Executive Summary

Even though the U.S. constitution has not formally set forth the provision for and access

to health, and nay endeavours related to the right to health. It is justifiable that access to

affordable healthcare is a critical aspect for any individual. Furthermore, the well-being of

society is a significant aspect of ensuring the prosperity of the citizens and the nation at large.

This policy analysis project aims to examine the challenges faced by people when sorting for

affordable health due to the escalated cost of treatment. The project mainly focuses on Medicaid,

which is a joint state and federal program that provide health coverage among ordinary and low-

income people. Thus, the project evaluates the effectiveness of Medicaid in promoting access to

health for the vulnerable population.

The project problem statement dictates Cleary the historical context of access to

affordable healthcare mainly through the provision of the Affordable Care Act (ACA). Moreover,

this statement highlights the role of the ACA in expanding insurance coverage. The persistence

of health care disparities among ethnic minority groups has led to unequal access to this

affordable health care. Due to this, medication and Medicaid were introduced as part of the

comprehensive health reforms to check on the issues of affordability and accessibility. To address

the issue, Medicaid was developed as a crucial program. The analysis compares Medicaid with

Medicare, aiming to identify strengths and weaknesses in ensuring equitable healthcare access.

Using a goals matrix, the analysis outlines objectives like improving equity and efficiency, with

impact categories for measuring progress. Three policy alternatives are assessed: the status quo,

current Medicaid policy, and potential reforms. Relying on evidence from reputable sources, the

analysis offers recommendations to address healthcare access gaps for vulnerable populations.
Problem Statement

More adults in the U.S. have a higher likelihood of failing to gain accessibility to the

required health care primarily because of the higher costs associated with the costs. A survey

conducted in 2016 showed that approximately one-third of the U.S. adults representing 33% of

the adults failed to fail access the recommended care meaning that they were either not capable

of seeing a doctor when sick or they were not capable of following their prescription fully

because of the costs (The Commonwealth Fund, 2016). Despite the U.S. making key progress in

expanding its insurance coverage primarily through the Affordable Care Act, it is important to

understand that the country still struggles with most citizens failing to access health care.

Most health insurers have shifted the increasing costs of health care to the patients by

increasing the deductibles. In cases where the patients are required to access some services,

including hospital stays and doctor visits, it is important to understand that the insurers tend to

share the negotiated costs with the respective patients. Although healthcare providers, including

doctors and nurses, are always there when the patients need them the most, hospital

administrators, on the other hand, tend to take advantage of patients by increasing the costs of

accessing health care. Hospitals tend to receive a significant share of health care spending, but at

the same time, they are considered the leading drivers of higher costs, which become expensive

for the patients.

Compared to other nations, it is important to understand that the U.S. spends a lot more

on health care, but the outcomes need to reflect the amount of investment directed toward the

industry. Therefore, such high costs of accessing healthcare can directly be associated with the

nation's challenges when responding to public health crises. There are a variety of potential

reasons why such costs of accessing health care have been increasing over the past years,
including the introduction of innovative healthcare technology and the complexity in the U.S.

healthcare system contributing towards administrative wastes.

Part of the most significant policies developed to address the issue of affordable

healthcare included the Patient Protection and Affordable Care Act (PPACA), also referred to as

the Obama Care. It is important to understand that the law was first amended on March 23, 2010,

with its full implementation on January 1, 2014(Fraser, 2019). The Act played a significant role

in the public health policy of the U.S. by establishing a legal framework for the health system

that was previously missing. The policy provides U.S. citizens with a near-universal guarantee

for accessing Affordable Care and does not discriminate against the age of the patients as it

covers everyone from their birth to retirement. fixed Act achieves all that by having shared

responsibility with different parties, including the government, individuals, and employers.

Additionally, the Act plays a critical role in maintaining fairness in health insurance

coverage and ensuring that patients are capable of accessing quality services. That way, the

health care system eliminates the possibilities of wasteful spending, promoting accountability

within the system. With the help of the policy, primary health care access has greatly been

strengthened, with long-term changes being implemented to promote the availability of primary

health care to the general population regardless of their social class. That was after realizing that

most of the low- or middle-class citizens could not access quality health care. The policy has

succeeded in making strategic investments in public health which have consequently played a

significant role in expanding both primary and preventive care.

