Health policy, politics and perspectives (POSTS)

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