Reply to the following two classmates’ posts. In your reply posts, include your analysis of the impact on quality of care generated by these generated by these coverage gaps and the non-financial barriers to access described in your readings and in your own research. Each reply should be 200 to 300 words.
Post # 1: Michael
When we discuss access to health care, we are primarily referring to health insurance (Harvard University, 2014a). Thus, when we are referring to gaps in health care, we are referring to gaps in insurance coverage. In the U.S., gaps in health insurance significantly affect vulnerable sub-populations, which include women, children, low-income (and homeless), migrants, the mentally ill, elderly persons who retire prior to age 65, people living in rural areas, and persons with HIV/AIDS (Shi & Singh, 2019). Prior to the passage of Affordable Care Act (ACA), persons with pre-existing conditions were considerably affected by denial of health insurance coverage (Levitt, Damico, Claxton, Cox, & Politz, 2017). Less emergent gaps, although not less significant or potentially financially distressful, include access to long-term care, dental, and caregiver support (Reinhard, Feinberg, Houser, Choula, & Evans, 2019; Shi et al., 2019). Since the passage of the ACA, a new gap in coverage has emerged and that is the underinsured (Collins, Bhupal, & Doty, 2019). Despite the ACA’s ability to reduce the number of Americans uninsured, significant gaps persist, especially for lower income earners and racial/ethnic minorities (Sommers, McMurtry, Blendon, Benson, & Sayde, 2017). In the United States, ethnic minorities are more likely to lack health insurance than whites, particularly in the western and southern areas (Shi et al., 2019). Per Shi and Singh (2019), people who are uninsured have a higher prevalence to having poor health. A couple of possible reasons for this are the uninsured tend to avoid accessing preventative services resulting in more expensive emergency health services and the uninsured tend to postpone obtaining essential prescriptions due to cost concerns (Shi et al., 2019). For those who assert that the poor bring it upon themselves and argue that society should not share the cost of their health misfortunes, Shi and Singh (2019) assert that Americans paid $85 billion in uncompensated care in 2013. Aside from the moral and ethical implications, ignoring these health care disparities among these vulnerable populations incurs a cost of approximately $1.5 trillion to the entire system every three years (Murphy, 2020). Collins et al. (2019) report that the most significant deterioration in health quality and comprehensive insurance exists among Americans with employer-based plans. Collins et al. (2019) claimed that 45%, or 87 million, Americans qualify as under-insured. Per Collins et al. (2019), under-insured is defined as those who spend more than 5% of their annual income on out-of-pocket costs, not including their premiums. Due to rising deductibles, co-pays, and other out-of-pocket expenses, covered Americans are increasingly avoiding obtaining necessary medical attention when ill, did not fill a prescription, skipped prescribed tests and treatments, and failed to follow through with follow-up appointments or seeing a specialist (Collins et al., 2019). Now we are back to the beginning of this conversation where avoiding obtaining early medical interventions due to lack of money results in seeking more costly emergent care, which is, in turn, affecting the shared pocketbooks of all Americans (Murphy, 2020). However, these exorbitant costs could be better controlled if states expanded their Medicaid programs and better informed the public, including those insured by their employers, of their options (Collins et al., 2019; Murphy, 2020). References Collins, S. R., Bhupal, H. K., & Doty, M. M. (2019). Health insurance coverage eight years after the ACA. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca Harvard University. (2014a). Topic 3: Access, Quality and Cost. Retrieved from https://courses.edx.org/courses/HarvardX/PH210x/1T2014/courseware/6ce98f482d6247c3aa65e260ea95bb3d/dc71cfef257548e28e5345af205c6000/1?activate_block_id=i4x%3A%2F%2FHarvardX%2FPH210x%2Fvertical%2F642e414f4862439fa0da074bf1d0f320 Levitt, L., Damico, A., Claxton, G., Cox, C., & Politz, K. (2017). Gaps in coverage among people with pre-existing conditions. KFF. Retrieved from https://www.kff.org/health-reform/issue-brief/gaps-in-coverage-among-people-with-pre-existing-conditions/ Murphy, M. (2020, January 28). Gaps in care: What you need to know. Medical Scribe Journal. Retrieved from https://www.scribeamerica.com/blog/gaps-in-care-what-you-need-to-know/ Reinhard, S. C., Feinberg, L. F., Houser, A., Choula, R., & Evans, M. (2019). Valuing the Invaluable: 2019 Update: Charting a Path Forward. AARP. Retrieved from https://www.aarp.org/ppi/info-2015/valuing-the-invaluable-2015-update.html Shi, L., & Singh, D. (2019). Delivering Health Care in America (7th ed.). Sudbury, MA: Jones and Bartlett. Sommers, B. D., McMurtry, C. L., Blendon, R. J., Benson, J. M., & Sayde, J. M. (2017). Beyond Health Insurance: Remaining Disparities in US Health Care in the Post-ACA Era. The Milbank Quarterly, 95(1), 43-69. Retrieved from doi:10.1111/1468-0009.12245
