Healthcare effects of North Carolina's Medicaid non-expansion decision

Healthcare effect for not expanding Medicaid under the ACA
Introduction
Research that is focused on the effect of expansion of Medicaid based on the Affordable Care Act, also referred to as ACA can enlighten people on the impact of ACA on care access, coverage, healthcare outcomes, utilization, economic outcomes such as state budgets and the labor/employment market. Findings from such research can also sensitize the current debates on the expansion of Medicaid. North Carolina, like many other states has been musing over the issue of expanding eligibility of Medicaid and whether to modify such an expansion by seeking a waiver under section 1115. Currently, Medicaid does not cover parents with incomes that are greater than 50% of the poverty level of the federal state which is approximately R$ 10 000 for a family of three members. Similarly, it does not cover childless adults with no disability or the advanced in age (Ku et al., 2014). It has been noted that Medicaid eligibility in Northern Carolina is among the lowest compared to other states. It is in the last quartile. It has been reported that 18.1% of the residents of North Carolina below 65 are not insured. This is above the national average. Since NC declined to adopt expansion of Medicaid programs in 2014, the state is exposed to several negative effects as a direct result of their decision. In 2014, NC lost 2.7 billion dollars in federal funding. It also lost another 3.3 billion dollars in 2015. This analysis is in relation to the total amount that the state would have gained if it had implemented the program when it was first made possible in 2014. Consequently, it has been noted that the state lost a chance to create over 23 000 jobs in 2014. It further lost another opportunity to create 29 000 jobs in 2015. Some direct stats from locations within the state show that Wake County created 25 000 fewer jobs in 2014. Generally, the state’s economy retarded by a margin of $ 1.7 billion in 2014 compared to if it had chosen to expand the Medicaid program. The state is said to have lost up $100 million in potential tax based revenue. Several counties also lost a lot of ground. For instance, Mackleburg County lost over $ 2 million in revenue because they did not expand Medicaid. The decision by NC not to implement the Medicaid program means that currently, there are over 95 000 people, most of whom are children, who quality for insurance but are not insured (Buettgens & Kenney, 2016). In addition, out of the North Carolina residents with private insurance policy, 200 000 of them earn above the federal level of poverty. The same population could have been covered by expanded Medicaid. Such a move would have helped to stabilize premiums in the market place by removing low income persons that are sicker.
By September 2016, up to 19 states had not expanded Medicaid programs. Eligibility for Medicaid in the states that failed to implement the expansion is limited. The limit for median income for parents in 2016 is at 44% of the level of poverty. This translates to a total annual income of $8 870 for a family of three members. Generally, in almost all the states that are not expanding Medicaid, adults without children are not eligible (Garfield et al., 2014). Owing to the fact that the ACA envisaged people with low income and receiving Medicaid coverage, it does not extend financial support for individuals below the poverty level in other coverage alternatives. Consequently, people in the states without expansion fall in what is referred to as the coverage gap, i.e. they have incomes that exceed the poverty levels but still fall below the lower limit for Marketplace tax credit premiums.
Consequences of not expanding Medicaid under the ACA
In total, there are about 7 million residents that were left uninsured in states that declined to expand Medicaid. It has also been inferred that the number of residents in the states that implemented the expansion dropped by 38% starting September 2013, the states that did not expand only experienced a 9% reduction. If the states expand Medicaid, the states would obtain over four hundred billion from federal funds in a 10-year span. Such a move would translate to an estimated 172 400 job placements in 2015, in the reports by the Council of Economic Advisors. Hospitals in the states would gain $ 168 billion in fresh revenue. It would in turn offset the cuts by ACA to Medicaid and reimbursement by Medicaid (Dorn, McGrath & Holahan, 2014). Every state level analysis we examined points to the fact that expansion aids state budgets. It has been observed to generate state revenue exceeding Medicaid costs and increases savings. It has been observed that the past history together with the current structure of Medicaid demonstrates that when leaders at federal level resort to reduction of deficit, they will surely find other options to reduce Medicaid without necessarily lowering the federal share of spending on Medicaid below the statutory level requirement of ACA. Officials in nonexpanding states face the challenge of ripping the practical benefits of expansion for the residents without violating the central principles of the lawmakers. Consequently, states have developed innovative expansion proposals that incorporate personal responsibility, privatization, and benefits fashioned in commercial style (Dorn et al., 2014). The federal authorities that receive such proposals also face the challenge of incorporating the philosophical commitments by the state leaders and still avoid setting bad precedents that would endanger what is widely perceived as the core features of Medicaid. The prospect of access to medical care by low income Americans depends on whether the leaders can work seamlessly together.
