When it comes to the government and healthcare the government plays a huge role. They are the
highest payer of healthcare and regulate the rules and policy making. The biggest government
healthcare service would be Medicare and Medicaid established in 1965 and now has over 63
million Americans enrolled in 2020 (Jain, 2021). The Affordable Care Act (ACA) of 2010 is a very
important piece of what the government follows that can help with the lack of the current
healthcare system. The ACA allows the federal government to focus on prevention areas like
improving health outcomes and reducing healthcare costs (Straube, 2013)
Even with healthcare systems like Medicare and Medicaid there are still about 28 million people
without some form of health coverage (American Hospital Association, 2022) Not having health
insurance impacts individuals on more than just a medical level, it can also affect then on an
emotional level as well as financial. The costs of an ER visit without health insurance roughly
averages about $2,200 for one visit (Corso, 2021). Whereas having healthcare coverage results in
better health outcomes and a general overall healthy well-being. If a person has access for
preventative care methods this reduces the risk of a potential serious condition being found much
later. The U.S is the only major nation that does not have universal health insurance and spends
more on health insurance then those that do over it. For example, the United Kingdom spends
$2546 on health expenditures per capita while the U.S is at $6102 (Davis, 2007). While the U.S
does not offer universal coverage there are steps that can be made to help reduce the costs and
cover more people. There could be state regulations to help with the cost for those uninsured. For
example, in 2016 Massachusetts had a program requiring employers to provide health benefits to
workers or pay an admittedly modest $295 a year into a fund to help cover (Davis, 2007). The
terms for meeting the requirements for Medicare and Medicaid should also be reevaluated in
order to accommodate more individuals. Reducing the restrictions and income could help assist
with getting some of the uninsured insured.
Reflecting on my thirty-two years of life, I have no hesitation when I say I have lived a very
privileged life and have been blessed with many things. One of these blessings has always been
having had health insurance. I was one of the fortunate ones positively affected by the Affordable
Care Act and was able to stay on my parent’s health insurance until I turned 26. By that time, I had
what I always referred to as my “big girl job” and was fully settled in my organization and luckily,
transitioning from my parent’s health insurance plan to my own was an easy task. This week, as we
have learned more about health insurance coverage and the laws surrounding health care, I cannot
help but feel for those that have or are currently struggling with this challenge. As a nurse it is
heartbreaking, and more specifically as a triage nurse, I hear the struggle people are going through
daily. Whether it is the cost of their medications or their hesitancy in coming in for an
appointment or going to the emergency room due to financial strain, there are many Americans,
both insured and uninsured, affected by our health care system.
Tang et al. (2004) reports access to quality health care for all Americans cannot be provided by the
market alone and as a result the government needs to assist. For this to be a success and to help
ensure all Americans have access to health insurance, there must be collaborations between
federal, state, and local governments as well as the private sector. The government created
programs for the public, such as Medicare and Medicaid, and influences private insurers with
policy regulations. To ensure affordable healthcare, the federal government has policies in place,
such as tax subsidies and regulations. On a state level, there are different functions including
official insurance companies and agents and while it is each State’s responsibility to regulate
insurance, the federal government looks to come to a resolution on medical insurance selected
problems. Straube (2013) mentions having the governments involvement in healthcare has pushed
the use of healthcare organizations putting emphasis on preventative medicine to promote quality
healthcare for all.
In 2010, the Affordable Care Act was adopted with the hopes all Americans would have the ability
to be insured and receive quality healthcare. Bowling et al. (2018) mentions Medicare developed a
shared cost-saving incentive to reward providers through their use of preventative care and
patient outcomes with the hopes of increasing quality care and the movement toward value-based
reimbursement. The Office of the National Coordinator for Health Information Technology (2020)
reported from 2015 to 2018, the value-based pay-for-performance model went up 23 percent.
