CHAPTER V-DISCUSSION, CONCLUSION AND RECOMMENDATIONS

Discussion

Various countries continue to debate on better ways of expanding insurance coverage among minority and low-income Americans. The data provides vital evidence on the benefits that Americans have realized since the Affordable Care Act (A.C.A.) was introduced. The data analysis indicates that the insurance coverage in various states has been increasing over time, with a small impact realized during the first two years of its implementation. The study realized a pattern that indicates that the increase in health insurance coverage under Obamacare significantly reduced the cost-related barriers to care, outpatient visits, and an increase in the number of yearly checkups.

The study realized a slower spending growth among the poor and middle-income individuals before A.C.A. and during the first year of its implementation. This pattern is associated with the increased disparity in health care spending within different income groups during the period. However, the data do not provide adequate insights into whether the current acceleration in health expenditure has the potential of reversing the trend. The sharp increase in health expenditures among the high-income Americans and slow growth for the rest of the American population widen the income-based medical care receipt gap. Besides, there are increased chances that the gap might signify increased disparities in health care.

Notably, the low-income individuals had the lowest healthcare expenditure before A.C.A., besides their increased need for healthcare services. However, the expenditure for the healthy was twice that of the poor. Several factors might have contributed to this occurrence. One of the factors the study realized from the data is that most wealthy individuals enrolled for Medicaid when the program was first implemented. Another factor that might have contributed to the pattern is a reduced number of health care facilities and professionals in areas occupied by low-income groups, thus the increased spending to access the services (Manchikanti et al., 2017).

Since the implementation of A.C.A., various countries have reported significant improvement in the quality of care and health (Stefanacci, 2017). The improvement is associated with the Medicaid expansion under Obamacare, which is consistent with findings from some of the earlier evidence on the impact of the legislation on the health care system in the United States. The collected data indicate the increased quality of care even in areas of care shortages. As a result, this suggests that expansion in insurance services has demonstrated a positive impact in the areas regardless of the capacity of the clinicians.

The analysis of the data provides key contributions to the growing research on the Affordable Care Act. An increase in insurance coverage under the legislation resulted in increased access to primary care and medications and affordability of care services. Most of the changes were realized during the first three years of A.C.A. implementation. In this regard, the Americans who gained insurance coverage during the period realized larger policy-relevant changes, including reduced out-of-pocket medical expenditure, increased likelihood of accessing the source of care, and increased chances of experiencing excellent health. Prior research indicates that poor health rating increases the mortality risk among low-income groups than the remaining population (Alcalá et al., 2017). Based on the finding of this study, the effect can be eliminated through the policy interest of A.C.A. on health status.

Most uninsured American families spend on premiums, deductibles copayments that are not subjected to their income. Due to this, the medical care expenses increase their poverty and income inequality level, which are some of the primary social determinants of health. In most cases, the techniques that the individuals use in care payment, especially when the insurance programs fail to scale premiums, can widen health disparities among a group regardless of their family status.

The pattern realized from examining the data related to the Gini index is attributable to the medical outlays. The values before the introduction of the A.C.A. suggest a modest improvement in the health care financing system. Based on this, it is possible to deduct that the individuals from low-income families increased their care utilization while ensuring that their medical outlays remain constant. The study findings indicate that most private insurance coverage offered under the legislation exchanges tend to lead to high deductibles. As a result, this can drive several families into extreme poverty despite the cost-sharing subsidies.

The data analysis indicates that various ethnic and racial minority groups experiencing disparities in health care access and coverage before the introduction of A.C.A. have realized improved measures under the legislation. In this regard, the African American minority group has realized the highest benefit as several individuals have had access to insurance coverage. For instance, African Americans are more likely to gain insurance coverage through Medicaid and Marketplace under A.C.A. than whites or other minority groups (Rosenkrantz et al., 2017). The findings also indicate a slower rate regarding the decline of the insurance rates among the Latino. This could be attributed to the individuals being more likely to live in American states that do not participate in the Medicaid expansion.

The study provides a snapshot of various ways in which the provisions of A.C.A. have significantly increased the insurance coverage among the minorities in American. The data demonstrate that the reform has increased America’s overall insurance coverage rate and eliminated insurance coverage disparities associated with ethnicity and race. The introduction of the legislation increased the number of insured Americans even though about 30 million individuals remain uninsured. Among the uninsured population, the number of racial and ethnic minorities remains the highest in the population size. This is because most minority groups experience low income. Considering that health expenditures account for a similar income share for the poor and rich, the difference in health care access exists.

The above results reflect the theoretical frameworks that support the study. Health and health care quality tend to differ greatly from one group to another. For instance, the results indicate increased access to health care services among black Americans than Latinos or whites after A.C.A. As a result, health care inequalities occur along with social class, race, and ethnicity (Alcalá et al., 2017). Notably, individuals from disadvantaged social backgrounds are most likely to experience limited access to health care services which negatively impacts their health status. Besides, the increased cost of healthcare services is likely to affect a portion of the population, with the highest impact felt among the minorities and low-income individuals.

The findings allow the demonstration of health care disparity as a social construction due to its existence as a result of human interactions. In this regard, the disparity is shaped by both historical and cultural contexts (Courtemanche et al., 2018). Based on this, society has a significant influence on the definition of the health status of individuals. For instance, the study results indicate that the low-class is associated with the minority groups. As such, society has a label for the position that such individuals hold. Thus they are often associated with increased levels of poverty and poor health conditions. Additionally, society and its members associate low-class families with reduced access to health care services, which explains health care disparities. Therefore, the results reflect the theoretical framework, conflict theory, and interactionism theory related to the causes of health care disparities in American society.