Restricted healthcare access
Health insurance is a major determiner on whether and when they access the needed medical care and the ultimate wellbeing in terms of health. Adults that are not insured are more likely to postpone medical attention to their health issues that people already covered by healthcare policy. The results of such tendencies are far reaching especially when chronic diseases and preventable conditions remain undetected for long. In states such as North Carolina, eligibility to Medicaid and access to healthcare by adults is likely to remain limited. In North Carolina, as at January 2014, eligibility to Medicaid for adults without disability is restricted to only parents with income that fall 43% below the poverty level or approximately $10 100 per year for a family with four members. Childless adults and those without dependants remain ineligible, irrespective of the level of income. Eligibility was expanded to higher levels by all states for children compared to adults via Children’s Health Insurance Program (CHIP) and Medicaid. In NC, children with family incomes of up to 216% above poverty level, i.e. $ 50 000 for a family of four members, are eligible for support from CHIP or Medicaid (Swan & Foley, 2016; Haeder & Weimer, 2015).
Just like it was with AC, immigrants that are undocumented are still ineligible for support from Medicaid. Those who have been documented in the recent past still face a raft of eligibility restrictions. Although NC failed to expand eligibility to Medicaid, some of the uninsured individuals at the present moment could have been covered by Medicaid when the expansion was launched in 2014. Higher eligibility levels are reflected for children, compared to adults. 77% of uninsured residents of NC that are eligible for support by Medicaid are children. They are eligible but not covered yet (Sommers et al., 2015; Blumenthal & Collins, 2014).
There is a small segment of the uninsured residents constituting about 2% are eligible for Medicaid support in North Carolina via eligibility channels in place. It has also been observed some eligible individuals are not enrolled because of lack of knowledge regarding their eligibility and known historic barriers to enrolment. In the course of the implementation of the ACA coverage options, it is likely that an expanded effort in outreach and improved processes for enrolment will result in more enrolment that captures those eligible to Medicaid coverage. North Carolina residents are faced with ever increasing barriers to healthcare insurance coverage. Although there are many healthcare access barriers, lack of insurance is the main one. Uninsured individuals in North Carolina are four times more likely to point out that they failed to seek healthcare services because of the prohibitive costs. In terms of percentages, it stands at 47% versus 10%. Some report that they did not seek the conventional healthcare services. Again, the percentages reflect a (59% versus 14%) (Lichstein et al., 2009; Sommers et al., 2015). There are over 319 000 which constitutes 20% of those uninsured in the state would have been eligible for Medicaid support if their states would have ratified the expansion program. All these adults are placed below the poverty; they earn extremely limited incomes. They are most likely to remain uninsured because they have no access to an affordable insurance via ACA.
There are two more groups of uninsured individuals in North Carolina that fall outside health coverage financial help under ACA. The first group includes people, who earn an income that is above the placed limit for subsidies for premium tax or those who have an affordable cover offer from their employer. Some among the lot can purchase affordable but unsubsidized cover in the marketplace. The second group includes undocumented and uninsured immigrant individuals. It should be noted that 16% of North Carolinians that are not elderly are not eligible for help under ACA and are prevented from buying coverage via the Marketplace (Glied, Ma & Borja, 2017). Although the above group will still have needs for health insurance, they will remain not covered by insurance policy.
NCs decision not to expand Medicaid made it lose the chance to provide help to many individuals who are uninsured. A lot of people that are eligible for coverage under an expanded program remain uninsured. In addition, the effect of ACA will be determined by the rate at which uninsured individuals decide to take up such coverage Efforts to enroll uninsured individuals and outreach programs will also play a significant role in the way the uninsured are affected by the law. Although ACA contains a requirement that most people should be covered, some people are exempt while others remain an uninsured lot. No deadline has been put in place for the implementation of Medicaid by the state. Open enrolment goes on through March in 2014 (Glied et al., 2017). Paying attention to the individuals eligible for coverage as the process of implementing ACA continues can help to influence decisions for future coverage in the state of North Carolina.
