The Impact of Health Insurance Coverage for the Uninsured Populace

Rashada Russell
HLTH 634
December 2, 2016

Introduction
The purpose of this review is to discuss the trivial matters that stem from the lack
of access to healthcare services. Many Americans today suffer from mortality and critical
health conditions that are consequences of their lack of insurance or even sub-par
insurance coverage that halfway meets the medical needs of patients who fall under this
category. This issue of insurance coverage that hovers over the lives of the uninsured and
underinsured populace is primarily triggered by a low - income status. Broader
insurance coverage and reduced financial barriers alone are not sufficient in guaranteeing
access to high-quality care, especially for low-income individuals and families1. The
eligibility qualifications that are required to receive quality care and access to health
services has created a strict system that is impairing the health progress of those who are
affected. Specifically explaining the health experience of the uninsured populace,
Research by The Commonwealth Fund demonstrates that compared with people who are
insured all year, people who lack health insurance are less likely to have a regular source
of care, are more likely to not seek treatment because of costs, are more likely to use
fewer and less appropriate health services, are less likely to receive timely preventive and
screening services, and are less likely to receive appropriate care for management of their
health conditions 1. Poor income standing equates to poor healthcare access, abundance
in income equates to plentiful access to health services, and those who fall in between,
occupying an intermediate level of income, their access is to be determined. A system so
complex, that is contingent upon circulation of currency in exchange for care.
The health intervention that I have proposed for the purposes of this academic
course is one that seeks to intervene on behalf of the low-income populace seeking health
benefits through means of Medicaid and Supplemental Security Income and Disability
Income government assistance. It would provide assistance for those seeking the services
of the intervention program with the application process for coverage through Medicaid
and compensation through the Social Security Administration. In addition to the
assistance that will be provided there will be healthcare policy education counsel
regarding both programs. The intent of my proposed health intervention program is to
advocate for the health advantages and compensation for the low-income populace, those
who are uninsured, yet eligible for health insurance coverage within their means of
income, and those who are uninsured, yet not eligible for health insurance coverage due
to their income level, but they are critically ill and seeking compensation to maintain the
state of their health.
Each literary component utilized in this review has been compartmentalized by
individual subtopics that are transparent in the matter of healthcare access. The selection
criterion was based upon well-known topics that are prevalent in the discussion about
health care access for low-income families. The specific topics that I found to be most
important to discuss are the role of health insurance coverage for low-income
populations, the Affordable Care Acts Medicaid expansion, and the policy implications
of the health insurance system. Each of these subjects achieves the purpose of explaining
the deficient areas that are implicated in the role of healthcare access. They represent the
bulk of research areas that define the need for solutions in the healthcare system on
behalf of those for whom it serves as a blockade.

Body of Evidence
The articles that have been selected for this review are a variety of literary
collections that range from journal articles, case studies, and government based
informational articles, each that discuss the delicate issues engulfed in the reality of
defective areas within the system of healthcare accessibility.
The journal articles are each composed of information that provide insight about
the health insurance system and the gaps thereof that impact the lives of those who are
uninsured. The first literary component is an issue brief composed by authors that
conduct analysis on research provided by the Commonwealth Fund, a private nonpartisan foundation that conducts research on healthcare issues. The article discuss the
healthcare inequities experienced by the low-income populace due to standards for health
insurance coverage. The results from the Commonwealth Fund 2010 Biennial Health
Insurance survey which was founded upon patient self-reported experiences revealed
Nearly all adults (93%) with income at or above 200 percent of the federal poverty level
($44,100 for a family of four in 2010) have a regular doctor or usual source of care,
compared with 83 percent of adults with income below 200 percent of poverty. Similarly,
over half (54%) of respondents with income at or above 200 percent of poverty have a
medical home, compared with just over one-third (37%) of survey respondents with
income below 200 percent of poverty. Lacking health insurance interferes with peoples
ability to have a regular source of health care or a medical home. Just three-quarters
(73%) of uninsured adults had a regular doctor or usual source of care, compared with
nearly all insured adults (95%). Similarly, while over half (54%) of insured adults had a
medical home, only 27 percent of uninsured respondents had one1. There is offered in the
brief, strategic suggestions of solutions that are sought to contribute in the reduction of
healthcare disparities. The analysis of the Commonwealth Funds survey conducted by
the authors of the article confirmed With health insurance and a medical home, lowincome adults are nearly as likely as higher-income adults overall to receive
recommended preventive services and rate their quality of their care as excellent or very
good. Yet, study results also demonstrate that few low-income adults have insurance
coverage and a medical home. The findings of the Biennial Health Insurance Survey
affirm the importance of the Affordable Care Act, which has multiple provisions to
expand access to health insurance coverage and promote the adoption and spread of
health care delivery system improvements, including medical homes.1 These are great
offers of solutions presented by the authors of this article, and if implemented in policies
it will produce forward progression in the lives of those without health insurance.
" In comparison, the United States spends much more on healthcare (reducing the
ability for competitive pricing on the global market) and offers fewer services to its
citizens, yet life expectancy is appreciably less than Germany or Japan. Much of the
reason for these differences is found in how the cultures promote and provide for
prevention, public health, and primary care 2, as explained by authors who share in their
report the importance of primary care coverage for those who are uninsured. In their aim
to design a primary care and prevention program for the uninsured populace, they
originated a strategy that would be beneficial in the future. Their proposed program titled
Access America (AA) included two additional benefits granted in the program titled
Access America Plus (AA+) and Access America Plus Plus (AA++). It would provide
five primary care visits (and one of the visits for preventive services) a year for those

