Mental Health the Recent Changes

Mental Health

The recent changes to the health care sector (from the passage of the Affordable Care Act) have raised concerns about its long-term effectiveness in dealing with the uninsured, rising costs and quality. To fully understand the lasting impacts there will be a focus on what segments are most influenced by these challenges. This will help to determine the effect of these changes and how they will transform the health care sector. (Eibner, 2012)

Over the last several decades, income inequalities have been occurring inside the health care sector. This is because the U.S. system is based upon a privatized model that requires individuals paying for more of these costs. The results are that a larger percentage of the population cannot afford health care services and are being priced out of the system. (Walt, 2012)

Evidence of this can be seen in the below tables which contains information provided by the U.S. Census Bureau. They found that there are certain demographics of the population who do not have health insurance. This is based upon economic, racial and citizenship variables. In the case of economic factors, the Census Bureau found that low income families will not have any kind of health care coverage (which is highlighted in the below table). (Walt, 2012)

Households with No Health Insurance from Annual Income Demographics

Income Level

Percentage without Health Insurance

Under $25,0000

13.6%

$25,000 to $49,000

13.0%

$50,000 to $74,999

10.2%

$75,000 and up

4.7%

(Walt, 2012)

These numbers are showing how low income families cannot afford the premiums, deductibles and copays which are associated with most plans. (Walt, 2012)

At the same time, select racial groups will have lower amounts of health insurance. This is because certain groups are more than likely have a higher percentage of immigrants. For instance, the Census Bureau found that Hispanics have the highest levels (which is illustrated in the below table).

Racial Groups that Do Not have any Health Insurance

Demographic

Percentage without Health Insurance

White

6.8%

Black

10.2%

Asian

9.1%

Hispanic

15.1%

(Walt, 2012)

This is demonstrating how Hispanics are more than likely to not have any kind of insurance. This is from higher amounts of immigrants inside this segment of the population. In both categories (i.e. naturalized and illegal), these individuals have larger rates. (Walt, 2012) (Eibner, 2012) (Baker, 2012)

A good example of this can be seen in the below table (which is highlighting the different citizenship demographics and their levels of health insurance coverage).

Immigration Status and the Percentage without any Health Insurance Coverage

Nativity

Percentage without Health Insurance

Born U.S. Citizens

8.8%

Naturalized Citizen

12.5%

Non-Citizens

29.2%

(Walt, 2012)

These figures are showing how non-U.S. And naturalized citizens will have the highest amounts of people lacking health insurance coverage. As a result, the Hispanic demographic has the largest rates based upon these segments encompassing a significant amount of this group. This means that these people will earn less and have greater financial challenges. When this is combined with having to learning a new language and culture; these individual will not have any form of health care coverage. (Walt, 2012) (Eibner, 2012) (Baker, 2012)

The above tables are illustrating how the rising number of uninsured is becoming a major challenge that is influencing the standard of living and quality of life. The passage of the Affordable Care Act, is supposed to help address these challenges. However, it is a new program which has never been tested before. This means that these disparities may or may not be addressed for certain demographics of the population. To determine the long-term effects, we are examining how these trends will become better or worse for various segments. Once this takes place, is when we provide specific insights that will highlight how the problem is being addressed and new challenges that will arise in the future. It is at this point when these insights can be used to create strategies that will help to address any kind of disparities. (Eibner, 2012)

Landscape Identification

There are a number of stakeholders and a host of factors that will have an impact on the uninsured. The most notable include:

Health care providers: These organizations are concerned that the government will impose new regulations and guidelines upon them. This hurts their ability to innovate and offer solutions which are meeting the demands of patients. Politically, they are concerned that they could lose influence and control over their facilities. Socially, many individuals are worried about if this will change the way medicine is practiced (with most people believing it is fundamental a right). ("How the Health Care Law Benefits You," 2012)

Economically, the new changes could increase costs and hurt the profit margins of health organizations. Legally, a number of facilities believe that the Affordable Care Act is opening the door in dealing with the uninsured by forcing them to treat patients without compensation. This is problematic, as any effort to address disparities with the uninsured will have an impact on quality and costs. When this happens, there is a possibility that the health care system will become similar to models that are utilized throughout: Europe, Canada and Australia. This could adversely affect innovation and any kind of solutions that are introduced. (Cogan, 2012)

Patients: Changes to different regulations will have a positive impact on select segments (most notably U.S. citizens). This is because they do not have to hide in the shadows or learn about how the system works. Instead, they can legally sign up for different programs and address any gaps in health care coverage. However, there are select groups such as illegal immigrants that do not have access to these services. To address these challenges, the law needs to consider ways to improve education and where everyone can learn about these programs. Politically, this may not be popular as some conservatives will argue that illegal immigrants should be provided with nothing. Socially, these disparities will hurt productivity, costs and the standard of living for these people. ("How the Health Care Law Benefits You," 2012)