Economic cost to hospitals
Increased private health care insurance coverage combined with Medicaid is expected generate revenue from hospitals that will offset $22 billion Medicaid cuts by ACA to disproportionate share of payments to hospitals, a corresponding $34 billion in disproportionate cuts by Medicaid and $260 billion in fees for service cuts implemented by Medicaid in the season 2013 to 2022(Dorn et al., 2014). Comparatively, in states that are not expanding the program, healthcare facilities will foot the bill for all funding mechanisms by ACA. They will, nonetheless still receive a part of the increased revenue earnings for those who are newly insured which was part of the original plan of ACA prior to the decision by the supreme court making expansion of Medicaid an option for states to choose. The states that remain as they were before the program was launched are projected to make their hospitals to lose out on Medicaid revenue of up to $15.9 billion in revenue for Medicaid in the period running through 2016. The total revenue forgone from 2013 to 2022 is projected to hit $167.8 billion (Dorn et al., 2014). These figures would have increased payments by Medicaid by 32.3% and 30.7 respectively for the states’ hospitals. Expansion of Medicaid increased costs in hospitals by enhancing utilization. Furthermore, the expansion slightly reduced the private insurance revenue for hospitals through raising the lower caps for financial eligibility for subsidies from the Marketplace from the previous 100 to 138% FPL. That notwithstanding, the two factors are clearly outweighed by higher Medicaid revenue that is generated as a result of the expansion.
It is clear that expanding Medicaid would help lend significant financial stimulus to North Carolina. This would happen courtesy of the jobs that would be created, reduced costs at state level among others. The state has already lost out on billions it would have benefited if it had expanded Medicaid. It has also lost out on a significant number of jobs it would have created. There are still many gains it can make if it expands the program now. The researchers have summed up the total revenue lost in federal funds as a result of North Carolina declining to expand Medicaid to stand at $6.02 billion (Ku et al., 2014). It has also been projected that the state will lose another $21 billion from 2016 to 2020 if it remains adamant about Medicaid expansion. It is worth noting that both state and local authorities have lost out $228 billion in revenue. Further, the counties would have made an additional $40 million (Ku et al., 2014). If the state does not expand Medicare, the total tax revenue lost out will stand at $862 million. The reduction on county tax revenue is projected to stand at $161 million. Many independent experts have estimated that if North Carolina had expanded Medicaid in 2016, the total number of jobs it would have generated is between 20 000 to 40 000 by 2020. A report by Cone indicated that nearly 30 000 jobs have been lost in the period between 2014 and 2015. If the state still refuses to expand the program, up to 40 000 jobs will have been forfeited by the 2020 mark (Conover, 2017; Ku et al., 2014). It has been pointed out that nearly half of the jobs would be in healthcare. The remainder would be in such fields as retail, construction, there service industry and in government. All the hundred counties would feel the employment effect.
Expanding Medicaid would also lower the cost care that is uncompensated for hospitals. In practice, state owned hospitals such as the University of Carolina Hospital would have medical bills settled for thousands of patients that would have never raised the amounts incurred in the course of the healthcare services extended to them. The experts point out further that up to one third of the uncompensated medical costs in the state would have been averted if Medicaid would have been expanded. The total savings made from these payments are estimated to be about $250 million between the years 2016 and 2020(Glied et al., 2017; Ku et al., 2014). Further, the state would have saved another $934 million in averted costs in the programs of mental health covered by Medicaid. Indeed, hospitals in rural locations have complained for a long time that they were negatively affected by the failure to expand Medicaid. The move, they say, undermines the ability of the hospitals to serve the public better. The research corroborates these concerns (Glied et al., 2017). Research by the University of North Carolina Chapel Hill showed that hospitals noted a better chance to generate profits if they were within a state that expanded the Medicaid program. Indeed, hospitals that were under stated that expanded the program generated more revenue compared to those that were in states that declined to expand the program. City hospitals did not show similar improvement though. Generally, it can be concluded that hospitals were better of under the expanded Medicaid programs. Further, it is also worth noting that rural hospitals gained much more from the expansion.
Disease prevalence by those with no insurance
ACA of 2010 is meant to provide healthcare insurance coverage to those who were previously uninsured in America. Medicaid coverage will be granted to adult Americans with an income below 138% of the federal poverty level (Brown & McBride, 2015). Those with incomes that exceed the set poverty level margins can access insurance policy plans through private insurance organizations in the marketplace. Premiums for the marketplaces are subsidized for individuals with household incomes ranging between 100% and 399% of the federal poverty level. It has been estimated that up to 60% of people that are uninsured will gain health insurance either of the two methods by 2019 Figures show that by 2014; ACA had seen a decline of 9 million in the number of uninsured individuals. There was no separate data for individuals with diabetes.