Limitations

The study has several limitations. First, the study used peer review as the data collection method, which might have affected the data used in answering the research question. It is possible that the data collected from various research studies have changed due to time, and many people have benefited from A.C.A. Therefore, our results might not reflect the current impact of Obamacare regarding the number of uninsured Americans. However, the information provides a broad overview of the state of health care among Americans. Additionally, the study provides a great understanding of different American groups and their access levels to health care services regardless of when the actual data collection occurred. This provides great ground for developing effective policies for reducing health care disparities among the American population.

Second, the study results may be prone to bias which might have occurred from the previous studies that have been used in the research. There are high chances that during the review of the article, the individuals reviewing them may misinterpret the data collected, and as a result, this distorts the findings. The occurrence of biases due to the methodology might have reduced the validity and reliability of the research findings. However, researchers can implement various strategies such as ensuring sufficient depth and relevance of data and ensuring different perspectives in future research to improve the validity and reliability of their findings.

Conclusions

A.C.A has significantly impacted the health care system of the United States since its implementation. The implementation of the legislation led to the expansion of health insurance coverage which provides increased opportunity to the Americans to enroll in the programs, thus saving thousands of lives. Its implementation reduced the number of uninsured individuals to historically low levels regardless of ethnic or racial groups of the individuals. Due to the complexity of the United States’ health system, it is difficult to measure the effects that the legislation has had on the cost and quality of the services offered within the system. However, based on other factors such as health status and health spending of various American families, it is safe to conclude that A.C.A has improved the quality and reduced the cost of health care services.

More Americans have been covered through the expansion of Medicaid under A.C.A. Historically, Medicaid has been used to insuring low-income adults, children, and disabled people. However, the introduction of Obamacare has expanded the insurance cover of adults living below 138 percent of the federal poverty level. Additionally, its expansion has improved the number of newly eligible low and middle-income families to insurance coverage. The various changes that have resulted from the legislation make it easier for children to get enrolled and stay covered at a lower cost. Besides, A.C.A has opened new opportunities for the development and promotions of systems that allow Medicaid beneficiaries to enroll online for the services, thus increasing the coverage.

The disparity in health care is one of the major social issues that have been prevalent in the history of the American healthcare system. Among the ethnic and racial groups which have continued to show an increased number of uninsurance rates are Hispanic, Blacks and Latinos. The introduction of Obamacare has increased the ability of individuals to access quality health care services through the expansion of insurance coverage. Therefore, the Medicaid expansion under A.C.A has played a significant role in reducing disparities among the ethnic and racial minority groups in the United States.

Various efforts have been put in place in the United States to reduce disparities in health care. However, A.C.A is the only effective effort that has shown the potential for reducing the disparity. Based on the research findings, dealing with differences in health care access requires strategies that consider the socioeconomic status of individuals. The research deepens the understanding of individuals on the impact of the Affordable Care Act on Americans’ lives. Also, it demonstrates effective strategies that various groups can implement in their programs to eliminate disparities in healthcare in the United States.

Recommendations

Considering that the introduction of A.C.A has not fully eliminated health care disparities, it is important for the government to initiate additional programs that raise public and provider awareness and expand health insurance coverage among the American population, especially among the minority groups. Additionally, there is a great need for the government and other private organizations to ensure an improved capacity of health care facilities and the number of providers in the underrepresented communities. It is vital to integrate information from different research to increase the knowledge base on the cause of healthcare disparities and interventions to reduce them.

There is a great need for different changes in the current health policies in America. It is essential for policymakers to assess the current health policies and determine ways to reduce the yearly increase in health care expenditure for the general population and increase access of the individuals to care despite the number of uninsured. The policies should also ensure improved quality and eliminate inequalities in healthcare. Achieving this will require the policymakers to stage a constructive policy debate that focuses on the coverage and spending of Americans on health care services.

Future research should explore healthcare utilization under A.C.A for specific racial and ethnic groups to provide detailed information on the impacts of the legislation on the health care system. Different states experience variations in health care reforms and strategies that include Medicaid expansion and health insurance coverage. Therefore, future research needs to evaluate the variation across different states to measure the impacts of the policies and identify the changes. Besides, the studies should incorporate other methodologies to explore the impacts further.

References

Alcalá, H. E., Chen, J., Langellier, B. A., Roby, D. H., & Ortega, A. N. (2017). Impact of the Affordable Care Act on Health Care Access and Utilization among Latinos. The Journal of the American Board of Family Medicine, 30(1), 52-62.

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the Affordable Care Act on Health Care Access and Self-Assessed Health after 3 Years. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 0046958018796361.

Manchikanti, L., Benyamin, R. M., & Hirsch, J. A. (2017). Evolution of US Health Care Reform. Pain physician, 20(3), 107-110.

Rosenkrantz, A. B., Nicola, G. N., & Hirsch, J. A. (2017). Anticipated impact of the 2016 Federal Election on Federal Health Care Legislation. Journal of the American College of Radiology, 14(4), 490-493.

Stefanacci, R. G. (2017). The Impact of Federal Health Care Reform on LTC. Annals of Long-Term Care.