Economically, this will create even larger divisions between these segments of the population. Practically speaking, this will address the root causes of the problem by targeting those segments which are not covered by the law. Legally, there are issues surrounding eligibility and who is considered to qualify for these programs. ("How the Health Care Law Benefits You," 2012)

Regulators: Regulators are focused on dealing with the large number of uninsured. The most effective way for them to address these challenges is to concentrate on directly confronting the problems impacting the largest segments of the population. Then, they will address other areas, after new challenges have emerged (later on). Politically, this is designed to show that everyone is doing something about the problem. Socially, this is reducing the disparities which exist based upon income, racial and immigration related factors. ("How the Health Care Law Benefits You," 2012) (Cogan, 2012)

Economically, this is decreasing costs for households by providing them with direct relief. Practically speaking, these provisions are making the family environment more stable through ensuring that there are additional funds to address other challenges. Legally, officials are using the power of regulation to protect the interests of the general public by controlling rising costs and preventing abuses. ("How the Health Care Law Benefits You," 2012) (Cogan, 2012)

Employers: Employers will benefit from having the government providing additional relief with health care costs. This allows them to invest these funds in expanding their business which will lead to an increase in hiring and capital spending. However, there are concerns that the mandatory coverage will increase costs for those firms that do not provide health insurance to employees. Politically, this is designed to provide assistance, but could affect the owner's views based upon their cost structure. Socially, this is ensuring that workers have access to affordable health care. This addresses any kind of disparities between management and employees. ("How the Health Care Law Benefits You," 2012) (Cogan, 2012)

Economically, this will reduce the costs that most firms are paying for health insurance. Practically speaking, these issues will transform the way these services are offered and areas of responsibility. Legally, this will create a change in what kinds of benefits will be provided to employees in the future. ("How the Health Care Law Benefits You," 2012) (Cogan, 2012)

These factors are showing how there conflicting views that will have an impact on the total amounts of uninsured. What is happening is the Affordable Care Act will address disparities between different segments inside the U.S. population. This will lead to a decrease in the total number of uninsured.

However, there will be various segments of the population that are ignored by these changes. This will create new divisions between select demographics (which have higher rates of uninsured). When this happen, there will be differences among these groups in contrast with the rest of society. The key for making the Affordable Care Act successful is to create programs which can help to address these differences. In the future, this will improve quality and it will reduce the total number of uninsured. This is when productivity and the standard of living will improve by proactively addressing these issues while they are small.

Alternatives

To deal with any potential challenges left behind from the Affordable Care Act requires looking at alternatives which can be augmented with the law. The various options that are available include:

Enacting provisions that apply to immigrants: The figures that were examined earlier in the table titled Immigration Status and the Percentage without any Health Insurance Coverage. They are showing that naturalized citizens and non-citizens do not have any kind of health care coverage. Inside the group of non-citizens are illegal immigrants. According to the Pew Foundation, they determined that the total number of illegal immigrants among this group is accounting for 28% of the population. (Lee, 2012)

Moreover, the Department of Homeland Security determined that this segment is rapidly increasing in size with the saying, "An estimated 11.5 million unauthorized immigrants resided in the United States as of January 2011. The estimates, released in March 2012, suggest that the unauthorized population is virtually unchanged compared to the revised 2010 estimate of 11.6 million. The largest shares of the 11.5 million unauthorized immigrants resided in California (25%), Texas (16%), and Florida (6%). Arizona and Georgia -- two states that recently passed immigration enforcement laws -- are home to 3% and 4% of the nation's unauthorized immigrants, respectively. Between 2000 and 2011, Georgia's unauthorized population nearly doubled (from 220,000 to 440,000 or by 95%), while the population in Arizona increased by 9% during the same period (from 330,000 to 360,000). These figures can be compared to 36% growth between 2000 and 2011 at the national level." The different numbers are showing how the illegal immigrant population is continuing to increase. (Lee, 2012)

To prevent these trends from leading a rise in the total number of uninsured requires having some kind of program that will offer them with low cost health solutions. One possible approach is to enact provisions that require select nonprofits and charities to work with these individuals. They can go to different locations and offer them with free health care services and establish some kind of regular screening procedures. This will have positive impacts on costs, political feasibility, administrative ease, fairness and timeliness. (Lee, 2012)

Create periodic Congressional reviews: Another possible option for dealing with potential disparities is to establish a system of accountability. One approach is to implement a consumer protection agency that will monitor health care costs and trends. Anything that is adversely affecting different stakeholders is presented to Congress in the form of an annual review. This is when they are examining the effects of the law and implementing slight changes that will address any kind disparities for the uninsured. If this kind of approach is taken, it will improve vigilance and the ability of administrators to respond to critical challenges. ("Periodic Review," 2012)

