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HealthcarePolicyandsocilabarrierstohealthcare.docxRunning Head: SOCIAL BARRIERS TO HEALTHCARE 1
SOCIAL BARRIERS TO HEALTHCARE 8
Social Barriers to Healthcare
Petty Degand
NR:506 Healthcare Policy
Chamberlain College
Social Barriers to Health care
Introduction to Healthcare Policy Concern
Healthcare policy encompasses creating and implementing laws, rules, and regulations for the management of the national healthcare system. This comprises the service provision by medical practitioners in the diagnosis, treatment, and prevention of injuries, physical and mental illness. Also included in the system is a wide array of sectors such as health IT, pharmaceuticals, and insurance (Bailey et al., 2017). In the United States, a third-party payer healthcare system is in place, which reimburses practitioners for the services they rendered to patients. There are private and public insurance systems offered in the states. The general insurance plans; Medicaid and Medicare care for two unprivileged groups. Qualifiers of the former are people with low-income and those with disabilities. Medicare is meant for the elderly aged above sixty-five years and patients with chronic medical conditions such as kidney disorder. Employers have enrolled forty-eight percent of America’s population into private insurance cover. The rest are either paying for the protection on their account or through government-funded programs for sectors such as the military.
Nurses are charged with the advocacy responsibility for policies that aim at shaping the well-being of the disadvantaged and sparse population, who are victims of social barriers to healthcare (Williams, Phillips & Koyama, 2018). The economically and socially disadvantaged in the society are at most affected by policies for the public. They stand the highest chance of gaining when the right policies are enacted; at the same time, uninformed policies expose them to more inadequacy in healthcare access. Nursing practice is rooted in the primary care for the society’s poor and disadvantaged, looking at their emotional, physical, and social needs. It is essential for Nurses to be concerned about social justice, inequalities, and conditions that exist in poverty. The right policies can be categorized as those that are made as investments by the nation to decrease poverty, prevention of diseases, and premature death precursors. Communities can become healthier when implemented policies are evidence-based and seek to address inequalities in access to healthcare resources. Thus, nurses have the prerogative of advocating for societal policies promoting fairness, justice, and health equity while addressing select social determinants of health (SDOH).
Advocacy is indispensable in healthcare policy development, through nurse’s contribution, social barriers to healthcare can be alleviated (Williams, Phillips & Koyama, 2018). Support can mean working for a cause on behalf of another person or speaking for them or in their defense. Advocacy in healthcare is a common practice for advanced practice nurses, perceived as a right and responsibility. Together with other health professionals, communities, and the rest of the public, nurses help to shape the communal, national, and international push to meet health goals. Furthermore, nurses advocate for their profession alongside professional standards of practice. When the legislation makes laws at the state or federal level, patients and neonatal nursing are affected. While some of the affected do not know or gave an insight into policy making, lack of input from nurses result in the development of ineffective policies. The contribution of nurses to the legislative processes requires exercising of their leadership will, authority and knowledge of healthcare concerns.
New health policies intended to improve healthcare provision have not addressed some of the social barriers that inhibit their goals. Social barriers to healthcare could include the complexity of the eligibility standards to healthcare cover, limited primary healthcare, unfamiliarity with healthcare systems, or other gender and culture-related factors (Williams, Phillips & Koyama, 2018). Lack of insurance cover, inadequate cover, and limited finances are some of the leading barriers to the disadvantaged in accessing healthcare. In America, over thirty million individuals remain without health insurance despite the introduction of Medicaid, Medicare, and the Affordable Care Act. The high rates of uninsured individuals can be accounted for in the complicated procedures in acquiring insurance, whereby there are qualification standards for public insurance plans, which do not accept many people who are not capable of acquiring private insurance. Also, the lack of proper information regarding these plans results to individuals signing up for plans that do not adequately cater for their needs or have high deductions that may lead to lapses. Other uninsured populations include immigrants who do not speak English or understand the service delivery systems for healthcare. These immigrants, too, could have a culture that restricts spending on regular medical and healthcare services.
