The Uninsured and Special Populations--Healthcare

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UNINSURED AND SPECIAL POPULATTIONS

Introduction

There are 45 million (17%) Americans without health insurance. Uninsured and special populations are experiencing problems mostly linked to unemployment, cost of health care, low income and decreased employer-based coverage. Also, many people are unable to find health insurance because of pre-existing health conditions. For some, citizenship status may also disqualify them for benefits. One example is Personal Responsibility Act of 1996, which prevents legal immigrant population and their U.S.-born children to receive certain benefits. These people have since experienced decreased access to health insurance, among other problems. Uninsured and special populations are more likely to suffer from illnesses at advanced stages, require more acute care and hospitalizations, and have higher mortality rates because they have poor access to health care. There are many stereotypes and myths surrounding the uninsured and special populations. Some of these are that these people are not working, choose not to have insurance, are immigrants and get free or reduced health care services.

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The uninsured are most likely to be:

Eight in ten uninsured come from working families. They are mostly poor Americans who earn less than $25,000/year. 79% of all uninsured are American citizens. 29.6% of the uninsured are without high school diploma as opposed to 8.7% of the uninsured with Bachelor’s degree or higher. They tend to be people ages 18-24 (30.2%) and mostly male (16.8%).

Who are the special populations?

In 1995, it was estimated that some 19% of the insured citizens are underinsured. These people have poor access to health care and higher out-of-pocket expenses. Others who fall in the category of the special populations are children, women, and chronically ill, homeless, mentally ill, racial minorities, medically indigent and elderly.

What Has Been Done?

Starting 1965, the U.S. government began to be actively involved in financing of the U.S. health care system through the creation of the public health plans that include Medicare, Medicaid, PACE, SCHIP, MHSS, VHA, and Indian Health Services (for Native Americans), among others. The federal and state governments share responsibility for the costs of the public insurance (mostly funded through taxes). Also, the government created federal mandates for health care facilities and individual providers to serve the uninsured and special populations. These are called “safety net" providers and include public hospitals, community health centers, private clinics and local health departments. However, the United States still has millions of uninsured citizens.

Most recently (2009), the U.S. government has taken serious steps to ensure that all legal U.S. citizens have health insurance. Among many provisions of the Affordable Care Act (ACA) there will be expansion of Medicaid, government assistance to small business to cover insurance costs (with 25 employees or fewer), and various prohibitions to insurers that in the past have excluded many from health insurance plans. One provision that has caused heated debates is the health insurance mandate. It requires that all citizens must buy health insurance or pay a penalty, and that all employers must offer health insurance benefits. The question that has been most often asked is whether the health insurance mandate is constitutional?

Opponents of Health Insurance Mandate

Majority of those opposing ACA, or what they call “Obamacare,” are members of the Republican Party, with minority of Democrats. They claim that the health insurance mandate is an attack on American people’s liberty. In his article, “At What Cost to Freedom?” Robert Moffit asserts what many who oppose ACA argue: the insurance mandate is unconstitutional because according to the Constitutional Article I, Section 8, the Congress has no authority to force Americans to buy any private good or...
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