Systemic racism has to do with inequities in income, employment availability, government surveillance, immigration arrests, infant mortality, and other issues which adversely affect minorities in the United States (The Center for Racial Justice, 2017).
The research question is as follows: Will a 2017 repeal of the ACA lead to a disruptive situation that may leave poor people, elderly persons, and others such as racial/ethnic minorities at a disadvantage for medical care?
With the turn of the New Year of 2017 only three months ago, there is concern about the status of health care insurance coverage in the United States. Specifically, there have been efforts to repeal the ACA and replace it with something else. Though Republicans have said for eight years that this is their intent, the proposal has essentially vanished because of an insufficient number of Republican votes to move it forward (Eltorai, A. and Eltorai, M., 2017). These striking events took place despite Mr. Trump’s campaign promise that he would repeal the ACA (Jost, T. and Lazarus, S., 2017).
The President of the United States cannot repeal the ACA via executive order because it is a statute which Congress enacted. Hence, Congress has to be the entity which executes the repeal. Moreover, there must be mutual cooperation between federal and state agencies in order to bring about such a dramatic change (Jost, T. and Lazarus, S., 2017). The Administrative Procedure Act enabled the Obama administration to create the ACA. If one were to override the ACA, there will need to be an alteration of rulemaking (Jost, T. and Lazarus, S., 2017).
Congress has already indicated that it wants to “provide affordable health care for all Americans” via the ACA (Jost, T. and Lazarus, S., 2017, page 1201). However, the Trump administration has suggested an approach which will “provide greater flexibility to States” and “encourage…a free and open market in…health care services and health insurance” (Jost, T. and Lazarus, S., 2017, page 1201). A concern of researchers is that the President’s strategy will weaken the administration’s legal defense of some initiatives for the ACA (Jost, T. and Lazarus, S., 2017). Researchers contend that dramatic changes in the ACA will disrupt insurance markets as well as lead to political consequences (Eltorai, A. and Eltorai, M., 2017; Obama, B., 2017; Clinton, H., 2016)
This opposition to repeal of the ACA, of course, somewhat stems from the Congressional Budget Office report, which suggests that the new plan will lead to a rise in health insurance premiums. This increase in cost for patients may result from the discontinuation of health insurance in young healthy individuals. In other words, as more healthy people leave the ACA, insurance companies will raise premiums in order to maintain adequate cash flow for themselves (Jost, T. and Lazarus, S, 2017; Eltorai, A. and Eltorai, M., 2017; Obama, B., 2017; Clinton, H., 2016).
In 1974, the United States spent $14.8 billion on major health care programs. Now that country spends $3.2 trillion yearly on health care, and these expenditures are the highest on the globe. Nearly a third of that has to do with excessive prices, inefficiencies, and waste. In the meantime, health disparities continue to be a serious problem there (Dzau et al, 2017).
In 2013, 44 million nonelderly individuals in the United States did not have health insurance. This situation left many poor people who were not able to pay for health care (Eltorai, A. and Eltorai, M., 2017). In 2014, the ACA became available. This enabled the establishment of marketplaces and Medicaid expansion. It offered coverage for those who had preexisting medical conditions. Additionally, patients whose incomes were less than 400 percent of the federal poverty level received subsidies (Eltorai, A. and Eltorai, M., 2017; Obama, B., 2017).
During 2014 and 2015, 31 states expanded Medicaid under the ACA. This led to $79 billion of federal funds for them. The outcome was increases in employment, hospital and physician revenues, and savings in state-funded programs such as prisons and mental health facilities. Additionally, the occurrence of uncompensated medical care declined (Eltorai, A. and Eltorai, M., 2017).
By 2015, there were still 28.5 million individuals without health insurance even though the ACA was already in place. Of those without coverage, more than four-fifths were from low to moderate income households (Eltorai, A. and Eltorai, M., 2017). Moreover, by 2016, the number of uninsured had declined to 17 million, and this too was obviously a result of the ACA. Nevertheless, 19 states chose not to expand Medicaid during that same year, and this left three
million Americans without health insurance (Eltorai, A. and Eltorai, M., 2017; Clinton, H., 2016).
The ACA also provides benefits for 150 million Americans who have coverage through their employer. It also furnishes a young adult option up to the age of 26 via their parents’ health insurance (Clinton, H., 2016). Through the Children’s Health Insurance Program, the ACA has enabled 8 million children to benefit from coverage. Furthermore, by 2016, 3 million African-Americans and 4 million Hispanic Americans were able to have health insurance through the ACA (Clinton, H., 2016).
Secretary Clinton observed in 2016 that less than a 10th of Americans were without health insurance, and this has not previously occurred in United States history (Clinton, H., 2016). She also advocates access to reproductive health care for all American women and that they have an input into decision-making on these issues along with physician and family. Women must also be free to consider their own religious belief with regard to these matters (Clinton, H., 2016).