The population percentage of uninsured individuals in the state of Florida effects on the quality of citizen health. The country has a population of more than nineteen million, with nineteen percent of them being uninsured. Citizens of Florida, inclusive of Pembroke Pines, face barriers that deny the value from state and federal funding into the plans affected by healthcare policies. According to a study by Ballotpedia.org (nd), employers are the top sources of insurance funding. However, 41 percent of Florida’s population had their insurance provided by their employer by the year 2013, which was low compared to its neighboring states. The United Health Foundation annual report for 2014 listed Florida as the 32nd state in a list showing the overall health of American countries. The median household income for Florida families is forty-seven thousand dollars, with families paying an average of $16,000 for insurance premiums. Compared to its neighbors, Florida has a higher number of individuals above the age of sixty-five, who are eligible for a public insurance plan. As a result, individuals who are not too poor or disadvantaged to qualify for free cover, and not capable of paying private cover premiums remain uninsured.
The rate of uninsured against the growing healthcare expenditure is complicating the policy development process (Ballotpedia.org, nd). In the past decade, the number of uninsured people has an increasing rate. Alongside it, spending on healthcare has reached record levels. For instance, in the year 2009, the state and federal funding accounted for forty-three percent of the annual sum reaching up to $132.5 billion. The year 2012 saw the state and federal government jointly spending close to eighteen billion on Medicaid, higher than in neighboring states. The above-demonstrated demand for more covers call for expansion of public insurance funding. However, the state and federal government contribution are high; there are lesser disposable funds for consumers resulting in difficulty in policy making for lawmakers. In the year 2013, Florida was one of the states that did not expand their Medicaid cover. This means that the state is missing out on annual federal government funding of up to ninety percent of the Medicaid cost.
The Solution
Expanding Medicaid coverage to include more low-income earners will ensure that the coverage gap reduces and enhances access to healthcare in the state of Florida (Buettgens, 2018). The Affordable Care Act (ACA) approves the expansion of eligibility for people under 65 years old. The eligibility level now stands at 138% of the FPL (Federal Poverty Levels). The overall reduction of uninsured people in the nation will be by approximately 25%, while the federal spending on healthcare will go up by about $35 billion. Currently, Florida, with nineteen other states that have not expanded, is missing federal funding totaling to three hundred billion. Besides Texas, Florida State will enroll more people into Medicaid cover than the rest of the states, counting to more than a hundred thousand. This will mean an increment of thirty-eight percent for people covered by Medicaid below old age.
Expansion of Medicaid in Florida will result in an increase of non-elderly insurance rate by about fifteen percent. Also, despite the increase in state spending, Florida’s economy is prone to grow due to various underlying factors, including saving and reciprocating federal funding (Buettgens, 2018). Comparing with the results from the states that expanded their Medicare cover, savings of more than $2.0 billion are expected from state savings on uncompensated care. The state would also save by enabling more people to enjoy the federal cover, who would otherwise have depended on the state based on pre-ACA eligibility categories for Medicaid. The state would also increase its tax revenue due to the increased economic activities brought upon by more federal spending in Florida. The fourth situation would be the state not spending on other programs for the low-income uninsured people, those which do not count as uncompensated care.
The state of Florida legislation needs to shift their focus on the expected inconveniences and risks that may result from expanding, and instead focus on the expected positive outcome (Buettgens, 2018). Through advocacy, the perception can change and ensure the expansion of Medicaid happens. It has been more than three years since the debate of whether to approve the expansion of Medicaid in the state of Florida. Despite Florida being one of the states with the highest uninsured rates, the Republican lead state legislation has not been keen to expand Medicaid. The legislators are opposing the invitation of the federal government into more of their service provision activities. The state also fears resultant inconveniences suppose the federal funding is reduced or stopped. Nursing practice through evidence-based advocacy can help to advise the legislation process in healthcare matters, especially on issues that address SDOH, and social justice regarding healthcare. The need for change should encourage more nurses into advocacy, especially advanced practitioners with research knowledge.
