Identifying a Local Health Care Economic Issue

Healthcare economics is an overlooked side of the care service in the United States. Affordable Care Act (ACA) 2010 provides Health Insurance to individuals and families to fulfill their healthcare needs. Different social determinants of health impact the functioning of the act. These include annual median income that many United States (US) citizens cannot buy health insurance. Middle and lower-middle-class families are highly disturbed by the financial aspects of care. These families have been reported for neither having enough income to purchase health insurance under ACA nor can they access care due to the high cost for the uninsured population of the US (Tolbert et al., 2022). The assessment discussed the issues caused by low insurance coverage across the US for middle and lower-middle-class families.

Healthcare Economic Issues and Population

According to data, about 8.6% of citizens were uninsured in 2021, and this statistic excludes immigrants (FAS, 2023). The statistics make up for a high number of the population in the US who cannot purchase health insurance due to social determinants of health. The annual median income in the US was about $54,132, a very low income for a sustainable life (Russo, 2022). The healthcare insurance cost per family for the cheapest category of ACA is $928 per month, which is over $11000 per annum (Tolbert et al., 2022). The cost of healthcare, in comparison to the median earning, is very high and consumes a large portion of it. Northwestern Memorial Hospital (NMH) is a public hospital in Chicago, US, that is most visited by uninsured people in the US. According to NMH, over 5% of the total patients were uninsured, while over 50% of patients from both in and out categories were uninsured by Medicaid provided by ACA (Illinois Hospital Report Card, 2023). The population that is highly affected by this issue of the high cost of insurance is the lower middle-class families with annual incomes less than the national median of $54,132 (Russo, 2022). The issue affects the population through poor health services, high healthcare debt, and other financial problems. Hence, the healthcare disparity for a wide range of populations is created with unequal distribution of healthcare funding and the designed cost of healthcare insurance in the US.

The rationale for Choosing Issue

The issue is of grave concern for many reasons. The first reason is that it proposes that healthcare insurance packages across the US are very costly, even with the funding provided by ACA (Morse, 2022). The second reason is that the low healthcare insurance coverage causes health disparities for selected populations. The third reason is that the standard of care is very low for uninsured US citizens compared to the insured ones at healthcare institutions. The cost of care for uninsured individuals is also higher than for insured US citizens. The NMH data also confirmed that over 50% of patients had no insurance (Illinois Hospital Report Card, 2023). According to a survey conducted by West Health, about 44% of American adults were not satisfied with the cost of healthcare due to their low income.

The survey suggested that a large proportion (93%) of US citizens stated that they were not getting the standard of care compared to the insurance costs they were paying (Morse, 2022). I have also encountered this issue personally as my family suffered to pay annual premiums for the ACA Bronze insurance package. A big amount of our family income was paid in the health insurance plan, which caused both my parents to work different shifts to earn for it. Therefore, I have selected this issue as many US citizens are suffering from paying health insurance premiums while others with no insurance suffer from chronic disease conditions due to high costs for uninsured care services and low standard of care. 

Effect of Healthcare Economic Issues on Community and Special Groups

There are different factors and reasons for people who do not have health coverage. The primary reason is the lack of financial resources, while the least acceptable reason is the low awareness of the individual citizens (Lopez et al., 2022). The low insurance coverage as an economic issue highly affects the provision of care in my nursing practice. For example, the patient records are mostly unavailable for the uninsured population at NMH, which causes difficulty in the care coordination and continuum. Similarly, in certain cases, the healthcare organization I work in can have a financial loss if the patients cannot pay the healthcare provision fees. The community around the NMH is affected by it as many low abiding citizens need care but cannot access it due to high cost. The lack of insurance coverage causes health emergencies in certain high-population areas where the cost of living is high enough to spend all the income of middle and lower-middle-class families. 

The issue greatly influences the care facility and low-income families in the mentioned population more than the ones with high family income. The reason is that the population above the median salary range can afford care costs irrespective of health insurance. Therefore, ACA health coverage through Medicare or Medicaid is ineffective as it is not designed to provide cost-effective care to the population below the median annual salary in the US (Herman et al., 2023). Social factors like the standard of living and social status of individuals are also disturbed by ACA’s uneven coverage of health insurance. The immigrant population with no public-level documentation is also an increasing healthcare issue as these individuals cannot register for health insurance raising their care costs to unbearable limits (Lopez et al., 2022). 

