Running Head: United States Healthcare Access Disparity

Unites State Healthcare Access Disparity:

Will Obamacare Fix the Problem?
Jacob Persily
Rutgers University

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Table of Contents
Abstract

Introduction

Methodology

Findings

Discussion/Recommendation

Conclusion

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Appendix

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References

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Table of Figures
All figures can be found in the Appendix on Page 13. Figure Credit can be found on page 13.

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Abstract
United States healthcare is the most expensive single industry in the world. Since the
development of Medicare and Medicaid in the 1960s, and the ever-increasing role of technology,
healthcare costs have skyrocketed. Access to healthcare has suffered the most; people simply do
not have, and cannot afford, the access to healthcare that they need. The Affordable Care Act
strives to bridge the gap in access to healthcare, but its full effect on this issue is yet to be seen
due to the infancy of the program. Whether moving toward government-run healthcare, or
placing price cleanings on the cost of care, changes must be made to ensure equal access to
healthcare for all, to improve the health of the people of the United States.

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Introduction
One of the most commonly discussed topics in the public discourse of the United States
today is healthcare. To properly discuss healthcare, it is important first to define the word. To do
so, one must first look at the root of the word, health, and its meaning in society today. The
World Health Organization defines health as a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity (WHO, 2003). It is important to
understand this state of well being when looking at contemporary healthcare, and its effects on
the population.
Cost
Healthcare is the management of the well being of the people of the United States, and it
costs, to say the least, a lot of money. The United States is well known, both in a good and bad
way, for how much the nation spends annually on healthcare. The current reports put the
healthcare spending of the United States at nearly 18% of the gross domestic product of the
country (Howell, 2014). The United States spends more on healthcare, by a wide margin, than
any other developed country in the world, and we are projected to spend 20% of the GDP of the
nation on healthcare by the year 2023, outpacing growth of the overall GDP (Howell, 2014).
Cost, as evident in Figure 1 of the Appendix, is often one of the major issues reported in access
to healthcare in this country. Cost creates more of a barrier to care than in any other major
country in the world.
Legislation:
The most-often discussed piece of legislation, which seeks to solve some of the problems
of the American healthcare system is the Patient Protection and Affordable Care Act (ACA) of
2010, most often referred to as Obamacare. The ACA has several components, including the

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expansion of Medicare and Medicaid services to a larger subset of the population, as well as
creating a federal mandate of health insurance. The Act came before the Supreme Court, and was
upheld as constitutional in 2012. The main goal of the ACA was to expand US access to
healthcare. Figure 2, found in the Appendix, shows the levels of primary care, sick visit, and
specialty care accessible to those with government, employer, and no health insurance. The
figure clearly indicates those with no insurance lagging far behind those with insurance in terms
of access to healthcare. This is one of the issues the Affordable Care Act strives to correct about
the United States Healthcare system
Problem/Thesis:
There is a major problem plaguing United States healthcare today, and threatening the
health and well being of the American populace. That major issue is access. Equal access to
healthcare is still lacking, despite the roll out of the Affordable Care Act, because the majority of
states are opposing the subsidies and issues in the development and rollout of the program.
Access to healthcare is essential to maintaining good health; without healthcare access, health
levels begin to decline, and medical issues become exacerbated.

Methodology
Conducting research on healthcare is a personal continuum among my coursework at
Rutgers. As a student in the Healthcare Administration Bachelors degree program, it is useful to
look at healthcare, and its continued changes, from a variety of different perspectives. Writing
about healthcare presents an interesting challenge, as the healthcare industry in the United states
is ever changing. The status of the Affordable Care Act appears to be somewhat stable for the
moment, but many potential Republican presidential candidates have already indicated that the

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abolishment of the Affordable Care Act will be one of their first tasks as President. Therefore,
looking at news articles is often more effective than scholarly literature, but both concepts are
included in the below findings.
Finding news items about the United States healthcare system is quite simple, as
healthcare is in the news for one reason nearly every day, and the system is ever-changing,
prompting constant reports. Scholarly articles were obtained through the JSTOR databases, and
various other databases of the Rutgers University
Findings
Affordable Care Act
Statistics. It is important first to look at the statistics regarding the uninsured portion of
the population of the United States. Prior to the rollout of the Affordable Care Act, roughly 18%
of the United State population declared themselves as uninsured. This number, after the first
cycle of ACA insurance sign-ups has dropped to 13.4%, but this means that over ten percent of
the population of the United State is still without health insurance, without an affordable means
of getting access to healthcare. Whether due to immigrant status, or not having the funds to
afford insurance on the created insurance exchanges, people are still without health insurance.
Rollout Issues. As was majorly publicized in the media, there were some major glitches
with the roll-out of the government insurance programs, including major technology issues with
the healthcare.gov website, which experienced major down time in the beginning of the open
enrollment process. This kept many who would have signed up from signing up for health
insurance through the government. The website outages were a massive hurdle, which some
chose simply not to jump in signing up for their healthcare on the exchanges.

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Legislative Issues. There have also been issues surrounding the Affordable Care Act
related to state legislature, keeping people from health insurance. As of early March 2015, 18
states governments have declared that they will not be participating in the mandate for health
insurance, and an additional 15, which have made less harsh, but similar claims about the
Affordable Care Act (Cauchi, 2015). Without the mandate, people are not gaining access to
health insurance, and are not increasing their access to healthcare.
Access
The academic literature is in fair agreement about the access to care issue in the United
States. Each study takes a slightly different look at the same issue, the fact that there is a major
problem in access to healthcare.
Harris, 2010, indicates that an important step in closing the healthcare gap in this country
is to place the patient back at the center of healthcare continuum. Often today, economics and
regulatory issues take over healthcare, pulling focus away from the patient who is the person
who really matters.
Litaker, 2005, shows that economic status of an individual is linked to lack of access to
healthcare. Though the ACA attempts to solve this particular issues, it is by no means a given.
Kelley, 2005, discusses the varying quality of healthcare provided by physicians and
other providers in this country. He then shows the link between access and quality, that those
who have limited access to care are likely also receiving care of sub-par quality compared to
those with full access.