It may be that by 2018, millions of other Americans will be without health insurance as a result (Jost, T. and Lazarus, S., 2017). Moreover, the Joint Committee on Taxation has a concern about removal of Medicaid expansion and an increase of premiums twofold by the year 2026 (Eltorai, A. and Eltorai, M., 2017).
Under the new American Health Care Act approach, coverage may not be very good for clients who have preexisting conditions, and protection will not be comprehensive (Eltorai, A. and Eltorai, M., 2017; Obama, B., 2017; Clinton, H., 2016).
The long-term consequences of inadequate or no insurance are evident. First, the patient may not receive preventive health care such as vaccinations and cancer screening, as they have under the ACA, in which the clinician can detect disease in its early stages. This also leads to chronic disease which perhaps will not receive proper medical attention. Subsequently, the individual may become seriously ill and require admission to a hospital (Eltorai, A. and Eltorai, M., 2017; Obama, B., 2017; Clinton, H., 2016). An important item to remember is that undocumented immigrants are not eligible for ACA coverage or Medicaid (Eltorai, A. and Eltorai, M., 2017).
The result of all this is a revolving door which worsens rather than improves the medical condition of the person. In essence, it is a vicious cycle which makes it even more of a challenge for the patient and the health care team. These clients are at greater risk of mortality than those who have money and insurance coverage (Eltorai, A. and Eltorai, M., 2017; Obama, B., 2017; Clinton, H., 2016).
In addition, this situation may lead to action from debt collectors, and the individual suffers from emotional stress. The financial crisis finds its way to consumer credit bureaus, and some of these patients face bankruptcy (Eltorai, A. and Eltorai, M., 2017).
The ACA, of course, removed preexisting medical conditions from the insurance application. This meant that illnesses such as heart disease, epilepsy, cancer, and diabetes mellitus were no longer reasons to deny health insurance to Americans. The same was true for pregnancy which is not, in many instances, a disease (Eltorai, A. and Eltorai, M., 2017; Obama, B., 2017).
Currently in the United States, there are 52 million adults who have not yet attained the age of 65 and who have preexisting conditions (Eltorai, A. and Eltorai, M., 2017). In fact, there are 133 million Americans overall with preexisting conditions (Obama, B., 2017; Clinton, H., 2016).
Medical literature suggests that there is a need for modernization of skills, advancement in science, and measurements of what is most important. The health care system has several problems such as structural inefficiencies, fragments in care delivery, cost, administrative matters, and hardship with payments (Dzau et al, 2017; Clinton, H., 2016). These issues present difficulties for clinicians, communities, employers, and others (Dzau et al, 2017).
Among those who suffer the most are poor clients who tend to have short life expectancies. Also, they may not have adequate social services or medical care in general. Very sick patients are obviously at a disadvantage as well (Dzau et al, 2017). Inadequate medical care on the part of the physician aggravates the situation too. This includes improper patient diagnosis and evaluation as well as other medical errors (Dzau et al, 2017).
In the 21st century, the changing scenario of public health leaves many issues which further complicate health care management. Some of these are disability, whether mental or physicial, advanced age, new infectious diseases, and overweight and obesity (Dzau et al, 2017; Clinton, H., 2016).
Though these complex issues pose concern everywhere across the globe, it is reasonable to say that some countries handle them better than others. In fact, Germany, Singapore, and Switzerland have been successful with mandatory health insurance and universal coverage while at the same time the ability to manage their health care budgets (Herzlinger et al, 2017). The three countries have various approaches. For example, the government will automatically enroll citizens of Switzerland into health coverage in the event they fail to do so voluntarily. Singapore requires employers to contribute to a medical savings account, and this provides coverage for all workers. Furthermore, impoverished individuals will benefit from government subsidies to cover insurance premiums (Herzlinger et al, 2017). Germany also requires contributions for health insurance as well (Herzlinger et al, 2017).
Some contend that although the United States has similarities to these other countries with the ACA, the differences leave the health care budget with an imbalance. This may stem from America’s use of only a few insurers whereas the other three countries have as many as several dozen. Moreover, the use of penalties in the United States may be too lenient to handle the high costs for very sick clients who have a lot of medical problems (Herzlinger et al, 2017).
It is obvious that high medical costs will occur with older patients, and the view of Germany, Singapore, and Switzerland is that a pooling of risk may alleviate the situation. In other words, those who have preexisting conditions perhaps will not create much of an imbalance in health costs when managers create risk pools (Herzlinger et al, 2017).
The use of pools in the United States may lead to more financial risk in the long run especially when Medicare recipients are of interest. If one were to direct a pool of patients who may have large medical bills, the federal government will have to inherit those expenses (Herzlinger et al, 2017). As do other countries, the United States utilizes private sector insurance. However, the use of a governmental single-payer model as a method to achieve universal coverage is not politically feasible in America (Herzlinger et al, 2017).
Some have suggested that the United States can lower insurance premiums for individuals whose health care will not yield high costs. Nevertheless, this avenue requires disbursement of large amounts of funds (Herzlinger et al, 2017).