In the event of the expansion of Medicaid cover in Florida state, a positive outcome would be indicated by declining numbers of the uninsured non-elderly population. Other determining factors include a lower number of cases of uncompensated care, benefits accruing from extra spending on healthcare by the federal source, and net benefits to state budgets (Buettgens, 2018). Research shows that most states that expanded their Medicaid cover according to the ACA have displayed the above characteristics as opposed to those that have not expanded. There is also evidence showing that state savings outweigh the state costs connected to higher caseloads. Finally, most states with expansion plans expect net financial gains even after paying for ten percent of the cost. Florida state legislators accepting federal funding will help bridge the gap of uninsured individuals. According to Change (2015), if Florida accepts to expand Medicaid to cover those earnings not more than sixteen-thousand annually, about a quarter of a million state residents will be able to access health coverage.
The challenges that may face the expansion of Medicaid include succeeding in the legislation process and need to effect changes in the Medicaid program resulting in complexities in implementation (Garfield et al., 2014). As discussed, complications arise when legislation for the healthcare budget takes place due to the competing increase in numbers of uninsured citizens and the rate of Florida State spending on healthcare. However, the solution lies in nursing practice capability to track data in their practice, find evidence-based solutions, and improving access to healthcare using innovative and low-cost methods (Williams et al., 2018). The current Medicaid program might have earned millage in terms of public policy literacy. Changing the plan might result in the need to inform the public again, which is costly and failure to do so will result in more cases of under-insured individuals. Also, the changes might involve programs like work requirement alongside the limits to lifetime benefits. Such waivers if taken by Florida state, will reduce the number of take-ups by Medicaid. The solution to this also lies within the Nursing practice, which can provide a frontier for public policy literacy, and professional insight to state legislation.
An elected official in the best position to lobby for the expansion of Medicaid in the state of Florida is Congresswoman Debbie Wasserman Schultz. She is a current member of Congress elected from Pembroke Pines. My advocacy through her would be possible since she is from the same district as me and would be more obligated to listen and lobby. Barbara M. Sharief, MSN, ARNP, DNP is a nurse first, and also a Broward County Commissioner in my county.
Conclusion
Nurses own experiences from interacting with many patients in different situations. Since it is one of the most trusted professions in the USA, Nurses advocacy will result in better impacts on public policy. Nurses must involve themselves more in support to ensure the well-being of disadvantaged and the poor are catered for. If nurses in the state of Florida can be united in advocating for changes in policy, this being allowing the expansion of Medicaid, then the access to healthcare will improve. This is possible as it will reduce the rate of uninsured people, which is a significant social barrier to healthcare.
References
Bailey, Zinzi D. Kreiger, Nancy. Agenor, Madina. Graves, Jasmine. Linos, Natalia. Basset Mary. (2017). Structural racism and health inequities in the USA: evidence and interventions. The Lancet. Retrieved from https://www.sciencedirect.com/science/article/pii/S014067361730569X
Ballotpedia.org. (nd). Healthcare policy in Florida. Ballotpedia. Statistical journal retrieved from https://ballotpedia.org/Healthcare_policy_in_Florida
Buettgens, Matthew. (2018). The implications of medical expansion in the remaining states: 2018 update. Robert Wood Johnson Foundation. Retrieved from www.urban.org/sites/default/files/publication/98467/the_implications_of_medicaid_expansion_2001838_2.pdf
Garfield, Rachel. Damico, Anthony. Stephens Jessica. Rouhani, Saman. (2014). The coverage gap: uninsured poor adults in states that do not expand medicaid – an update. Retrieved from http://www.nasuad.org/sites/nasuad/files/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-issue-brief.pdf
Williams, Shanita. Phillips, Janice. Koyama, Kirk. (2018). Nurse advocay; adopting a health in all policies approach. The Online Journal of Issues in Nursing. Retreived from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/ TableofContents/Vol-23-2018/No3-Sept-2018/Policy-Advocacy.html
