Industrialized nations throughout the world, with the notable exception of the United States, provide their citizens with some form of national health care and national health insurance (Russell, 2018). Although their health care systems differ in several respects, their governments pay all or most of the costs for health care, medicines, and other health needs.

In Denmark, for example, the government provides free medical care and hospitalization for the entire population and pays for some medications and some dental care. In France, the government pays for some of the medical, hospitalization, and medication costs for most people, and all of these expenses for the poor, unemployed, and children under the age of ten. In Great Britain, the National Health Service pays most medical costs for the population, including medical care, hospitalization, prescriptions, dental care, and eyeglasses. In Canada, the National Health Insurance system also pays for most medical costs. Medical debt and bankruptcy due to accidents or disease is a uniquely American problem. The reality is that you can buy trips to countries for a week at a lower price than an ambulance ride, and a two-day hospital stay in the United States is both embarrassing and devastating to the most marginalized communities. People have called Lyft or Uber instead of ambulances to the hospital for medical emergencies.

These national health insurance programs are commonly credited with reducing infant mortality, extending life expectancy, and, more generally, for enabling their citizens to have relatively good health. Notably, the United States ranks 33 out of 36 for infant mortality among countries who belong to the Organisation for Economic Co-operation and Development (OECD). The infant mortality rate in the United States is 5.9 deaths per 1,000 live infant births, compared to the average rate of 3.9 deaths per 1,000 births. Five countries have death rates lower than 2 per 1,000 births. Their populations are generally healthier than Americans, even though health care spending is much higher per capita in the United States than in these other nations. In all these respects, these national health insurance systems offer several advantages over the health care model found in the United States (Reid, 2010).

Access to Health Care Coverage and Insurance

Access to health care is inequitable in the United States, and as human services practitioners it is critical that we view this as a social problem and not a personal failing. When people have less access to health care, or have to choose between medical visits, prescriptions, food, and housing, they are less likely to be able to achieve and maintain good health.

There are many insurance options in America, and they disproportionately benefit some and disadvantage others based on factors like sex, income, geographical location, and ethnicity. In 2017, some of the most common ways people accessed insurance was through private plans—employer-based (56%) and direct purchase (16%)—or through government plans: Medicaid (19.3%), Medicare (17.2%), and military health care (4.8%) (U.S. Census Bureau, 2017). To learn more about how people accessed health insurance coverage and who remained uncovered, watch the seven-minute video provided by the United States Census Bureau in figure 6.3.

https://www.youtube.com/watch?v=0mZPDJhZ5Qc

The Patient Protection and Affordable Care Act (ACA) was created in 2010 to make health care less costly and less discriminatory. In 2016, section 1557 provided new regulations to the ACA, including a way to enforce civil rights protections in health care by making it unlawful for healthcare entities to discriminate against protected populations if they receive any type of federal financial assistance. This included health insurance companies participating in the Health Insurance Marketplace; providers who accept Medicare, Medicaid, and Child Health Insurance Program (CHIP) payments; and any state or local health care agencies, among others. This marked the first time that discriminatory practices on the basis of race, skin color, national origin, age, sex, disability status—and in some cases, sexuality and gender identity—were broadly prohibited in the arena of public and private health care (Rosenbaum, 2016).

Some of the common ways that lower-income families and individuals access insurance in Oregon are through programs like Medicaid and (CHIP), which is referred to as the Oregon Health Plan (OHP) in Oregon. Oregon is one of 39 states that elected to expand Medicaid after the ACA made that possible in 2014. This has resulted in many more Oregonians having access to health care. Figure 6.4 shows eligibility requirements.

Medicaid is a federal and state-funded program that is managed by individual states. It provides government insurance to those who need it. The fact that 39 states have expanded eligibility but 12 have not points out the inequities people face based on geography. This variance in Medicaid eligibility creates great inequity for low-income families based on location. Those in states that have not expanded Medicaid face a much larger coverage gap, meaning that many more families do not have access to healthcare insurance.

Each state has the power to decide who is eligible for Medicaid, and most states focus on low-income individuals and those with disabilities.

• The U.S. government’s website about Medicaid [Website] provides state-by-state report cards on a wide variety of health access and health quality measures.
• For up-to-date information on each state, consult this Kaiser Family Foundation interactive map and narrative [Website].

Those who are age 65 or older can access health care insurance through Medicare, which is federally funded. Medicare covers about half of health care expenses for those enrolled, and many retirees who can afford to do so purchase private insurance or additional coverage from Medicare itself to cover the gap (MedPac, 2020).

The Oregon Health Plan also provides transportation to and from medical appointments, which can include mileage reimbursements, lodging, and meals. This is something that medical providers would need to help clients request and get pre-approved for, but it helps reduce barriers for many people. This benefit is not only for long distances but also for weekly appointments, such as physical therapy or mental health appointments. Clients can be picked up and dropped off at different locations, such as school and home, which helps with consistency.

Licenses and Attributions

“Health and Health Insurance” is adapted from Health and Health Insurance by Elizabeth B. Pearce, Jessica N. Hampton, and Christopher Byers in Contemporary Families 2e and licensed under CC BY 4.0. Adaptations by Elizabeth B. Pierce: Updated; minor editing for clarity; shortened; refocus of content on to human services. Revised by Martha Ochoa-Leyva.

Figure 6.3. “Income, Poverty and Health Insurance – Health Insurance Presentation” by The Census Bureau is in the public domain.

“Case Study: Tahir” is adapted from Financing Quality Healthcare in Social Work & Social Welfare: Modern Practice in a Diverse World by Mick Cullen and Matthew Cullen, and is licensed under CC BY 4.0. Adaptations by Elizabeth B. Pierce: minor editing for clarity. Revised by Martha Ochoa-Leyva.