Health Care Reform, Poverty, and America's Uninsured

Introduction

For the more than 40 million Americans who do not have health insurance coverage, the consequences of a prolonged illness or a severe injury can be financially devastating. The prohibitively high cost of hospitalization, medication, treatment, laboratory testing, surgical procedures, and the use of medical equipment can ultimately produce an economic burden that cannot be sustained by the individual payer. This reality is only compounded by the nature of the health insurance industry in the United States. An absence of regulation over costs such as health insurance premiums and a lack of oversight over insurance company denial rights tend to reflect a legal hierarchy with highly socioeconomic implications. The result is a private healthcare system and a public health context in the midst of a crisis.

While most modernized and developed nations offer some form of socialized healthcare, American healthcare has become virtually inaccessible to a substantial fraction of the population. Thus, when pressing medical needs afflict members of this population, the cost can be sufficient to induce poverty. The research proposal presented here proceeds from the hypothesis that the Health Care Reform (HCR) legislation signed into law by the Obama administration — and at the time threatened by the sweeping midterm victories of the president's Congressional Republican opponents — is highly compromised and will not go far enough to protect the uninsured from descending into poverty. The research intends to examine the experiential differences of the insured and uninsured in light of the legislation, with the expectation that a significant economic gap will still remain such that the latter group remains at high risk of descending into poverty.

Statement of Problem

The primary problem facing the American healthcare system and public health in general is the intersection of poverty and a lack of health insurance coverage. As this research proposal will demonstrate, there is a clear and reciprocal relationship between a lack of healthcare coverage and proximity to the poverty line. This is confirmed by Reece (2010), who argues that "costs skyrocket when you're treating poor patients. When poor patients, who are sicker than most in the first place, go home after being treated, they often return to their doctors sicker than ever because of miserable conditions at home. That's why Medicare costs are highest in cities with poverty ghettos and in poor regions, such as the American South. Poverty is the main reason for regional cost spikes" (p. 1).

This highlights the inverse dynamic as well: cost spikes further stimulate the cycle of poverty by making health insurance inaccessible to those with limited means and by imposing medical costs that cannot be absorbed by the average working-poor American. It is to this latter effect that the proposed research will devote its focus, contextualizing the discussion within the framework of the debate over President Obama's recently passed HCR package. The primary research question is therefore: How will the Obama HCR package reduce, or fail to reduce, the poverty gap between the insured and uninsured in America's healthcare system?

Justification for Research

The research proposed here is justified by the need to objectively evaluate the impact of a legislative package that is currently clouded by politicization, commercial interests, and philosophical agendas. The healthcare industry's various competing interests have far overshadowed the needs of the American public, which is struggling to stay afloat in a recession economy. With jobless numbers soaring, companies cutting costs at the expense of worker health plans, and many Americans persisting without healthcare coverage, it is important to critically but fairly assess the HCR package as it relates to issues of poverty.

More objective research on the subject may promote an honest and open political dialogue about what works in the new package, what does not work, and how legislative improvements can be made. Ultimately, the research is justified by the view that reform on some level had been absolutely necessary, particularly given the reciprocal and causal relationship between poverty and the state of being uninsured. This perspective informs the assumption that a comprehensive evaluation of the current reform package will contribute to the discussion on a legislative action that will no doubt require ongoing evaluation and refinement.