Healthcare services require compensation so our access to healthcare in the United States is certainly influenced by our economy. This access is very limited for the uninsured because of the extreme high costs of healthcare services and medications. According to the Social Security Advisory Board, health care spending is increasing at a more rapid rate than are earnings for workers and their families (Social Security Advisory Board, 2009).
Also, healthcare premiums have increased at a much greater rate than inflation (Divino, 2008). Many Americans are unable to obtain health insurance because it is not provided to them by their employers and/or it is too expensive. Medical bills can easily become overwhelming causing both financial and physical stress. The uninsured usually need to pay for most of their care out of pocket and do not have any net assets to help pay their medical bills. This can lead to debt accumulation, compromised credit ratings, and bankruptcy (Kaiser Commission on Medicaid and the Uninsured , 2013). Almost half of all bankruptcies in the United States can be attributed to medical costs (Kaiser Commission, 2013). There are many causes of the increase in healthcare costs. According to a policy analysis by the Cato Institute, the excessive costs of our current medical system are mainly due to an “overuse of medical resources by patients” (Liebowitz, page 1, 1994).
“When the marginal value of the resources used in a medical treatment is greater than the marginal value provided to the patient by the medical treatment, then the medical treatment is classified as “excessive” ” (Liebowitz, page 1, 1994). This does not mean that Americans receive or seek out treatment that is not to their medical benefit, it means that “patients receive treatment that the patients themselves value at less than the cost of the treatment” (Liebowitz, page 1, 1994). In other words, patients are not really aware of the economic value of the medical services they seek are not held accountable for the entire actual costs of the treatment. Also, increases in healthcare technology and pharmaceuticals along with the use of these new technologies and treatments without considering effectiveness, contribute a great deal too excess cost.
Other causes include an overall increase in the U. S. population, with an increase in the number and percentage of elderly people in the population, administrative and paperwork costs that are unnecessary for the provision of health care costs and higher malpractice insurance, case settlements and jury awards (Social Security Advisory Board, 2009). The uninsured contribute to this excessive cost of health care as well because when the uninsured cannot pay, the cost is shifted to those who have insurance coverage and can pay and this causes higher health insurance premiums (Conklin, 2002). The uninsured population usually must seek care at community health centers, free clinics, and emergency departments.
Most of the uninsured receive no preventive care and do not have a primary care physician (Kaiser Commision, 2013). With the exception of emergency care facilities, which are required by federal law to screen and stabilize all individuals, health providers are not required to accept uninsured patients and can choose to ask for payment upfront or refuse to provide care. Because they lack sufficient primary or preventative care they do not receive many recommended screenings for various disease processes. The insured must often delay medical treatment for their ailments and symptoms which leads to late diagnosis and treatment. After a chronic condition is diagnosed, they are less likely to receive follow-up care and as a result are more likely to have their health decline. There are significantly higher mortality rates among the uninsured (Kaiser Commission, 2013).
They are also less likely to be compliant with any prescription medications. In general, they receive poor care for chronic illnesses and are at an increased risk of premature death. People with lower incomes are more likely to be uninsured. “In 2012, 24.9 percent of people in households with annual income less than $25,000 had no health insurance coverage” (DeNavas-Walt, page 28, 2012).
According to the Kaiser Commission on Medicaid and the Uninsured, “nine out of ten uninsured people are in low- or moderate-income families, meaning they are below 400% of poverty” (Kaiser Commission, 2013). The Census Bureau has reported that the overall poverty rate in the US for 2011 was 15.0% meaning that about 46.2 million people were living in poverty in 2011 (DeNavas-Walt, 2012). According to Economic Research Service data, , 17.8% of the population was considered in poverty in North Carolina in this same year and 17.1% in Mecklenburg County, which was higher than the national average (United States Department of Agriculture, economic Research Service, 2013).
The number of uninsured Americans has increased substantially during the last decade, and currently only about 85% of the population has some type of health coverage. According to the US Census Bureau, the percentage of the population in the US without health insurance in 2012 was 15.4 and the number of uninsured people in 2012 was 48.0 million (DeNavas-Walt, 2012). In the South, the numbers were much higher with 18.6 percent of those under the age of 65 estimated to be uninsured North Carolina Institute of Medicine, 2012). North Carolina was also above the national number, with 18% of its population uninsured and in it is 17% for Mecklenburg County (North Carolina Institute of Medicine, 2012).
An effort aimed at increasing access to health care for this uninsured vulnerable population, especially the poverty stricken, is underway. The Affordable Care Act (ACA) of 2010 is to take full effect in 2014 and is estimated to make a 50% reduction in the uninsured rate (Kaiser Commission, 2013). There are different provisions of the ACA designed to affect the different levels of uninsured income groups. There is an expansion of Medicaid for adults with incomes at or below 138% of poverty and the nonelderly uninsured people with incomes between 139% and 399% of the federal poverty level, will be eligible for subsidies and to purchase health coverage through a Health Insurance Exchange (Kaiser Commission, 2013). Young adults will be able to stay on their parents until age 26 if they are unable to get coverage on their own.
There will also be a new Pre-Existing Condition Insurance Plan which will provide affordable coverage for individuals who are uninsured because they have been denied health insurance because of a pre-existing condition (Kaiser Commission, 2013). According to the Obama Administration’s Record on Supporting the Nursing Workforce, “The health care law – the Affordable Care Act – has given nurses and other health care professionals a historic opportunity to improve the health of millions of Americans” (Obama Administration Record, 2013). It also states that the Affordable Care Act’s “ emphasis on keeping people healthy, preventing illness, and managing chronic conditions, opens new opportunities for nurses and capitalizes on the expertise of the nursing profession (Obama Administration Record,2013).
Implementation of the Affordable Care Act will increase clinical preventive care and community investments. An increase in access to preventative care for uninsured Americans will create a greater emphasis on prevention and wellness. . “Expansion of medical care homes, community health care centers, and enhanced coverage for preventative care services will help to shift the delivery system’s current focus on acute care to a greater emphasis on prevention and treatment of chronic care conditions using health care teams and information technology” (Applebaum et al., page 318, 2012 ). This will result in a great opportunity for nurses to work in the community helping patients with preventative care including administering vaccines, tobacco cessation counseling and preventative screenings (Brody and Sullivan-Marx, 2012).
More nurses will be needed to work in community health centers, school-based health centers, and in home visiting services that offer counseling and intervention services to improve health outcomes. It is also an opportunity for nurses to become primary care providers. More primary care nurse practitioners and nurse midwives will be needed in order to meet the demand for more primary care providers and “the Affordable Care Act’s Prevention and Public Health Fund is supporting the training of 600 new nurse practitioners and nurse midwives by 2015”( Obama Administration Record, 2013).
In addition to Prevention and Public Health Fund, the Affordable Care Act includes increased funding and eligibility for nursing education programs which help nurses to advance their education and obtain baccalaureate or graduate education. Some programs include the nurse student loan program, nursing workforce diversity program, nurse faculty loan program, and loan repayment for nurse practitioners upon graduation with a 2-year service commitment (Brody and Sullivan-Marx, 2012). In