6.4 Health and Health Insurance
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.
| Family size | Adults (19-64) | Children (0-18) | Pregnant Individuals |
|---|---|---|---|
| 1 | $1482 | $3274 | $2040 |
| 2 | $2004 | $4428 | $2759 |
| 3 | $2526 | $5582 | $3477 |
| 4 | $3048 | $6736 | $4196 |
| 5 | $3570 | $7890 | $4915 |
| 6 | $4092 | $9044 | $5634 |
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.
Case Study: Tahir
Tahir is a 53-year-old Black man who struggles with back problems he has had for many years. Tahir was a seasonal employee and found work when he could, though this did not provide him with any health insurance benefits through his work. So when he was in a car accident at age 44, he had to rely on his car insurance to cover any medical costs.
Though the accident was not his fault, the other driver had no insurance. Tahir’s insurance had to cover the initial hospital bills. Not having a lot of money, he had opted for the least expensive insurance he could get, so his policy did not cover follow-up visits to the doctor. Because he earned too much to receive Medicaid benefits, Tahir would have to pay out of pocket for any additional services he needed, which he could not afford. He was slowly recovering and still able to work, though he was often in pain.
One day while on the job, he had an accident that caused further injury to his back. Since it was determined to be a preexisting condition, workers’ compensation at his job refused to cover any care. Tahir could no longer perform his duties and was fired. He has since spent the last ten years taking odd jobs that did not last very long or for which he could not continue working at the level needed.
When his back pain became unbearable, Tahir’s only option was to go to the emergency room. As he struggled with chronic pain, he also became depressed. Since he was without insurance, the hospital reduced and stabilized his pain but did not provide any treatment beyond that. Tahir’s back issues are now only temporarily relieved, and he knows he will end up back in the hospital when things become intolerable again.
Questions
- What services would help Tahir stabilize his health and work life?
- How would universal health care help Tahir?
- What other problems is Tahir at risk for if he doesn’t have adequate health care?
- How do you think Tahir’s identities impacted his access to systems of support?
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.
a professional field focused on helping people solve their problems.
any condition or behavior that has negative consequences for large numbers of people and that is generally recognized as a condition or behavior that needs to be addressed. Multiple factors contribute to the complexity of social problems. Typically the solution to the problem needs to be systemic in nature; in other words, it cannot be solved by any one individual.
a biological descriptor involving chromosomes, primary, and secondary reproductive organs.
social identity based on the culture of origin, ancestry, or affiliation with a cultural group
the joint federal and state-sponsored program aimed at providing medical care to lower income individuals.
the federal health care program in the United States provided to adults 65 and older as well as disabled citizens.
socially created and poorly defined categorization of people into groups on basis of real or perceived physical characteristics that has been used to oppress some groups
refers to the geographical location that a person was born and spent (at least) their early years in
A physical, cognitive or emotional condition that limits or prevents a person from performing tasks of daily living, carrying out work or household responsibilities, or engaging in leisure and social activities.
a person’s emotional, romantic, erotic, physical, and spiritual attractions toward another in relation to their own sex or gender.Sexuality exists on a continuum or multiple continuums
the socially constructed perceptions of what it means to be male, female or nonbinary in the way you present to society