among the uninsured who earn up to four times the federal poverty level. AA+ provides
five visits and four ancillary authorizations attached to those visits (e.g., laboratory,
radiology, physical therapy, occupational therapy). In addition to the AA+ benefits, the
AA++ program would provide four pharmaceutical prescriptions per year. Primary care
visits for program beneficiaries that exceed five visits, four ancillaries, and four
prescriptions would be paid out of pocket by the beneficiary or patient up to the amount
allowed in the program ($268.70).2 In agreement with the authors, it is their belief their
proposed program would provide as a useful resource for the uninsured populace and
ultimately reduce the misuse of emergency room visits.
Leading to the following journal article that discusses the expansion of Medicaid
coverage under the Affordable Care Act, the authors reveal the authorization of this
proposal in particular states. They make known that The ACA required mandatory
participation by states in Medicaid expansion programs. The law included a provision to
withhold all federal Medicaid funding from states refusing to comply with expansion
requirements. After passage of the ACA, a number of states brought suit against the
federal government; they questioned the constitutionality of requiring all Americans to
have health insurance coverage and mandating state participation in Medicaid expansion.
On June 28, 2012, the Supreme Court ruled in favor of the individual mandate for
insurance coverage. However, the justices ruled that the ACAs provision to withhold all
Medicaid funding from states refusing participation in the Medicaid expansion program
was overly coercive and unconstitutional. Rather than strike Medicaid expansion entirely
from the ACA, the Supreme Court ruled to limit the federal governments power by
allowing states to opt out of Medicaid expansion without losing current federal Medicaid
funding3. The conspicuous truth of this matter revealed the response of the dilemma
faced by legislative authoritarians regarding the health of the poor in comparison to
upkeep of money.
The next set of reviews that have been based on case studies, discuss elements of
access to healthcare and the elements associated with affordable care act Medicaid
expansion. The first authored by Lisa C. and her coauthors is a study of the potential
effects of Medicaid coverage in its expansion under the ACA. The primary focus of the
authors analysis was based on health care use and spending, supplemented by some
indicators of health care access4. The authors utilized the data from the Medical
Expenditure Panel Survey (MEPS) to compare low-income uninsured adults with chronic
conditions with adults covered by Medicaid. The results of their findings indicated find
that low-income adults with chronic conditions who are covered by Medicaid have
much better access to care than do their uninsured counterparts. They are significantly
more likely to use health care services, including ambulatory care services and inpatient
care, and significantly less likely to have unmet need for health care4. These findings are
important to know because it demonstrates the need for Medicaid expansion under the
ACA for the uninsured populace because those who are remain unprotected of being
insured remain tormented by the chronic conditions they maintain.
In the second article, Steven H. and his coauthors used simulation methods and
data from the Medical Expenditure Panel Survey to compare nondisabled adults enrolled
in Medicaid prior to the ACA with two other groups: adults who were eligible for
Medicaid but not enrolled in it, and adults who were in the income range for the ACA's
Medicaid expansion and thus newly eligible for coverage5. The methodology of the

