The Present Health Care Programs of U.S Government - Essay Example

 Introduction According to George Bernard Shaw, the utmost of evils and the most awful of tribulation is poverty. Though , U.S.A has been referred the world’s robust economy , according to census figures released in the year 2007 , about 37.3 million people were suffering from poverty in U.S.A alone in the year 2007 as compared to 36.5 million in 2006 Further ,in 2007, the official poverty rate was 12.5% whereas the poverty rate stood at 12.4% in 2006. Poor people are always found it difficult to pay for food, housing, child care, education and health care. With limited sources, they are often unable to pay housing as it may absorb a high proportion of their income. 12.5% of U.S population or 35.9 million lived in poverty during 2003. Both the quantum of poor people and rate of poverty have amplified in recent years from 12.1% in 2002 and up 1.3 million from 2002. (U.S.Bureau of the Census, 2004). About 36% of those living in poverty are children and this is significantly high in recent years. This research essay evaluate the efficacy of public health insurance for low-income and "medically need" people as an antipoverty strategy in light of the available social-scientific evidence about the causes of poverty. Analysis Subsequent to economic boom of the 1990’s , America has underwent a number of impediments together with the satiated of technology bubble, 9/11 attacks, poignant deterioration of stock market wealth , a sluggish market , accounting scandals like Enron and economic repercussions pertaining to the war in Iraq. But during 2000- 2002, the U.S.economy perched for a more unrelenting recovery and it has witnessed stumpy inflation, lowering rates of interest, sturdy output expansion and a booming residential market. My research mainly deals with public health insurance for low income and medically needy people. Americans who are living under poverty line needs free and timely medical aid for the following reasons; medically needy persons include those are who are chronologically disabled and ill, high-risk infants and mothers, individuals living with AIDS /HIV, substance or alcohol abusers , mentally disabled or ill , individuals with homicide or suicide mentality , homeless individuals , abusing families , refugees and immigrants. The following shall be taken into consideration for evaluating about the efficacy of the health care benefits offered. These poor people needs are severe and in most cases, their health is either life-threatening or debilitating. These sects are under the immediate need of either an intensive or extensive set of both non-medical and medical services. Since the number of poor people is constantly increasing and due to recent economic recession, this places enormous demand on the medical care, public health and associated service delivery segments. The present service delivery or financial arrangement does not meet the multifaceted and complex needs of these vulnerable groups. (Aday 11) Various Social Welfare Schemes There exist many anti poverty programs in U.S.A. For instances , Food Stamps (1971) , Social Security ( 1975) , Child Nutrition Programs (1971) , Supplemental Security Income (1975) , and railroad retirement (1971) . (Jennings 34). Title V of the Social Security Act established Crippled Children Services (CCS) and the Maternal and Child Health programs to look after the medical needs of poor people belonging to this segment. Title X of the Public Health Service Act is offering federal fund for family planning services. For providing adequate nutrition to poor pregnant women, the U.S Department of Agriculture supported the Special Supplemental Food Program for Women, Infants and Children (WIC) and Food stamp programs for welfare-eligible mothers in America. However , these programs have experienced reduced levels of support funding over the last two decades due to the use of block grant funding to states and political pressure exerted to minimize support for social service program in general. (Aday 121) The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) scheme offers vision, nutrition, hearing and dental screening to children covered under Medicaid. However, only about 21 to 30% of the targeted children have been benefited from this program. (Aday 123) Medical care for long-term chronic diseases frequently demands comprehensive, frequent, coordinated case management of social and clinical services over an extended period of time. In minimizing the risk of long-term disability or death, the roles of emergency medical trauma center services are essential. Thus, chronically disabled and ill patients require long hospitalization and medication under Medicaid or Medicare which are the greatest solace to these patients who are at the lost leg of their life. (Aday 125) Under Title III of the Older Americans Act, Area Agencies on Aging have offered home-delivered meals and other referral and support services. For both disabled children and for the elderly, there exists a social day care program which offer choices for more independent living and reprieve for family caregivers. Table 1: U.S. and New York poverty Rates, 2000 to 2004. 2000 2001 2002 2003 2004 % point change ,2000-04 U.S.All People 12.2% 12.1% 12.4% 12.7% 13.01% 0.9% New York City All People 17.9% 19.2% 19.0% 19.0% 20.3% 2.4% Source: U.S. Census Bureau, American Community Survey. Table II People in poverty by selected characteristics: 2006 & 2007 2006 2007 Total number of people below poverty 296,450 298,699 Total % of people below poverty 12.3% 12.5% Source: U.S. Census Bureau, American Community Survey Table III Total Mass lay offs events in 2008 in U.S.A Period Events Initial Claimants of Unemployment Insurance First Quarter of 2008 4005 388,552 Second Quarter of 2008 4446 457,023 Third Quarter of 2008 4610 469,967 October and November 2008 4699 463,373 Source: Bureau of Statistics (Labor), Department of Labor, U.S.A Many observers are of the view that the current economic downturn holds distressing resemblance to the beginning of the Great Depression. Both in the great depression and in the current economic downturn, stock market crashes brought down investors’ net worth and minimized spending. The Dow fell about 47% in 1929 whereas in