Previous studies show that individuals who are uninsured face notable barriers to getting healthcare and are faced with more costs for healthcare out of their pockets compared to individuals insured individuals (CDC, 2015). Additionally, uninsured people often experience health issues for extended periods as a result of lack of access to medical assistance. While much research has been concentrated on the uninsured population in general, few studies have been done on the diabetic population. There was a study that also focused diabetes and Medicaid, even though older data was used in the study. People with higher incomes and also affected by ACA were also excluded. Owing to the fact that healthcare reform, being a major social public policy in decades is in the process of implementation, there are few studies that have focused on the US population with diabetes that remains uninsured and made observations on how their health coverage is shifting under the ACA implementation as from 2014 and yonder. The effects of failure to expand Medicaid in North Carolina mean that the poor people will remain without medial cover. In the end, it is expected that the disease prevalence will remain the same in the state.
Stroke, cancer, heart disease and chronic lung disease are the main death causers in NC. 60% of all deaths in the state are caused by chronic diseases. The past decade has seen dramatic increases in the number of diabetic cases. It is has been shown that these conditions exacerbate several other health issues. 30% of adult North Carolinians were obese while another 35% were already overweight (CDC, 2015). Health factors for overweight and obesity include staying physically inactive and consumption of foods that are unhealthy.
The state of North Carolina ranks among the ten worst ones in infant mortality. Major racial disparities prevail in the state. It has also been pointed out that 17% of college students in the state experience chronic health problems. About 11% of children from birth to 18 years do not have insurance cover. Mental health issues experienced in North Carolina are hard to document owing to lack of sufficient data. 33% of adults in North Carolina reported that they experienced poor mental health on one or more days over the past month, according to Behavioral Risk Factor Surveillance Survey.
Healthcare literacy and its effects on the cost of healthcare
The issue of poor health literacy did not feature in the legislation targeted at healthcare, passed in 2010. However, some analysts point out that the law is in vain if awareness concerns are not dealt with. Over 87 million adult Americans constituting 36% are regarded illiterate, functionally (Somers & Mahadevan, 2010). While ACA makes its move to include more (32 million lower income earners) Americans in its health insurance package, there should be a concerted effort to create awareness, there agencies charged with implementing the law should seek ways of promoting health literacy and incorporate such strategies in the recruitment drives. In this paper, health literacy is described as the extent to which individuals acquire, process and interpret basic health services and information necessary to for making the right health related decisions (Somers & Mahadevan, 2010).
Notably and by good luck, a number of ACA provisions take note, directly, of the need to promote health literacy and others imply the same indirectly. The provisions in the law point out the need to communicate healthcare information and health in a clear fashion remain focused on the patient and create health homes for patients. The need to assure patients of equity and to provide high quality care is also addressed (Vernon et al., 2007). It has also been observed that individuals with low literacy levels are disadvantaged when it comes to the probability to access the ACA. This situation comes to them with an even worse ramification that those who pay and deliver care will incur direct and higher cost. It is worth noting that the literacy rate of low income earners is disproportionately high among low income earners who are eligible for Medicaid support in America.
The data available at national level points out that only 12 % of American adults have sufficient literacy on health issues. Although low health literacy is common among all low-income groups, it does not affect these groups in the same proportion. Non-white groups, those who are aged, lower socio-economic status and education groups, those with mental and physical disability. It also affects those with low English proficiency and those who are English speakers but are not native (Kindig, Panzer & Nielsen-Bohlman, 2004). Poor health literacy is linked to reduced utilization of preventive healthcare services, higher mortality and chronic conditions. It is a situation that leads to misdiagnosis due to poor communication between healthcare givers and the patient, poor guidance of patients and poor compliance. Other effects of healthcare service illiteracy include unnecessary visits to the emergency room, hospital readmissions, extended stay in hospitals, fragmented healthcare access and poor response to emergencies relating to public health. It has been estimated that low health literacy has cost the US economy a whopping $ 106 billion to $ 236 billion every year (Vernon et al., 2007; Somers & Mahadevan, 2010).
Although ACA was not meant to be a landmark legislation piece on health literacy, it has inherent structures that make it easier to incorporate cultural competencies and highlighting disparities and literacy concerns. It encourages innovation investments by state agencies, regulators, providers payers advocacy groups among others in order enhance care in a range of ways including high quality care that is centered on the patient (Somers & Mahadevan, 2010) Health literacy promoters will not be equipped readily with resources, by legislation or regulation, to carry out the awareness. Therefore, they have to continue to innovate and identify opportunities for investment for private and public healthcare players in the healthcare system.
ACA creates opportunities for emphasizing the essence of health literacy in the key areas of healthcare including:
1. Expansion of coverage, expanding universal coverage for 16 million citizens of the US up to 133% of FPL and insurance alternatives that are subsidized will only succeed if the new eligible individuals understand the dynamics of the expansion and seamlessly move through the enrolment process.