Practice Gap

The research gap regarding low public insurance coverage in the US due to high cost and the issue of economic disparities has been found in the defined population. The primary view of researchers in the literature is that eliminating barriers and health disparities from the health insurance coverage from private and public institutions can eliminate the gap regarding the high costs of ACA health insurance in the US. Arnold (2023) strengthened the argument for this gap regarding healthcare insurance coverage in the US. The research identified that people experiencing poverty, especially from immigrant communities and lower-middle-class families, did not have proper access to the healthcare insurance provided by Medicaid, Medicare, or ACA. Similarly, Zhao et al. (2020) stated the gap by proposing that there was not adequate insurance coverage for people experiencing poverty as costs proposed by ACA and other private health insurance providers were very high. Both research articles emphasized the need to reduce insurance premium costs per year to make services like ACA accessible for the lower middle-class population in the US. The gap can be eliminated by removing high cost-related barriers from the healthcare provision for the public. The researchers proposed lowering the costs of healthcare coverage programs and allowing the immigrant population to register for these coverages as an effective solution to economic issues and disparity in the US healthcare system (Arnold, 2023; Zhao et al., 2020). 

Conclusion

It has been found that ACA, which provides access to quality care, significantly neglects the low-income population in the US. The health disparities like low access, high cost, and low income are developed in the population. The data showed that almost all citizens believed that the care provided did not match the cost charged to them. It was observed that the lower middle-class population was most affected by the high cost of insurance coverage from ACA and other private institutions. Research has been identified to strengthen the argument for the existence of economic disparity in the population of the US regarding health insurance coverage. 

References

Arnold, J. (2023). The poverty of opportunity: Where are we going; where have we been. The Legitimacy of Healthcare and Public Health: Anthropological Perspectives, 1, 151–170. https://doi.org/10.1007/978-3-031-25592-2_8

FAS. (2023). U.S. health care coverage and spending. In FAS: Congressional Research Service. sgp.fas.org. https://sgp.fas.org/crs/misc/IF10830.pdf

Herman, W. H., Schillinger, D., Bolen, S., Boltri, J. M., Bullock, A., Chong, W., Conlin, P. R., Cook, J. W., Dokun, A., Fukagawa, N., Gonzalvo, J., Greenlee, M. C., Hawkins, M., Idzik, S., Leake, E., Linder, B., Lopata, A. M., Schumacher, P., Shell, D., & Strogatz, D. (2023). The national clinical care commission report to congress: Recommendations to better leverage federal policies and programs to prevent and control diabetes. Diabetes Care, 46(2), 255–261. https://doi.org/10.2337/dc22-1587

Illinois Hospital Report Card. (2023). Illinois hospital report card and consumer guide to health care. www.healthcarereportcard.illinois.gov. http://www.healthcarereportcard.illinois.gov/hospitals/view/101281

Lopez, K. N., Baker‐Smith, C., Flores, G., Gurvitz, M., Karamlou, T., Nunez Gallegos, F., Pasquali, S., Patel, A., Peterson, J. K., Salemi, J. L., Yancy, C., & Peyvandi, S. (2022). Addressing social determinants of health and mitigating health disparities across the lifespan in congenital heart disease: A scientific statement from the American Heart Association. Journal of the American Heart Association, 11(8). https://doi.org/10.1161/jaha.122.025358

Morse, A. (2022, March 31). 112 million Americans struggle to afford healthcare – westhealth.org. www.westhealth.org; Gallup Inc. https://www.westhealth.org/press-release/112-million-americans-struggle-to-afford-healthcare/#:~:text=WASHINGTON%2C%20D.C.%20%E2%80%94%20Mar.

Russo, F. (2022, December 7). How much does the average American make in 2022? First Republic Bank. https://www.firstrepublic.com/insights-education/how-much-does-the-average-american-make#:~:text=The%20median%20American%20worker%20brings

Tolbert, J., Drake, P., & Damico, A. (2022, December 19). Key facts about the uninsured population. KFF. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-populationZhao, J., Mao, Z., Fedewa, S. A., Nogueira, L., Yabroff, K. R., Jemal, A., & Han, X. (2020). The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years. CA: A Cancer Journal for Clinicians, 70(3). https://doi.org/10.3322/caac.21604

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