study was based upon the observation of the patterns of health status and conditions
among groups of individuals who were enrolled and eligible for Medicaid among all the
states in America and those states were grouped according to their active or inactive
policy stance on Medicaid expansion in early 2014. The results of the study revealed in
both groups of states, the newly eligible were generally healthier than pre- ACA Medicaid
enrollees.5 Also, adults who were eligible for Medicaid but not enrolled before passage of
the ACA and those in the income range for the ACA's Medicaid expansion ("newly
eligible") had similar or better health than adults enrolled in Medicaid through a pathway
other than disability before the ACA - in spite of the fact that the newly eligible were
somewhat older than the currently enrolled.5
In the next article Laura W. and Sarah M. conducted a quasi-experimental study in
2014 to evaluate whether the state Medicaid expansions were associated with changes in
insurance coverage, access to and utilization of health care, and self-reported health.6
They measured the type of health insurance coverage and medical care and conditions of
individuals in the 2010-2014 National Health Interview Surveys between the ages of 1964 who maintained incomes below 138% of the federal policy level. The results of their
study showed the ACA Medicaid expansions were associated with higher rates of
insurance coverage, improved quality of coverage, increased utilization of some types of
health care, and higher rates of diagnosis of chronic health conditions for low income
adults.6
The last set of articles consists of governmental reports. The first article that was
extracted from the U.S. Department of Health & Human Services the Agency for
Healthcare Research and Quality (AHRQ) discussed in detail of a study conducted by
researchers of the agency who focused on the consequential effect of lack of insurance
that leads to poor health specifically among African American and Hispanic individuals.
The researchers found that the black-white difference in the proportion of uninsured was
at its widest in the 5559 age group (12 percent) and the Hispanic-white difference was
near its widest in the 4045 age group (29 percent), both ages when medical needs are
likely rising.7 The researchers found that Hispanics can expect to live 24 years without
health insurance coverage compared to 14 years for blacks and 10 years for whites.7
The next article was a report from the National Center for Health Statistics
(NCHS) that estimated the number of people covered by public and private insurance
based upon the data from the 2015 National Health Interview Survey (NHIS). By doing
so, the researchers estimated the number of persons who lacked health coverage in three
categories that covered the (a) uninsured at the time of interview, (b) uninsured at least
part of the year prior to interview (which includes persons uninsured for more than a
year), and (c) uninsured for more than a year at the time of interview.8 The results of the
study indicated that about 7.4 million fewer persons lacked health insurance coverage in
2015 compared with 2014.8
In the third article, prepared by the U.S. Department of Health & Human Services
in consultation with the Centers for Medicare & Medicaid Services presented a report to
Congress that discussed a plan in 2014 to reduce racial and ethic disparities in health care
access by means of strengthening the Affordable Care Act (ACA). By standardizing data
collected on demographic characteristics associated with health care disparities, and by
requiring collection and evaluation of this data, section 3101 of the PHS Act has better
positioned Medicaid and CHIP to track progress in addressing disparities in health care.9

To improve the identification of health care disparities in Medicaid and CHIP, while
continuing to build off of the approaches already implemented, HHS recommends
improving the: 1. Quality of health care disparities data across delivery systems; and
2. Completeness of health care disparities data collection in managed care.9
The last article was based upon a report provided by the United States Census
Bureau. The report described research that showed the measuring health insurance
coverage in the United States in 2014. There were statistics from the report revealed from
a myriad of categories that of which involved household income. The statistics of that
category showed that People with lower household income had lower health insurance
coverage rates than people with higher income.10 In 2014, 83.4 percent of people in
households with annual household income of less than $25,000 had health insurance
coverage, compared with 89.3 percent of people in households with income ranging from
$50,000 to $74,999 and 94.7 percent of people in households with income of $100,000 or
more.10 People in households with lower income were more likely to have government
coverage than people with higher income.10 In 2014, 65.3 percent of people with
household income below $25,000 had government health insurance coverage, compared
with 18.5 percent of people in the highest income category.10 Each of the references
discussed, harmonically reveal insight about the elements associated with healthcare
access and use for the low-income uninsured populace. The articles represented in this
review distinctively address unique theoretical perspectives on areas affected by the
health insurance system that pertain to the uninsured populace and they each contribute
diverse solutions on their behalf.
Summary and Conclusions
The research provided by the articles that have been discussed in this review
provide insight about the American health insurance system and its impact on the
uninsured populace. Much of the research discussed in the articles were consistent in its
results, the differences lied in the statistics that were reported. The limitations in the
findings presented in each of the articles may have been affected by the restricted areas of
focus that limited the generalizability of findings of the topics that were being examined.
Flaws in the research discussed in the case studies and common review articles could
have been associated with a bias in the results of the studies. Overall the research findings
provide meaning to all that is entailed in health care access and use for low-income
uninsured adults in America. To ensure significant understanding about the healthcare
insurance system for the uninsured populace there is a critical need to properly guide and
educate them about policies and regulations of the federal programs they depend on for
healthcare access and use.