Friday, November 30, 2018

Obamacare or Nah: discussing poverty, healthcare affordability, and ethics


Do you remember the Affordable Care Act?  Yeah.  It’s pretty controversial still.  Three years after it was approved during the Obama Administration, 54% of Americans opposed it.  Many find consolation in that President Trump and Congress have acted to try to weaken and replace it.  In fact, the recent Tax Cuts and Jobs Act repealed the tax on people who do not buy insurance, and it is estimated that millions of healthy people will drop their insurance plans when the law becomes effective in 2019.  Here is a link to a site that briefly outlines some of the pros and cons people are passionate about if you want more information on what the Act is https://www.thebalance.com/obamacare-pros-and-cons-3306059.

Part of Obamacare, the controversial healthcare reform law, stated the option to expand Medicaid to people who earn up to 138% of the federal poverty line, which addressed the gap in medical coverage for low-income families and individuals who were not eligible for Medicaid or insurance from employment.  The Affordable Care Act, in this way, increased the medication options available for patients in this low-income category who had type 2 diabetes and hyperglycemia.  The reform gave access to medications other than the normal metformin, sulfonylureas, and insulin (Brooks, Kalyanaraman, & Malek, 2018).

People who experience poverty and homelessness have benefited greatly from this aspect of the Affordable Care Act.  553,742 United States citizens, as estimated in November of 2018, experience homelessness, and if we include in our estimation the people who are in unstable housing conditions, 4.5 million people in the US experience homelessness in any given year.  To add to that altogether too high number, the rate of diabetes has been increasing among the homeless population.  And even further than that, there are many social, psychological, and physical challenges that homelessness brings people that can contribute to the rate of diabetes growth and complicate its management.  People experiencing homelessness actually report poorer health and a larger rate of early onset diabetes than people who have stable housing situations and are not experiencing poverty.

Keeping in mind all the challenges that homelessness and poverty bring to people, and remembering the health aspects that challenge these people, do healthcare providers and insurance companies have a responsibility to sustain and increase affordability of healthcare and preventative care to people who experience poverty?  Does the government have a responsibility?  Does anyone?  The Affordable Care Act has its pros and cons, and it certainly affects people all over the country in negative and positive ways economically.  But do its positive impacts on those who would not be able to afford healthcare otherwise outweigh the negatives?  As a scientist, student, and/or future healthcare provider, what do you think?

References

Brooks, L. K., Kalyanaraman, N., & Malek, R. (2018). Diabetes Care for Patients Experiencing Homelessness: Beyond Metformin and Sulfonylureas. The American Journal of Medicine. doi:10.1016/j.amjmed.2018.10.033

2 comments:

  1. Thank you for talking about this! I find this issue really interesting. In my opinion, I think that all individuals and families, including low income and homeless deserve and should have the right to affordable and accessible healthcare. Of course, this is easier said than done. I personally think the Affordable Care Act was a step in the right direction. It may not have been perfect, as very few things ever are, and it certainly had its drawbacks. However, when it comes down to it, I think that the positives were fairly significant, and in ways do outweigh the cons. I think as we go forward, although the Affordable Care Act needs some adjustments, it is going to help the issue of low income families and individuals getting healthcare.

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  2. I agree with MacKenzie. As a human race, we should be working towards a healthcare system that is affordable for everyone. Money should not limit the types of procedures or what you can do when your life is on the line. Everyone has a story and life throws curve balls, so you never know when you can be with no job or income. The Affordable Care Act is in the right direction, but like all things is not perfect. To me, I think that if healthcare does not become to a reasonable and affordable point, the implications can be worse. Working at a dental clinic where we provide free dental care for the community, I am able to see first hand some of the implications of the expensiveness of dental care. Most patients will wait until their pain is at its absolute worst to come into see the dentist because they weren't able to afford one filling or a yearly cleaning. When the patients wait this long, usually the outcome is not what they want. To have a way where healthcare is accessible to all would help in the reluctance of patients to seek treatment.

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