2. Equity: movement towards universal care and creating a level playing ground for all the low-income populations should go a long way in alleviating the critical disparities in the US. The success of the program will in part be determined by how much attention is given to the issue of health literacy, language and healthcare delivery (Somers & Mahadevan, 2010; Paasche?Orlow et al., 2006).
3. Workforce: the training provisions by ACA for providers relating to disparities, competency and focus on patients all provide opportunities for drawing more attention to issues relating to health literacy.
4. Information on healthcare: varied styles of information presentation ranging from patient information at numeracy and reading levels must be provided for easy access by millions of American citizens with literacy skills (Paasche?Orlow et al., 2006)
5. Wellness and Public health: the presentation of information for patient consumers must be made with literacy issues in mind.
6. Improvement of quality: the emphasis by ACA to develop testing and spreading the best procedures for quality improvement and cost reduction provides many avenues for arguing for investment in health literacy.
Recommendations for universal healthcare coverage without political or commercial interference
The healthcare system in the US has a myriad of private and public programs, services, information and institutions pose a hurdle to individuals seeking to access quality healthcare that is also affordable. Understanding the nuances of prescription, insurance, guidance on therapies, disease management and similar details is a complex and can be daunting for consumers with limited literacy in reading and numeracy (Somers & Mahadevan, 2010). Individuals looking to successfully take part in the healthcare system need an array of skills.
The financing of healthcare in the US is usually a combination of players including doctors, hospitals, insurance companies, pharmaceuticals’, Medicaid and a range of other healthcare players. In order to deal with this, effectively, it has been suggested that the universal healthcare system would counter his situation with a strategy to cut out all the players mentioned and giving freedom to access cover from your job. It is apparent that it is middlemen such as private insurance companies that lose the most. To the disappointment of most of the wealthy households, that have frustrated the system, their taxes would also increase the most (Voorhoeve et al., 2016; Somers & Mahadevan, 2010). On the other hand, it is the wealthy middleclass that would ordinarily not qualify for Medicaid that would benefit the most. It is either the government or the states that would negotiate on matters prices, setting plans and dealing with paperwork.
If the system is implemented in the right way, it is only a centralized structure of payment that would create a system of healthcare that is organized in a genuine way around health issues. It may not be believable that the system in the US is disorganized. However, such development s is a matter of common knowledge to those who have been following developments in the healthcare system or sought help in a time of need (Brooks, 2017a; Brooks, 2017b). it is evident how the healthcare system in the US has consistently produced expensive drugs and treatments that few people can access with no insurance of high quality. It is likely that a single payer model will alter the state of affairs. It may do it my giving incentives to bundled payments and other similar new systems of payment. The models contrast with fee for service schemes by making sure that they do not attach the providers’ compensations to the expense of care frequency. (Voorhoeve et al., 2016). The fixed dollar amount compensation for a given care type such as knee replacement provided over a specified time frame would lead to better care efficiency by ensuring that providers only compete based on price and quality. If compensation was linked to the assigned patients, it would open a possibility to increased preventive focus. Time and money would also be saved in the process.
Although there is room for the actualization of such innovative payment systems, a system focused on single payer creates an avenue for a wider scale adoption of fresh approaches with potential to transform health care provision in the US (Brooks, 2017b). A health system that is designed to stop diseases before they become real, as opposed to treatment before the disease worsens, it is possible to direct health savings to other related fields. We may begin to see investments in areas other than healthcare. These may be focused on environmental, social and economic factors that may be contributing to the occurrence of disease across society. All residents would be enrolled in some kind of health insurance scheme such as NHI. The stretch of coverage would span all the important medical care aspects such as long-term illnesses, dental services, mental health and drugs for prescription. A national board of experts and the community would be charged with issues related to coverage decision making. Ineffective or unnecessary interventions would not be included in the coverage. There would be np billing for patients under the NHI government program. Instead, all costs would be footed by the NHI program (Voorhoeve et al., 2016; Brooks, 2017b). No private insurance would be allowed to cover services already covered by NHI program. Hospitals would, therefore receive a lump sum cover package for all opera rational costs per month. Hospitals will be forced to stick to their global budget even as they provide all the services expected. Such a global budget would exclude all capital expenditures including expansion of facility costs and the cost for new equipment (Savedoff et al., 2012; Gulliford & Morgan, 2013). The decision of approving global budgets would be informed by the needs of the community. This would ensure even spread of technology.
