Discussion Essay. Answer the question below. Effective initial postings to the discussion should be at least 200 words in length, rarely more than 400 words. Your opinion will come from your reading so you will need to cite and submit one reference in correct APA format to your initial posting and one reference (different from your initial response) to your response to another classmate’s posting. You may use your textbook as one of your references and include at least one peer-reviewed journal article (not older than 5 years). Do not use a website, newsletter, blogs, etc. Please put your name in the subject area when you create your thread.
Chapter 13: Identify one current healthcare policy issue of interest to public health nursing in terms of the policy problem, the solution, interested parties, and their relative power and influence.
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There are many pressing issues within the modern healthcare system that impact public health nursing. One such issue is the ongoing debate around expanding access to healthcare coverage in the United States. Lack of health insurance leaves millions of Americans unable to access necessary medical care, contributing to poorer health outcomes and higher costs across the system (Sommers et al., 2017). This paper will examine the policy problem of the large uninsured population in America, potential solutions to expand coverage, interested stakeholders in this debate, and their relative power to influence policy changes.
The Policy Problem: Millions Lack Health Insurance
It is estimated that around 28 million Americans currently lack health insurance coverage (Berchick et al., 2019). Those without insurance face significant barriers to accessing primary care, specialty services, prescription medications, mental healthcare, and other medical needs. Not having insurance disproportionately impacts low-income individuals, racial and ethnic minorities, the unemployed, and other vulnerable groups (Sommers et al., 2017). Lack of coverage has been shown to lead to delays in receiving necessary care, increased reliance on emergency rooms for non-emergency issues, worse health outcomes, higher mortality rates, financial burdens from medical costs, and higher healthcare expenditures overall (Sommers et al., 2017; McMorrow et al., 2017). The high rate of uninsured has been a long-standing problem in the United States healthcare system.
Potential Solutions: Expanding Public and Private Coverage
There are a few main policy options that have been proposed and debated as ways to expand health insurance coverage to more Americans and reduce the number of uninsured. One solution is to expand public insurance programs like Medicaid and Medicare to cover more individuals (McMorrow et al., 2017). For example, all 38 states that have adopted Medicaid expansion under the Affordable Care Act (ACA) saw significant decreases in their uninsured rates compared to non-expansion states (Sommers et al., 2017). However, conservative states have resisted further Medicaid expansions due to costs and ideology (McMorrow et al., 2017).
Another option is to strengthen private health insurance marketplaces and subsidies. The ACA established health insurance exchanges to allow individuals and small businesses to purchase private plans, along with income-based premium tax credits to make coverage more affordable (Sommers et al., 2017). Enrollment in exchange plans grew rapidly after implementation, but the exchanges still face challenges with affordability and insurer participation in some areas (McMorrow et al., 2017). Proposals to fix issues with the exchanges and make subsidies even more generous could potentially expand private coverage to more individuals (Sommers et al., 2017).
A third approach is a single-payer “Medicare for All” system that replaces private insurance with a universal, government-run health plan (Woolhandler & Himmelstein, 2017). Supporters argue this could achieve universal coverage at lower overall costs than the current mixed private/public system (Woolhandler & Himmelstein, 2017). However, critics worry a single-payer system would be too costly and disruptive, and that it may negatively impact healthcare choice and innovation (Eibner & Saltzman, 2017). Overall, there is no consensus on the best policy path forward.
Interested Stakeholders: Insurers, Providers, Voters, Politicians
There are many groups with a stake in how the nation’s healthcare system and insurance landscape evolves. Health insurers have a strong financial interest in the policy debates, as expansions of public programs could reduce their customer base while marketplaces and subsidies impact their business models (McMorrow et al., 2017). Healthcare providers also have much at stake, as coverage expansions could influence demand for services as well as Medicaid and Medicare reimbursement rates that support safety net clinics and hospitals (Sommers et al., 2017).
Individual voters across the political spectrum care about access, affordability and choice in health insurance due to its direct impact on families and the economy. However, liberals and conservatives often disagree on the appropriate role of government intervention versus private markets (Eibner & Saltzman, 2017). Politicians must weigh these competing public and special interests when crafting healthcare legislation. Democrats have generally favored more government action to expand access, while Republicans support private sector solutions and limited public spending (McMorrow et al., 2017).
Relative Power and Influence
Insurers and providers wield strong lobbying power through industry associations and political donations (McMorrow et al., 2017). However, public opinion also carries weight, and politicians are responsive to voters on high-salience issues like healthcare (Eibner & Saltzman, 2017). The ACA survived multiple repeal attempts partly due to its popularity provisions once implemented (Sommers et al., 2017). Still, partisan divides mean conservatives have blocked certain expansions through legislation and litigation (McMorrow et al., 2017). State governments also exercise power through decisions around Medicaid adoption (Sommers et al., 2017). Overall, no single group dominates the policy process, and consensus remains elusive due to the many tradeoffs around costs, freedom of choice and the role of government.
Conclusion
In summary, the ongoing problem of millions lacking health insurance in America remains a pressing issue for public health nursing. Expanding coverage through mechanisms like Medicaid, marketplaces or single-payer models could help reduce the uninsured rate and barriers to care. However, major stakeholders from insurers to voters to politicians have competing interests and disagree on the best policy solutions. Finding an approach that balances access, affordability, choice and fiscal sustainability will likely require ongoing negotiation and compromise. As advocates for population health, public health nurses are well-positioned to inform this debate with evidence and help craft policies that can improve health equity.
References
Berchick, E. R., Barnett, J. C., & Upton, R. D. (2019). Health insurance coverage in the United States: 2018. Retrieved from https://www.census.gov/library/publications/2019/demo/p60-267.html
Eibner, C., & Saltzman, E. (2017). How does single payer compare to the Affordable Care Act? Retrieved from https://www.rand.org/pubs/research_reports/RR2424.html
McMorrow, S., Kenney, G. M., Long, S. K., & Anderson, N. (2017). Uninsurance disparities have narrowed for Black and Hispanic adults under the Affordable Care Act. Health Affairs, 36(1), 140–150. https://doi.org/10.1377/hlthaff.2016.1027
Sommers, B. D., Maylone, B., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2017). Three-year impacts of the Affordable Care Act: Improved medical care and health among low-income adults. Health Affairs, 36(6), 1119–1128. https://doi.org/10.1377/hlthaff.2017.0293
Woolhandler, S., & Himmelstein, D. U. (2017). Single-payer reform—The only way to fulfill the president’s pledge of more coverage, better benefits, and lower costs. New England Journal of Medicine, 376(23), 2102–2104. https://doi.org/10.1056/NEJMp1706589