These techniques have been used by officials in the UK to identify and deal with new issues inside the health care sector. The results are that there is improved monitoring for costs, quality and customer satisfaction. Over the course of time, this has enhanced the system's ability to identify and address the most pressing needs for consumers. Moreover, it will also offer a number of long-term advantages including: costs reductions, enhanced benefits, political feasibility, administrative ease, fairness, improved compliance with legal provisions and timeliness. ("Periodic Review," 2012)

Create programs that will offer additional assistance to minorities and low income families: This is when community nurses and nurse's aides will work in locations where there are high levels of these groups (such as community health centers). The basic idea is to educate and inform patients about health care related challenges. This means discussing with them the different problems they need to be aware of and offer solutions. (Wolf, 2008)

For instance, professionals in this program could provide referrals to families about other services that are available. This will help the most vulnerable segments by offering them with cost effective and flexible solutions that will address these challenges over the long-term. This will create a number of advantages that are dealing with the root causes of these problems. To include: cost-benefits, political feasibility, administrative ease, fairness, improved compliance with legal provisions and timeliness. (Wolf, 2008)

This process will have a positive impact on the uninsured. The way that this will occur by saving lives, as improved access to these services will reduce the possibility that conditions are allowed to go undiagnosed for long periods of time. For example, a study was conducted by Families USA. They found that the total number of people who die from not having access to affordable health care services is 26 thousand per year. These figures are up from 2005, when they were coming in at 20,500 cases for this demographic. (Morgan, 2012)

Commenting about what was occurring the report observed, "Lives are truly on the line. If the Affordable Care Act moves forward and we expand coverage for tens of millions of people, the number of avoidable deaths due to being uninsured will decrease significantly. The reform law would extend coverage to more than 30 million Americans who are uninsured. The uninsured get healthcare about half as often as insured Americans. There is an overwhelming body of evidence that they get less preventive care, less chronic disease care and poorer quality hospital in-patient care. The number of uninsured will continue to rise without reform as healthcare costs accelerate, employers scale back on benefits for their workers, and the social safety net frays under fiscal pressures." (Morgan, 2012) These comments are showing how the Affordable Care Act can address the large number of challenges impacting the uninsured.

This will improve quality by providing routine services that will screen and identify chronic conditions. During this process, is when cost will decrease, patients are more educated and the levels of health are enhanced. If these provisions, were offered to other segments that are overlooked by the Affordable Care Act. There will be an increase in the total number of lives that are saved. This is because everyone is aware of possible health related issues and will do what is necessary to address them. It is at this point that they can deal with any challenges and increase their longevity. (Morgan, 2012)

Side by Side Tables of the Alternatives

To determine the best alternatives the below table is comparing the above approaches with each option that was provided for the analysis

Contrasting the Different Options

Strategy

Benefits and Drawbacks

Enacting provisions that apply to immigrants

This will directly deal with the number of uninsured who are ignored by the Affordable Care Act. However, the implementation of this program will face political and legal challenges.

Create periodic Congressional reviews

This will require lawmakers to continually addressing the new challenges that are arising inside the sector. In the future, this prevents costs from running away by dealing with any kind of disparities.

Create programs that will offer additional assistance to minorities and low income families

This process will have community nurses working with the most vulnerable segments. These approaches are popular based upon the government's limited involvement. At the same time, the resources that are being utilized are not increasing costs and they are dealing with critical challenges which are impacting the sector. However, the biggest drawback is that these solutions will not last over the long-term. This is because charities will cut back on funding to different programs based upon economic considerations. Over the course of time, these reductions will create disparities when this happens.

Recommendations

The best approach is to have Congress conduct an annual review of possible challenges impacting the health care sector. This is because there are rapid changes to the system. These transformations will create new issues that must be addressed. Those nations that do not have any kind of review process in place will not understand the problems they are facing or how to fix them over the long-term. It is at this point that disparities will become more extreme (which is leading to a rise in health care costs and the total number of uninsured). ("Annual Report and Accounts," 2012)

If Congress is able to review the sector on an annual basis, they will understand the challenges and what steps need to be taken. This will enhance quality and it will make the system more flexible. Over the long-term, this will improve the ability of professionals to treat different conditions and prevent any kind of disparities. ("Annual Report and Accounts," 2012)

For example, in the UK there is the Periodic Review that is conducted every year. This is designed to examine for quality and any kind of challenges impacting the sector. During the process, there is an emphasis on: registration, enforcement, inspection and care. These findings are reported to the Care Quality Commission. They will implement these changes inside different health care facilities. The long-term effects are that 4 thousand lives are saved every single year. This is because the report is focused on addressing any kind of issues that can impact quality and costs. The ability to proactively deal with these problems prevents it from becoming worse. ("Annual Report and Accounts," 2012)

If this were implemented in America, it will allow officials to see the underlying challenges and introduced solutions to them. This is when the sector will be more responsive to these changes by having everyone continually monitoring for problems. It is at this point that the industry can become more flexible and responsive. Annual reports ensure that this happens by creating a process of transparency and openness. ("Annual Report and Accounts," 2012)