Universal health care would be a responsibility of three levels of government. The federal, state and territory/local would be expected to lead on this front. The federal government would support states but in an indirect way. It would subsidize primary providers by availing funds for state programs. By subsidizing health providers through making them to access to Medicare Benefits Scheme (MBS) and the Pharmaceutical benefits scheme, including availing funds for services of the state (Levesque, Harris & Russell, 2013). Its sole role would be to provide services directly. The state would be mainly responsible for the provision of services in public hospitals, public dental care, ambulance service, mental health care, and community health care service (Voorhoeve et al., 2016). They would organize funding on their own part from and in addition to the one extended by the federal government. The local authorities have an important role to play in the provision of community health services and programs that are focused on prevention including food standard regulation and immunization. The budget for health would take care of constructing health facilities and purchasing high end equipment. The health planning boards in the various regions would be in charge of allocating the funds to the capital funds. The boards would also supervise the major projects financed by private donors when there is an element of an increase in operational costs that are publicly supported (Voorhoeve et al., 2016). Investor owned hospitals, HMOs, clinics and nursing homes would be compensated for relinquishing their clinical facilities and important equipment. They would not be compensated /reimbursed for the business opportunities lost or administrative costs not utilized by the system. Operating costs are driven by capital spending and signals the geographic resources distribution (Voorhoeve et al., 2016; Shi & Singh, 2014). Capital funds must be directed to efficient projects serving areas that need them the most. When capital and operating costs are combined as is the case currently, developed hospitals have a chance to expand and embrace modern service provision strategies, while the poor ones do not expand ; irrespective of their quality or need. A national health Insurance Scheme would substitute the mechanisms of capital allocation that are implicit and replace them with those that are explicit.
All necessary prescription drugs would be paid for by the health care system. This would be done using a nationally formulated approach. Such a formulary would be managed and constantly updated by an expert panel. Drug and equipment services from providers would be negotiated by the program based on costs. In the cases where there are medically equivalent drugs are available at a lower cost, the government would point them out and encourage their use White, 2015; Pettigrew & Mathauer, 2016). The Universal health care system would be billed by outpatient suppliers using the wholesale price negotiated. They would also bill for dispensing fee for items in the formulary prescribed by a practitioner that is licensed. The National Health Insurance is bound to address two pertinent issues: provision of full health coverage that comes with drug cost coverage for all American citizens. As a purchaser with significant influence, the system would significantly influence pharmaceutical outlets to lower their prices.
A single payer system would solve the issue of wastage in administration and billing. It has been observed that independent medical outlets and hospitals often employ more staff for billing than they do for doctors. Furthermore, patients and their kith and kin often spend significant amounts of time in back and forth arguments with insurance providers (Pettigrew & Mathauer, 2016). Pharmaceutical companies spend huge amounts of money advertising their products. A single system would help to reduce administrative costs significantly. Thus, our money would be spent on disease prevention and healthcare, as opposed to debt collection and paper publishing.
A single payer system provides hope for creating employment because it will offset he weight that businesses feel because of the health expenses of employees. A lot of people in America retain their jobs only because of their decent health cover provided by their employers. If they have a worry-free health environment, they would become more creative and adventurous to explore more productive opportunities that they wish for (Pettigrew &Mathauer, 2016; Shi & Singh, 2014). Lifting the employee health care burden expenses will empower them to invest in their business growth.
A National Health Insurance Program would eliminate the financial threat of treatment. It would also expand the scope of choice for physicians and health outlets. Although taxes would rise, they would be offset (save for the extremely wealthy) by eliminating insurance premiums and costs out of pocket. NHI would also establish a right to healthcare access (Saluja et al., 2014). Decisions in clinical circles would be informed by compassion and science and not the insurance status of the patient or the bureaucracy thereof. Physicians would be offered by NHI a choice of payment channels and settings for their practice. Paperwork reduction would also benefit nurses and other healthcare staff. The clinical milieu would also be more humane (Saluja et al., 2014; Pettigrew &Mathauer, 2016). The entrepreneurial aspects of medical practice would be curtailed by the National Health Insurance. There would be insurance for all patients and it would provide a uniform schedule for the same. The physicians who dedicate more time and skill to their practice would inevitable earn more. The billing process would be made simple. Thousands of dollars in office expenses would, thus, be saved annually.
Refer to global healthcare comparisons that have better outcomes in industrialized nations, analyze savings possibility from green technology, preventing premature hospital re-admissions, and public education for healthcare awareness.