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Discussion/Recommendations
Discussion
Scholarly literature about healthcare access is, more or less, all in agreement. There is a
major gap in healthcare coverage, dependent on economic factors and various other issues.
Though the Affordable Care Act attempts to solve this problem, the final effects of the ACA
remain to be seen. It will take at least five years after the full program rollout to see any
measurable effect, once the kinks are worked out. It will, from there, take quite a bit of time for
updated literature to be released. The below recommendations are hypothetical means to fix the
gap in healthcare access, knowing that the ACA may fix the problem without any other major
changes needed.
Recommendations
There are several possible means of creating increased access to healthcare.
Nationalized System. One must simply look to our allies in the United Kingdom and
Canada to see the ability to provide all equal access to healthcare. These countries have
nationalized healthcare, where the government pays for and provides all healthcare for the
citizens, and yet these countries spend less of their GDP on healthcare then the United States
does.
Though many have said that moving towards a system of nationalized healthcare in the
United States would never work, nor never happen, it has the potential to solve many of the
problems faced by the United States healthcare system. It ensures that all people have equal
access to healthcare, as every individual is put into the system at birth, and it applies to all
citizens; the issues surrounding undocumented immigrants would need otherwise to be

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developed. It also puts all people on a level playing field in terms of access, regardless of
economic means at one particular moment in time.
National healthcare also has the tendency to lower cost of healthcare. As has been seen in
America, medical providers have charged higher and higher amounts for healthcare, just to make
a profit. National healthcare puts limits on healthcare costs to ensure that we do not spend too
much money on healthcare.
There is one issue that comes up with national healthcare, and that is a two-tiered system
of care. In countries with national healthcare, there can be very long waits, often months or
sometimes years, for some basic medical treatments. Those of little economic means wait for
healthcare. Those with more money will pay providers cash, often at the high American costs, to
skip ahead of the queue for care and treatment in the evenings. This has the potential to occur
here as well, though at least a system of nationalized healthcare will provide care to all.
Healthcare Price Ceilings. Without out creating a full system of nationalized healthcare,
the United states could potentially use some of the lessons learned from the British National
Health Service (NHS) to create similar programs here. One major economic component of the
NHS is the price ceiling it places on all major medical services. By establishing a maximum
price that can be charged for a particular medical procedure, the United States could assist in
creating equal access to healthcare for all. By ensuring that medical providers can not charge
exuberant amounts for procedures, to pay for their luxury cars and mansions, the government
will aid those not of exceptionally great financial means, the lower class, in gaining access to
healthcare, without having to take out massive loans or second mortgages on their homes.

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Conclusion
Healthcare is an essential part of living a healthy life. Though that may sound a bit
redundant, it is a true fact of life. History has proven this. In the medieval times, people were old
if they lived past the age of 40. The plague wiped out a large portion of the population of Europe.
Today, life expectancy is pushing 80, and most major disease have been eradicated; the only
remaining sample of the Bubonic Plague in the country is locked away in a freezer at the CDC.
Access to healthcare is an important part of keeping America healthy, given the threat of
obesity, heart disease, diabetes, cancer, and all of the other ailments that plague Americans today.
Those without insurance often head straight for the Emergency Room, which will provide care
regardless of means of payment. Emergency room care is among the most expensive, and filling
emergency rooms with non-emergent medical issues keeps provider to tending to those who have
truly life-threatening medical emergencies. Figure 3, found in the Appendix, shows the expense
of Emergency Room Care, compared to a less costly urgent care setting.
Access to healthcare will eventually lead to a healthier country. With full access, the
whole of America will begin to seek preventative care, the current shift in focus of the American
healthcare system. It is being quickly proven that regular preventative care, seeing a primary care
doctor on a regular basis leads to healthier people. This is something that equal access will yield,
people seeing a doctor regularly, catching illness early, and staying healthy longer to live a better
life.
It is the hope that equal access to healthcare will continue to improve the health of the
country, and decrease healthcare costs, to bring the United States in line with the rest of the
develop world in this area.

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Appendix
Figure 1.

Figure 2.

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Figure

3:

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References
Cauchi, R. (2015, March 3). State Laws and Actions Challenging Certain Health Reforms.
Retrieved March 23, 2015.
Harris, G. (2006). CULTURAL COMPETENCE: ITS PROMISE FOR REDUCING
HEALTHCARE DISPARITIES. Journal of Health and Human Services Administration,
33(1), 2-52.
Howell, T. (2014, September 3). Health care spending expected to pick up, grab bigger share of
GDP. Retrieved March 23, 2015.
Kelley, E., Moy, E., Stryer, D., Burstin, H., & Clancy, C. (2005). The National Healthcare
Quality and Disparities Reports: An Overview. Medical Care, 43(3), 13-18.
Litaker, D., Koroukian, S., & Love, T. (2006). Context and Healthcare Access: Looking Beyond
the Individual. Medical Care, 46(6), 531-540.
WHO Definition of Healthcare. (2003, January 1). Retrieved March 23, 2015.

Figure Credit
Figure 1. http://medicynic.com
Figure 2. http://kff.org/health-reform/issue-brief/medicaid-moving-forward/
Figure 3. http://www.forbes.com/sites/briansolomon/2014/07/02/drive-thru-health-care-howmcdonalds-inspired-an-urgent-care-gold-rush/