From this increase and my experience as an ambulatory nurse, I have gathered providers, while
looking to help people, are also motivated by money. If the provider feels they are likely to get
something out of the care they are providing, such as reimbursement, they are more likely to
provide quality health care. But what does this mean for those that are uninsured? The Patient
Advocate Foundation (2019) finds the uninsured population are at risk for poorer health outcomes
because of putting off or declining preventive and routine healthcare. The Office of the National
Coordinator for Health Information Technology (2020) found individuals will avoid receiving
healthcare if they are uninsured and if they do receive healthcare, they are more likely to suffer
financially as a result than their insured counterparts. However, for individuals with health
insurance, receiving proper care continues to be a challenge due to affordability through the costs
of deductibles and co-payments. Providers treating the uninsured and those who are insured but
are unable to make their payment, forces the providers to go uncompensated. With this, access to
healthcare is further limited by placing specific healthcare providers within the insurer’s network. I
have a hard time trusting that insurers having “in-network providers,” is in the best interest of the
patient. Having had my primary care physician retire after being my provider for 28 years, I felt lost
trying to find a new provider. As a nurse and a patient, I understand the bond patients form with
their providers. Patients need to feel comfortable with their provider and a level of trust needs to
be established. Removing patients from their entrusted provider may deter the patient from
receiving the care they need including preventative medicine.
Knowing all of this leads to the million-dollar question, how can we reduce the number of
uninsured people while maximizing quality and access and minimizing costs? When addressing this
issue special attention should be paid to the underserved or disadvantaged communities and
populations, such as those patients in rural areas, health professional shortage areas, or
communities with a high prevalence of negative health outcomes associated with social detriments
of health. Also, in America we deal with the immigration issue as well the returning veteran issue.
These are all key stakeholders in under insurability.
Short of green lighting Universal Healthcare for all creating an innovative all-payer model using
rate setting is a viable option to consider. Crowley et al. (2020) reports prospective hospital rate
setting was once a popular policy option, with as many as 30 states implementing programs by
1980. However, deregulation—attributable to the rise of managed care and political, economic, or
institutional factors—reduced the number of states participating in these types of programs to two
by 1997. However, policymakers are again considering whether all-payer models and global
budgets can limit unsustainable spending growth. e I want to put my point of emphasis here as
political. Profits did not come fast enough, and the patient’s affordability never mattered and
neither did their care. Corporate greed won the day.
The all-encompassing answer to maximizing quality health care while minimizing overall costs can
only be found if we truly are looking for an answer. e Example, in the 1990s the National
Transportation Safety Board put the greatest aviators together to stop planes from crashing. e We
have also seen the greatest medical minds get together and stop medical fatalities in hospitals with
improvements in medical patient recordation. e This needs to happen NOW with health care as we
know it and how we are about to experience it. We will never get a grip around this behemoth
until a) our politicians want an answer and b) we get the right people chasing the answer. Until
then, our world will be full of the haves and the have nots of the medical menagerie.
References
Bowling, B., Newman, D., White, C., Wood, A., Coustasse, A. (2018). Provider reimbursement
following the affordable care act. e e e e e The Health Care Manager, 37(2), 129-135.
https://doi.org/10.1097/HCM.0000000000000205
Crowley, R., Daniel, H, Cooney, T.G., Engel, L.S. (2020). Envisioning a better u.s. health care system
for all: coverage and cost of e e e care. Annals of Internal Medicine, 172(2), 7-32.
https://doi.org/10.7326/M19-2415
Patient Advocate Foundation. (2019). Finding care when uninsured.
https://www.patientadvocate.org/explore-our- e e e e e e e e resources/getting-care-while-
uninsured/finding-care-when-uninsured/
Straube, B. M. (2013). A role for government. American Journal of Preventive Medicine, 44(1), 39-
42. e e e e e e https://doi.org/10.1016/j.amepre.2012.09.009
Tang, N., Eisenberg, J.M., & Meyer, G.S. (2004). The roles of government in improving health care
quality and safety. The Joint Commission Journal on Quality and Safety, 30(1), 47-55.
https://doi.org/10.1016/S1549-3741(04)30006-7
The Office of the National Coordinator for Health Information Technology. (2020). 2020-2025
federal health it strategic plan. https://www.healthit.gov/sites/default/files/page/2020-
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American Hospital Association. (2022). Report: The Importance of Health Coverage | AHA.
Www.aha.org. https://www.aha.org/guidesreports/report-importance-health-coverage
Corso, A. (2021, December 1). How Much an ER Visit Costs Without Insurance | Mira.
Www.talktomira.com. https://www.talktomira.com/post/how-much-does-an-er-visit-cost
Davis, K. (2007). Uninsured in America: problems and possible solutions. BMJ, 334(7589), 346–348.
https://doi.org/10.1136/bmj.39091.493588.be
Jain, S. (2021, September 8). The Government’s Role as the Largest Payer of Healthcare Services is
Growing. Www.trillianthealth.com. https://www.trillianthealth.com/insights/the-compass/the-
governments-role-as-the-largest-payer-of-healthcare-services-is-growing
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