Green Technology
Denmark’s healthcare system is ranked number one on the planet. It has a universal healthcare system that is funded by taxes and implemented by local municipalities. Similar models are used by other Scandinavian countries with single payer networks (Drummond et al., 2015). A climate report provided by a government climate commission showed how Denmark can pursue alternative energy solutions away from fossil fuels. The report demonstrated that although it would cost Denmark more to invest in green energy solutions, the difference with the cost of running the current energy channels is marginal. A multi disciplinary research outfit named Centre for Energy, Environment and Health has developed a new model that incorporates all healthcare costs in the total cost of the various energy systems the computations of the research centre show that adopting the revolutionary plan which would involve using energy from wind turbines, geothermal sources all the way to 2030 would be the most balanced energy system shift considering the total expenditure compared with sticking with the current dependence on fossil fuels(Drummond et al., 2015; Viuf, 2012). The commission points out that shifting to renewable energy sources will cost Denmark between 270 and 670 million Euros by 2030.

Preventing premature hospital re-admissions
The provision of some kind of universal healthcare for citizens has led to numerous iterations around the globe. Australia, for example, provides services that are mostly given by a mix of private practitioners and the hospitals and clinics run by the government. They are funded by both government and private agencies. A portion is also paid by the patient (Kripalani et al., 2014). It has also been observed that reducing hospital readmissions to 40% is one of the best interventions. They are designed to make the patient focus on the recovery, healing or wellbeing. The interventions were also found to be cost effective. The most effective approaches have been noted to be multifaceted and those that understand the context. They include personal visits to the homes of patients after they have been discharged. The visits inform decisions on the level, quality and type of support that is appropriate for the patient.
It is an important springboard for monitoring and intervention. Both of these opportunities are provided by telehealth monitoring strategies. However, the strategy has not been incorporated into the current interventions. Studies earlier on showed the likely gains of telemonitoring for the management of disease. An extensive trial indicated zero readmissions (Kripalani et al., 2014). A combination of technologies must be examined in the context of broader multifaceted interventions. As the number of care transition associated IT products come rolling in, more work will be required to make clear that the products are the most clinically effective and cost effective for particular populations.
Public education for healthcare awareness
Germany has the oldest universal social health insurance system believed to date back to insurance law of the Otto Von Bismarck of 1883. Just like nations with single payer policies the German people have access to a system that is decentralized. Independent, and non-profit hospitals provide a large portion of care for inpatients (Sharma, 2016; Kaffes et al., 2016). Awareness in healthcare issues is attained through promoting health through influencing lifestyles, better healthcare services among other strategies. All these are not restricted to the physical surroundings. They include the socio economic and cultural circumstances that influence people’s health. The health sector incorporated a number of components which included health education as a central element. Some schools of thought believe that promotion of health comes with three components that are overlapping, i.e. health protection, prevention and health education (Sharma, 2016). The areas are potentially significant. Health education incorporates a raft of efforts to enhance better preventive healthcare and encourage participation in preventive strategies. On its part, health protection deals with policies and rules which are by nature, preventive. Fluoridation of water supply points for purposes of forestalling dental caries is an example of health protection actions. Health education that focused on health protection is meant promote health protection interventions among policy makers and the public. The three elements combined stir a social environment that is enabling to the success of measures meant to enhance preventive health protection. A typical example is legislation on motor vehicle seat belts.


References
Blumenthal, D., & Collins, S. R. (2014). Health care coverage under the Affordable Care Act—a progress report.
Brooks, A. C. (2017a). How Did the Great Recession Affect Charitable Giving? Public Finance Review, 1091142117691604.
Brooks, A. C. (2017b). The Dignity Deficit: Reclaiming Americans' Sense of Purpose. Foreign Aff., 96, 106.
Brown, D. S., & McBride, T. D. (2015). Peer Reviewed: Impact of the Affordable Care Act on Access to Care for US Adults With Diabetes, 2011–2012. Preventing chronic disease, 12.
Buettgens, M., & Kenney, G. M. (2016). What If More States Expanded Medicaid in 2017? Changes in Eligibility, Enrollment, and the Uninsured. Urban Institute.
Centers for Disease Control and Prevention (CDC), (2015), BRFSS Prevalence & Trends Data. Retrieved from https://www.cdc.gov/brfss/brfssprevalence/ on Jul 07, 2017
Conover, C. J. (2017). The case against Medicaid expansion in North Carolina. North Carolina medical journal, 78(1), 48-50.
Dorn, S., McGrath, M., & Holahan, J. (2014). What Is the Result of States Not Expanding Medicaid? Washington, DC, Urban Institute.
Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., & Torrance, G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford university press.
Garfield, R., Damico, A., Stephens, J., & Rouhani, S. (2014). The coverage gap: uninsured poor adults in states that do not expand Medicaid–an update. Kaiser Family Foundation.
Glied, S., Ma, S., & Borja, A. A. (2017). Effect of the Affordable Care Act on Health Care Access. Issue brief (Commonwealth Fund), 13, 1.
Gulliford, M., & Morgan, M. (Eds.). (2013). Access to health care. Routledge.
Haeder, S. F., & Weimer, D. L. (2015). You can't make me do it, but I could be persuaded: a federalism perspective on the Affordable Care Act. Journal of Health Politics, Policy and Law, 40(2), 281-323.
Kaffes, I., Moser, F., Pham, M., Oetjen, A., & Fehling, M. (2016). Global health education in Germany: an analysis of current capacity, needs and barriers. BMC medical education, 16(1), 304.
Kindig, D. A., Panzer, A. M., & Nielsen-Bohlman, L. (Eds.). (2004). Health literacy: a prescription to end confusion. National Academies Press.
Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: current strategies and future directions. Annual review of medicine, 65, 471-485.
Ku, L., Bruen, B., Steinmetz, E., & Bysshe, M. T. (2014). The Economic and Employment Costs of Not Expanding Medicaid in North Carolina: A County-Level Analysis. Center for Health Policy Research, The George Washington University. Cone Health Foundation and Kate B. Reynolds Charitable Trust. Retrieved from: http://www. conehealthfoundation. com/foundation/initiatives/nc-medicaid-expansion.
Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International journal for equity in health, 12(1), 18.
Lichstein, J., Holliman, R. H., Rand, T., Dobson Jr, L. A., Lerche, J., Holmes, M., & Silberman, P. (2009). Expanding Access to Health Care in North Carolina. NC Med J, 70(4), 310.
Paasche?Orlow, M. K., Schillinger, D., Greene, S. M., & Wagner, E. H. (2006). How health care systems can begin to address the challenge of limited literacy. Journal of General Internal Medicine, 21(8), 884-887.
Pettigrew, L. M., & Mathauer, I. (2016). Voluntary Health Insurance expenditure in low-and middle-income countries: Exploring trends during 1995–2012 and policy implications for progress towards universal health coverage. International journal for equity in health, 15(1), 67.
Saluja, S., Zallman, L., Nardin, R., Bor, D., Himmelstein, D., Woolhandler, S., & McCormick, D. (2014, April). SUPPORT FOR A SINGLE PAYER NATIONAL HEALTH INSURANCE PROGRAM SIX YEARS AFTER MASSACHUSETTS HEALTH CARE REFORM: VIEWS OF SAFETY NET PATIENTS. In JOURNAL OF GENERAL INTERNAL MEDICINE (Vol. 29, pp. S214-S215). 233 SPRING ST, NEW YORK, NY 10013 USA: SPRINGER.
Savedoff, W. D., de Ferranti, D., Smith, A. L., & Fan, V. (2012). Political and economic aspects of the transition to universal health coverage. The Lancet, 380(9845), 924-932.
Sharma, M. (2016). Theoretical foundations of health education and health promotion. Jones & Bartlett Publishers.
Shi, L., & Singh, D. A. (2014). Delivering health care in America. Jones & Bartlett Learning.
Somers, S. A., & Mahadevan, R. (2010). Health literacy implications of the Affordable Care Act. Center for Health Care Strategies, Incorporated.
Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2015). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. Jama, 314(4), 366-374.
Swan, G. A., & Foley, K. L. (2016). The Perceived Impact of the Patient Protection and Affordable Care Act on North Carolina's Free Clinics. North Carolina medical journal, 77(1), 23-29.
Taylor, D. H. (2017). The case for Medicaid expansion in North Carolina. North Carolina medical journal, 78(1), 43-47.
Vernon, J. A., Trujillo, A., Rosenbaum, S. J., & DeBuono, B. (2007). Low health literacy: Implications for national health policy.
Viuf, B. (2012). Green energy will cut healthcare costs, Science Nordic.
Voorhoeve, A., Edejer, T. T., Kapiriri, L., Norheim, O. F., Snowden, J., Basenya, O., ... & Hussein, R. H. T. (2016). Three case studies in making fair choices on the path to universal health coverage. Health and Human Rights, 18(2), 11.
White, F. (2015). Primary health care and public health: foundations of universal health systems. Medical Principles and Practice, 24(2), 103-116.