changing,

prompting constant reports. Scholarly articles were obtained through the JSTOR databases, and

various other databases of the Rutgers University

Findings

Affordable Care Act

Statistics. It is important first to look at the statistics regarding the uninsured portion of

the population of the United States. Prior to the rollout of the Affordable Care Act, roughly 18%

of the United State population declared themselves as uninsured. This number, after the first

cycle of ACA insurance sign-ups has dropped to 13.4%, but this means that over ten percent of

the population of the United State is still without health insurance, without an affordable means

of getting access to healthcare. Whether due to immigrant status, or not having the funds to

afford insurance on the created insurance exchanges, people are still without health insurance.

Rollout Issues. As was majorly publicized in the media, there were some major glitches

with the roll-out of the government insurance programs, including major technology issues with

the healthcare.gov website, which experienced major down time in the beginning of the open

enrollment process. This kept many who would have signed up from signing up for health

insurance through the government. The website outages were a massive hurdle, which some

chose simply not to jump in signing up for their healthcare on the exchanges.

United States Healthcare Access Disparity 7

Legislative Issues. There have also been issues surrounding the Affordable Care Act

related to state legislature, keeping people from health insurance. As of early March 2015, 18

states governments have declared that they will not be participating in the mandate for health

insurance, and an additional 15, which have made less harsh, but similar claims about the

Affordable Care Act (Cauchi, 2015). Without the mandate, people are not gaining access to

health insurance, and are not increasing their access to healthcare.

Access

The academic literature is in fair agreement about the access to care issue in the United

States. Each study takes a slightly different look at the same issue, the fact that there is a major

problem in access to healthcare.

Harris, 2010, indicates that an important step in closing the healthcare gap in this country

is to place the patient back at the center of healthcare continuum. Often today, economics and

regulatory issues take over healthcare, pulling focus away from the patient who is the person

who really matters.

Litaker, 2005, shows that economic status of an individual is linked to lack of access to

healthcare. Though the ACA attempts to solve this particular issues, it is by no means a given.

Kelley, 2005, discusses the varying quality of healthcare provided by physicians and

other providers in this country. He then shows the link between access and quality, that those

who have limited access to care are likely also receiving care of sub-par quality compared to

those with full access.

United States Healthcare Access Disparity 8

Discussion/Recommendations

Discussion

Scholarly literature about healthcare access is, more or less, all in agreement. There is a

major gap in healthcare coverage, dependent on economic factors and various other issues.

Though the Affordable Care Act attempts to solve this problem, the final effects of the ACA

remain to be seen. It will take at least five years after the full program rollout to see any

measurable effect, once the kinks are worked out. It will, from there, take quite a bit of time for

updated literature to be released. The below recommendations are hypothetical means to fix the

gap in healthcare access, knowing that the ACA may fix the problem without any other major

changes needed.

Recommendations

There are several possible means of creating increased access to healthcare.

Nationalized System. One must simply look to our allies in the United Kingdom and

Canada to see the ability to provide all equal access to healthcare. These countries have

nationalized healthcare, where the government pays for and provides all healthcare for the

citizens, and yet these countries spend less of their GDP on healthcare then the United States

does.

Though many have said that moving towards a system of nationalized healthcare in the

United States would never work, nor never happen, it has the potential to solve many of the

problems faced by the United States healthcare system. It ensures that all people have equal

access to healthcare, as every individual is put into the system at birth, and it applies to all

citizens; the issues surrounding undocumented immigrants would need otherwise to be

United States Healthcare Access Disparity 9

developed. It also puts all people on a level playing field in terms of access, regardless of

economic means at one particular moment in time.

National healthcare also has the tendency to lower cost of healthcare. As has been seen in

America, medical providers have charged higher and higher amounts for healthcare, just to make

a profit. National healthcare puts limits on healthcare costs to ensure that we do not spend too

much money on healthcare.