Racial and ethnic disparities in health care have contributed to ethical dilemmas, resulting

in the social issue of access to health care and affordability. It is important to understand that the

U.S. is equipped with a variety of healthcare facilities, but for many reasons, healthcare has not
been accessible to the overall population. Evidence gathered over the past 3 to 4 decades shows

how health facilities have been visited unevenly among the different population groups in the

country.

The genesis of the health disparities dates back to 1985 when most African Americans

could not access quality care. The country still experienced an excess burden of death in the

same period, with the majority of the blacks and a variety of other minority groups in the country

experiencing illnesses compared to the rest of the population. It is worth noting that such

disparities were still in existence even before the collection of federal statistics took place

regularly.

Part of the historic approaches developed by the government to solve the social issue of

access to health care and affordability included the creation of Medicare and Medicaid in 1965.

That included the development of comprehensive reforms aimed at improving accessibility,

affordability, and the quality of health care in a manner that would be available to all citizens.

The emergence of the Affordable Care Act later played a critical role in solving the challenges

that U.S. citizens used to experience whenever accessing healthcare systems. The federal

government still embarked on transforming the healthcare payment systems hence assisting in

ensuring that Medicare payments are made through reliable organizations. Those form part of the

historic approaches the government had previously implemented to solve the social issue.

As part of addressing the social issue of access to health care and affordability, the

government has then developed various programs directed towards the same. Part of those

programs includes Medicare, which is primarily federal health insurance aimed at providing

services to people older than 65 years while at the same time serving younger people with

disabilities (Clemente et al., 2018). The government developed this program to ensure that older
people are capable of accessing quality health care. Another program developed by the

government to address the social issue is Medicaid, which is primarily a joint program between

the federal and state governments aimed at providing people from both middle and low-income

backgrounds with the opportunity of accessing health coverage. Medicaid provides people with

specific benefits, which were not available from traditional health insurance coverage. That

includes long-term services and support (LTSS) for all older citizens who qualify to access the

services and those with disabilities (Hu et al., 2018). Medicaid still offers individual

transportation services not covered by other insurance services.

The primary program developed by the government to address the social issue is the

Affordable Care Act. The policy provides U.S. citizens with basic legal protection when it comes

to accessing affordable health care. It is worth noting that the policy has contributed greatly

towards reducing the number of uninsured individuals in the country while, on the other hand,

increasing the number of Medicaid beneficiaries within the country. The policy has also

contributed towards promoting fairness and affordability of health insurance, ensuring it is

accessible by people from both middle and low-income backgrounds.

One of the most significant reasons why it is important to have a change in the policy

includes ensuring it is fully prepared for the transformational reform experienced in the

healthcare system as part of achieving universal health coverage for all people in the country.

The government then needs to increase the open enrollment period for insurance coverage as part

of ensuring everyone gets the opportunity to be included. That way, the general population will

be prepared to pay the rising premiums while at the same time providing the insurer with an

opportunity to participate in different areas of the enrollment process.

Goal Matrix

Enhanced healthcare Improved Enhanced

equity healthcare access healthcare quality

Achieve fairness and Expand affordable Elevate healthcare

equal healthcare access for healthcare standards, focusing

all, addressing disparities availability, removing on patient-centred

among diverse barriers for broader care and improved

populations. and more inclusive health outcomes.

coverage.

Status Quo Provides moderate equity, Offers some access to Offers reasonable

Existing but disparities persist. healthcare, but quality but room

Medicare and Medium/High challenges remain for for improvement.

Medicaid the low-earning Medium/High

population.

Medium/High

Alternative 1 Substantially improves Significantly Positively impacts

Comprehensive equity by expanding enhances access for quality by

Expansion of coverage. vulnerable providing more

Medicaid High populations. comprehensive

High care.

High

Alternative 2 Ensures equitable access Achieves universal Strives for optimal

Universal to healthcare for all access to healthcare healthcare quality

Healthcare citizens. for everyone. and outcomes

System High High High