October 2007, the Dow fell by 42%. Worsening employment opportunities for wider section of the work force and eroding esteem and accessibility of public aid is the chief reason for homelessness which is also prevalent due to poverty. (Burt 1267) There are one another category called chronically homeless people and these are people suffering from mental ill health, alcohol, health and drug problems. (Burt 1267) It is dismay to observe that though the U.S.A is said to be the richest nation in the globe, poverty is widely rampant in U.S.A The prevalence of poverty in U.S.A to such amazing scale which indicates that there exists injustice and inequality in U.S.A. Poverty has distressing effect on communities and families. The working poor families in America are the worst affected community from poverty which is seeking for fundamental needs assistance on continuous basis. Gas price and increasing oil price is having greatest effect on the budget of all families in U.S.A irrespective of their income level. There has been steep increase from 2 to 4% of the proportion of income spent on transportation related fuel from 2006 to June 2008. Further, the recent census predicts that the percentage of population that was regarded as extremely poor stood at a 32-year high. It is to be observed that in between 2000 and 2005, the percentage of living at 50% of poverty –scale rose by 27% One another distressing fact is that the number of severely poor category is increasing. In 1975, the severely poor remained at one-third of the total population of America. In 2008, it rose by alarming rate and about 43% of persons are living in poverty that falls under the category of extremely poor by national standard. The truly poor category consists of children under the age of seventeen. The severely or extremely poor category belongs to working age than old or young. It is surprise to note that large chunk of abjectly poor are white which is two times as high as of blacks. However, Hispanics and blacks are unreasonably seems to be most impacted. Women by one third are likely to suffer deep poverty than as compared to men. (Glasmeire 2007) Though U.S.A is said to be the most economically class-conscious of all the industrialized nations , the gap between poor and rich is found to larger than in U.K, Canada , Italy , France , Germany and Finland. Thus, the poverty rate in America is well above the other industrialized, western countries and the sharp disparity between rates in U.S.A and that of other nations is not influenced much by non-cash benefits. (Jennings 18) President Harry S.Truman liberalized the Social Security provisions which are famously known as “Fair Deal” and President Eisenhower also continued the New Deal initiatives and strategies. President Eisenhower introduced Anti-Recession Act in 1958 which provided $ 1.86 billion to create about 500,000 new jobs through construction of 200,000 housing units. As one of the approach to minimize poverty in America, President Kennedy initiated tax cuts, both personal income tax and corporate tax cuts to generate jobs. He also introduced a grant of seven percent tax credit on industrial equipment mainly to generate employment and minimize poverty. Further, Kennedy and subsequent U.S government used education and training as a famous approach employed to fight against poverty. (James Jennings, 25) In his State of the Union address, President Johnson even declared “war on poverty. During President Nixon period, grants to states for social welfare schemes witnessed a large swell. In 1975, President Ford granted $ 4.5 million economic stimulus scheme that included $ 2.5 billion for providing employment to unemployed both at state and local levels. (Jennings 35). The Kerner Commission appointed by the President Johnson in 1968 found that “White racism” was the root cause of poverty in America. About 45 million citizens are uninsured at any given point of time. Individuals who are undocumented persons, homeless persons and young minority victims of violence are also fall under the category of medically uninsured. Medicaid is the income eligibility –oriented scheme for individuals who are eligible to receive through federal Supplementary Security Income (SSI) or state public assistance programs for the blind, aged and disabled. (Tomsic 12)Medicaid is the primary source of payment for poor, pregnant women. High-risk mothers and infants, individuals living with HIV /AIDS, chronically disabled individuals and refugees are eligible to avail health care benefits under Medicaid scheme.( Wiggins 1487)Further, the blind, disabled and aged who are under financial need who are eligible for SSI are involuntarily eligible for Medicaid. Due to diminished financial contribution from federal government, Medicaid is being restrictively used by some states now. (Donenberg 1498) The Welfare Reform Act of 1996 had major effects on the eligibility of pregnant women and their child for Medicaid. The Temporary Assistance for Needy Families (TNAF) rules really impacted employed low-income mothers. Due to this, a large chunk of women lost their Medical benefits, without aftermath access to private insurance coverage. (Aday 163) Further, about 30% of doctors offering obstetric services decline to support Medicaid patients as many poor do not have coverage under Medicaid due to program access restrictions or due to the fact that their income fall above the restrictive state income eligibility guidelines. Medicare is a federal social insurance scheme that offers some particular health care benefits for individuals in the age group of sixty-five years and old. Those who are working in private institutions and companies on full time basis are covered under private medical insurance benefits. Due to accelerating costs of medical care, the number of Americans with no health insurance covered soared due to cutbacks in health care benefits both in industrial and governmental sector. The Omnibus Budget Reconciliation Act of 1981 declined many poor working class employees from eligibility by restricting deductions for work-associated overheads, earned income, child care and by shrinking the budget for the Aid to Families with Dependent Children (AFDC) resource requirements. For those with no private or public insurance