There are numerous issues that continue to undermine the quality and accessibility of healthcare services in the US. The nation has been topping the lists of countries with the highest medical expenditures per person for decades. Economists claim that there are multiple factors contributing to the persistence of the phenomenon. The current healthcare system in the US relies heavily on costly private insurance plans. Multiple attempts have been made to eliminate the negative consequences and imbalances that the reliance on private funding brings.
The US healthcare system relies predominantly on premiums that are paid either through employers or via individual insurance plans. Glied (2018) claims that most providers are “independent businesses that must manage their own operations and finances”. Thus, unlike in many other nations, the US government has relatively little involvement in healthcare funding. Moreover, there is still a lack of regulation concerning the price levels in the sphere. Nevertheless, both Medicare and Medicaid have proven to be essential for the provision of healthcare services to the particularly vulnerable groups of citizens, the former for the elderly and the latter for the poor.
The Patient Protection and Affordable Care Act, often shortened to ACA, has been instrumental in expanding the accessibility to affordable healthcare services to millions of Americans (with income up to 138% of the federal poverty line). The Act’s most significant provisions came into force in 2014 and started changing the quality of life across the country immediately. The new legislation implied a substantial expansion of both funding and eligibility for Medicaid (CrashCourse, 2016). The federal funding skyrocketed while ensuring that more than 70 million people have access to all the essential healthcare services.
Although it was hard to overestimate the volume of positive effects, it soon became vivid that several states were unwilling to participate in the expansion encouraged by the Patient Protection and Affordable Care Act. Therefore, the Supreme Court of the United States ruled in National Federation of Independent Business v. Sebelius that states were not obliged to agree to the expansion. As a result, dozens of states currently maintain the pre-ACA funding levels and eligibility standards.
The economic situation in the US has been changing rapidly for several decades. The middle class that has always been the cornerstone of the affluent and politically active American society has been shrinking rapidly. A number of scholars claim that a large part of these people will soon find themselves in a precarious position where they can no longer afford the insurance costs and certain healthcare services.
There is a large part of the population in the US that has small salaries that elevate them above the renewed Medicaid threshold while not allowing them to pay even for basic healthcare services. Moreover, according to Ritz et al. (2014), “politically determined rules affect the trajectory of current and future Medicare costs, premiums, and out-of-pocket spending”. Thus, numerous policymakers hinder the prospects of realizing the ACA’s potential in the near future.
Medicare has proven to be a crucial step that allows for the enhancement of the welfare state. Nevertheless, there are numerous issues that undermine the efficiency of the multiple measures seeking to expand the eligibility for the program. Therefore, the Supreme Court has supported various types of legislation designed to develop a sophisticated universal framework for addressing the issue. Nevertheless, the complexity of the current American political system allows numerous business people and lobbyists to successfully promote the status quo, depriving millions of working Americans of a much-needed sense of security.
CrashCourse. (2016). The economics of healthcare: Crash course econ #29 [Video]. YouTube.
Glied, S. A. (2018). Financing medicare into the future: Premium support fails the risk-bearing test. Health Affairs, 37(7), 1073–1078.
Ritz, D., Althauser, C., & Wilson, K. (2014). Connecting health information systems for better health: Leveraging interoperability standards to link patient, provider, payor, and policymaker data. PATH and Joint Learning Network for Universal Health Coverage.