Health Care by Age, Gender, Class & Race
Historically, access to health care for every citizen in the United States has been a challenge. There are, for instance, disparities in availability of health care for people of various income levels, and the care that is available is not necessarily the best. Children and seniors are two of the most vulnerable groups of people in any society. Their health care needs are high, but not all children and seniors have equal access to the same quality of health care. Children of poor, homeless, or immigrant families are particularly vulnerable. Health care for women is also a concern, and many women endure various gender-related conditions without adequate health care.
Keywords Contraceptive Management; Geriatric Medicine; Hepatitis C; Infertility; Post-Traumatic Stress Disorder; Primary Care Services; Traumatic Brain Injury
Health Care by Age, Gender
One of the primary concerns in the United States is the lack of adequate health care for every citizen. In particular, people who are poor, homeless, or are newly arrived tend to be without health care insurance. Additionally, some of the people most deeply affected are women, children, and seniors. The class structure in the United States is very much evident in the health care system. Historically, those with wealth and/or high-paying, secure employment have excellent health care plans and therefore have access to better facilities. This is not the case for people with partial insurance or no insurance at all who in turn have limited access to quality health care, which then leads to poor health and additional barriers to success in life.
The Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA) of 2010—commonly called the Affordable Care Act (ACA) or Obamacare, after its major backer, US president Barack Obama—sought to reform a number of aspects of the US health insurance industry, as well as improve the access to and quality of health care services. Since the passage of ACA, insurers have been required to cover preventive services without a deductible, copayment, or other out-of-pocket expense; extend coverage to children with existing medical conditions; cover young-adult children up to age twenty-six on their parents’ plans; spend most of their premiums on benefits to consumers rather than on administrative costs; and provide justification for rate increases. Starting in 2014, insurers will no longer be allowed to set annual dollar limits on coverage, reject anyone based on preexisting medical conditions, discriminate against women, or restrict or deny coverage to those who participate in clinical trials. ACA also expands Medicare coverage through the state governments (US Department of Health & Human Services, 2013).
At the time of its passage, the Affordable Care Act was the most substantial overhaul of the US healthcare system since the passage of Medicare and Medicaid during the Johnson administration in the mid-1960s. Although it has encountered intense opposition from the general public, medical professionals, and various public officials, and has had numerous problems and glitches in its start-up, the ACA promises to dramatically improve the affordability of and access to health insurance.
Health Care for Children
There is perhaps no issue as salient and distressing as that of the millions of Americans who are uninsured. In 2012, an estimated 48 million Americans were uninsured, 7 million of them were children under eighteen (DeNavas-Walt, Proctor & Smith, 2013). According to DeVoe (2007), "children from lower socioeconomic backgrounds have poorer health outcomes. These health disparities are due, in part, to barriers in accessing medical care and utilizing primary care services" (DeVoe, et al., 2007, p. 511). Libby (2006) further explains that "one specific vulnerable and often low-income population is children and adolescents involved with child welfare. Children in contact with child welfare systems have been shown to be particularly vulnerable to health and mental health problems…" (Libby, 2006, p. 40).
The Children’s Health Insurance Program (CHIP) is a health program that emerged in 1997 from the collapse of the Clinton administration's efforts at health care reform in 1994. CHIP is part of Medicaid and provides health insurance to many children below the age of nineteen. States have a great deal of leeway in deciding how to administer the program. Prior to the Affordable Care Act, very few programs besides CHIP and Medicaid provided health insurance to very poor or uninsured children. Problems arose with these programs, however, from inadequate state funding for CHIP, and children on Medicaid were reported to have to wait longer for appointments than were children with private pay insurance. Physician access for children on Medicaid was also poor (Roy, 2011; Grady, 2011). The Affordable Care Act as it was passed in 2010 proposed to expand Medicaid coverage and benefits and address the issues of substandard health care for children by increasing Medicaid payment rates to health care providers to help ensure access to primary care providers for more low-income children. Children will also no longer be denied coverage for preexisting conditions and will no longer have annual or lifetime caps placed on their health insurance. For very poor or uninsured families, ACA provides tax credits and vouchers to help with quality health insurance coverage (Children’s Defense Fund, 2012). Additionally, ACA allows parents to keep their children on their policy until age twenty-six.
Resources for Mental Health Care and Substance Use Disorder
Primarily due to the stigma associated with mental health disorders and addiction, the United States has for generations suffered from a lack of access to and adequate provision for services for mental health issues and often concurrent substance use disorder, especially for children and adolescents. "Children's mental health needs [have been] underserved, poorly served or completely unmet . . . with untenable waiting lists for services and uneven geographic availability of services and providers. Those children with the most severe, chronic mental illnesses have the fewest options for care” (Jellinek et al., 2005, pp. 31–32). The Affordable Care Act of 2010 extends coverage and accessibility for children and adolescents by requiring all health plans to include mental health and substance use disorder services. In addition, increased funding will be provided for school-based health centers that will provide mental health services in addition to medical care. Medicaid was also marked for improvement in that it would cover chronic conditions that would include mental illness and substance use disorder.
Mental health and substance use disorder insurance coverage has been inadequate for much of the nation. Prior to the implementation of the Affordable Care Act, approximately one third of individuals with private insurance did not have mental health benefits, and close to twenty percent did not have any coverage to treat addiction. An estimated 47.5 million Americans lacked health insurance, and twenty-five percent of those uninsured were estimated to be in need of mental health and/or addiction treatment (Beronio, et al., 2013).
Health Care for Seniors
Medicare is a federal health care program that provides people over sixty-five with medical care. It also provides support for persons with certain disabilities and people of all ages who have end-stage renal disease (kidney failure). Medicare has become far more complicated than it was in its original form. There are four sections to Medicare: A, B, C, and D. Respectively, they cover hospital insurance, medical insurance, advantage plans, and prescription drug coverage. One of the ongoing problems for the Medicare program has been to continue to provide the health insurance required by seniors and persons with disabilities while also containing costs. Like Medicaid, Medicare also has variations in practice among states, which has lead to some confusion over and frustration with the program.
Senior citizens are living longer than ever before. "Two factors—longer life spans and aging baby boomers—will combine to double the population of Americans aged sixty-five and older during the next twenty-five years" (Centers for Disease Control, 2007, p. III). Seniors also tend to be far more independent into their later years...
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