Post # 2: Molly
The purpose of this discussion is to analyze the major current contributors to insurance coverage gaps. More than half of Americans under age 65 receive health insurance through an employer (Collins et al., 2019). Two major contributors to gaps in coverage is loss of employment and the state does not expand Medicare eligibility. This means “individuals have an income above the Medicare eligibility but below the limit for Marketplace premium tax credits” (Garfield et al., 2020). The main contributor to no coverage is that individuals cannot afford the insurance. All these factors contribute to the insurance coverage gaps in America. Loss of employment can be a form of being released from your employer or voluntarily leaving your employer. Some jobs will have different timings on when insurance coverage stops, for example coverage could last one month after leaving your job. Some jobs don’t activate health insurance coverage until 90 days into the job. Options for a person with a gap in coverage to get coverage are through a spouse’s plan, COBRA, ACA or individual insurance, short-term plans, and Medicaid (Masterson, 2020). It is important to plan ahead to know when your gap in coverage will be and get insurance accordingly, although if released from your employer this could be a major problem. If states expanded their programs and adopt the Medicaid expansion, 2.3 million adults with gain Medicaid edibility (Garfield et al., 2020). People in the coverage gap are usually people with limited family income and live below poverty level, therefore these people will not be able to afford ACA coverage (Garfield et al., 2020). For example, in 2020 the premium for a 40-year-old non-smoking individual purchasing coverage through the Marketplace was $331 per month for the lowest plan (Garfield et al., 2020). This is sometime half of an individual’s income, which ends up relating to the reason of not getting coverage because people cannot afford it. This is huge problem for people because they will face barriers to needed health services or if they do require and receive medical care, they will have financial consequences (Garfield et al., 2020). If states expand Medicaid eligibility this might prevent these problems. As discussed earlier, another problem is no coverage due to not being able to afford insurance coverage. Two of the contributors discussed apply to this as well because if you do not have employment you don’t have income and if you live below the poverty level, income is low. Some of the worries with health care costs are difficulty affording routine costs of insurance, costs stop people from getting needed care or filling prescriptions, and difficulty paying medical bills and having consequences on families (Kirzinger et al., 2019). Twice as many people with insurance from employers say cost-related concerns are the most important feature to them when choosing a health plan compared to coverage-related concerns (Kirzinger et al., 2019). Ultimately this means people will only look at the cost of health insurance and not worry if it covers what they need medically. Health care coverage is extremely important and when someone can’t afford it or has a gap in coverage this is a critical time in their life. References
Collins, R. S., Bhupal, K. H., & Doty, M. M. (2019). Health insurance coverage eight years after the ACA. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca Garfield, R., Orgera, K., & Damico, A. (2020). The coverage gap: Uninsured poor adults in states that do not expand Medicaid. KFF. Retrieved from https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/ Kirzinger, A., Munana, C., Wu, B., & Brodie, M. (2019). Data note: Americans’ challenges with health care costs. KFF. Retreived from https://www.kff.org/health-costs/issue-brief/data-note-americans-challenges-health-care-costs/ Masterson, L. (2020). How to get health insurance if you’re unemployed or changing jobs. Insure.com. Retrieved from https://www.insure.com/health-insurance/job-change-and-obamacare.html