There is one issue that comes up with national healthcare, and that is a two-tiered system

of care. In countries with national healthcare, there can be very long waits, often months or

sometimes years, for some basic medical treatments. Those of little economic means wait for

healthcare. Those with more money will pay providers cash, often at the high American costs, to

skip ahead of the queue for care and treatment in the evenings. This has the potential to occur

here as well, though at least a system of nationalized healthcare will provide care to all.

Healthcare Price Ceilings. Without out creating a full system of nationalized healthcare,

the United states could potentially use some of the lessons learned from the British National

Health Service (NHS) to create similar programs here. One major economic component of the

NHS is the price ceiling it places on all major medical services. By establishing a maximum

price that can be charged for a particular medical procedure, the United States could assist in

creating equal access to healthcare for all. By ensuring that medical providers can not charge

exuberant amounts for procedures, to pay for their luxury cars and mansions, the government

will aid those not of exceptionally great financial means, the lower class, in gaining access to

healthcare, without having to take out massive loans or second mortgages on their homes.

United States Healthcare Access Disparity 10

Conclusion

Healthcare is an essential part of living a healthy life. Though that may sound a bit

redundant, it is a true fact of life. History has proven this. In the medieval times, people were old

if they lived past the age of 40. The plague wiped out a large portion of the population of Europe.

Today, life expectancy is pushing 80, and most major disease have been eradicated; the only

remaining sample of the Bubonic Plague in the country is locked away in a freezer at the CDC.

Access to healthcare is an important part of keeping America healthy, given the threat of

obesity, heart disease, diabetes, cancer, and all of the other ailments that plague Americans

today. Those without insurance often head straight for the Emergency Room, which will provide

care regardless of means of payment. Emergency room care is among the most expensive, and

filling emergency rooms with non-emergent medical issues keeps provider to tending to those

who have truly life-threatening medical emergencies. Figure 3, found in the Appendix, shows the

expense of Emergency Room Care, compared to a less costly urgent care setting.

Access to healthcare will eventually lead to a healthier country. With full access, the

whole of America will begin to seek preventative care, the current shift in focus of the American

healthcare system. It is being quickly proven that regular preventative care, seeing a primary care

doctor on a regular basis leads to healthier people. This is something that equal access will yield,

people seeing a doctor regularly, catching illness early, and staying healthy longer to live a better

life.

It is the hope that equal access to healthcare will continue to improve the health of the

country, and decrease healthcare costs, to bring the United States in line with the rest of the

develop world in this area.

United States Healthcare Access Disparity 11

Appendix

Figure 1.

Figure 2.

United States Healthcare Access Disparity 12

Figure 3:

United States Healthcare Access Disparity 13

References

Cauchi, R. (2015, March 3). State Laws and Actions Challenging Certain Health Reforms.

Retrieved March 23, 2015.

Harris, G. (2006). CULTURAL COMPETENCE: ITS PROMISE FOR REDUCING

HEALTHCARE DISPARITIES. Journal of Health and Human Services Administration,

33(1), 2-52.

Howell, T. (2014, September 3). Health care spending expected to pick up, grab bigger share of

GDP. Retrieved March 23, 2015.

Kelley, E., Moy, E., Stryer, D., Burstin, H., & Clancy, C. (2005). The National Healthcare

Quality and Disparities Reports: An Overview. Medical Care, 43(3), 13-18.

Litaker, D., Koroukian, S., & Love, T. (2006). Context and Healthcare Access: Looking Beyond

the Individual. Medical Care, 46(6), 531-540.

WHO Definition of Healthcare. (2003, January 1). Retrieved March 23, 2015.

Figure Credit

Figure 1. http://medicynic.com

Figure 2. http://kff.org/health-reform/issue-brief/medicaid-moving-forward/

Figure 3. http://www.forbes.com/sites/briansolomon/2014/07/02/drive-thru-health-care-how-

mcdonalds-inspired-an-urgent-care-gold-rush/