coverage, state governments undertake the responsibility of financing both the mental patients and persons fighting with AIDS / HIV. (Aday 160) There are about 12 million uninsured children in U.S.A and seven millions are presently eligible for health insurance under CHIP (Child Health Insurance Program) and under Medicaid. Further, nearly 5 million children are not benefited from any program at all. One survey found that Latina and Black women are more prone to poverty than White women. Educational disadvantage among minority women plays a pivotal role in the higher unemployment and poverty rates suffered by this segment. (Hartman, 104). There were strong proofs about the differential treatment of recipients within local welfare systems based on ethnic or racial origin. During the past decade, the public, private health care providers and third-party payers had reduced the resources spent on health care and had developed new organizational models for the cost-effective practice of medicine. The worst affected due to this is the Americans who are living under the poverty line and those who are suffering from terminal diseases as the doors have been virtually closed to get free health care facilities to minorities ,poor and uninsured . To revamp the system of U.S health care benefits, plethora of new proposals have been recommended for covering and paying for health care services. Comprehensive health care program was thwarted at the federal level when Clinton health care reform initiatives were defeated in the early 1990’s. Various states in U.S have taken their own initiatives like universal coverage strategies like tax credits or employer mandates, widespread cost reduction strategies through state global budget, managed competition and single-payer schemes. Due to this, an increasing number of Medicaid –eligible persons are admitted in managed care schemes. For children and families who do not qualify under a state’s Medicaid program, the federal program of Child Health Insurance Program has offered finance to states for extending Medicaid coverage to these children and families. Carve-outs are schemes which are widely employed as alternative for covering and deferring for services higher cost groups like mentally retarded and substance abusers. Recommendations U.S government should simplify and combine application and eligibility criteria to make it friendlier for poor persons to get health care. It should initiate massive and emergency campaign to enroll and reach everyone who is eligible for Medicaid and CHIP. It should expand health coverage to all uninsured poor people in U.S.A. It should encourage all employers to widen the coverage for employees and their dependents and to cease dropping dependent coverage. U.S government should impress every community network to join in a persistent and massive awareness and enrollment campaign till everyone is offered with appropriate medical care. (Hartman 19) Conclusion The present health care programs of U.S government is poorly integrated and under developed and creates major financial and organizational barriers to access for many U.S based communities. The present technique of both public and private third-party reimbursement tends to make worse than improve these issues. For the individuals who fall under the lowest income groups , the saddle of out –of –pocket expenses for health care has become more difficult and they find it very difficult to meet even small dollar medical expenses due to their level of disposal income. Though health maintenance organization (HMO) offers lower overall satisfaction to enrollee as compared to customary fee-based health care services, it was reported by HMO enrollee that enjoyed greater satisfaction with costs. As remedies for our individual and collective vulnerability can be traced in the bonds of caring human communities, it is necessary to examine the required preventive public health and medical care investments and evaluates the disincentives and incentives structured into proposed and existing method of coordinating and financing health care in United Stated for minimizing the peril of Poor’s emotional, physical and communal health. Works Cited Aday, Lu Ann. At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States. San Francisco: Jossey –Bass Health Series, 2001. Burt, M. R. “Chronic Homelessness: Emergence of a Public Policy. “Fordham Urban Law Journal, 30(3) (2003):1267+ Chester W.Hartman. Challenges to Equity: Poverty and Race in America. M.E Sharpe, 2001. Donenberg, Jon. "Medicaid and Beneficiary Enforcement: Maintaining State Compliance with Federal Availability Requirements." Yale Law Journal 117.7 (2008): 1498+. Glasmeire, Dr.Amy K. “The Nation We’ve Become” 26 February 2007. Poverty in America. 18 February 2009 < http://www.povertyinamerica.psu.edu/>. James Jennings et al. Understanding the Nature of Poverty in Urban America. Greenwood: Greenwood Publishing, 1994. Tomsic, Trinity D. "Managing Medicaid in Tough Times: States Are Struggling with Soaring Medicaid Costs. Some Are Using Short-Term Solutions, Others Have Launched Bold Reforms." State Legislatures June 2002: 12+. Wiggins, Kenneth R. "Medicaid and the Enforceable Right to Receive Medical Assistance: The Need for a Definition of "Medical Assistance"." William and Mary Law Review 47.4 (2006): 1487+. Annotated Bibliography Aday, Lu Ann. At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States. San Francisco: Jossey –Bass Health Series, 2001. Aday being the professor of behavioral science and management and policy sciences at the University Of Texas School Of Public Health had focused on policy-specific research on correlates and indicators of health service access and its utilization. In early twentieth century, policy development paved the expansion of the U.S health care system and it had enhanced access to health care benefits to the disadvantaged segment of the U.S population. Aday, in this book vividly details about the evolution of the health care system in U.S.A, the present health care benefits, its advantages and disadvantages and her recommendations to revamp the present U.S health care system for extending the benefits to the poor people in America. Burt, M. R. “Chronic Homelessness: Emergence of a Public Policy. “Fordham Urban Law Journal, 30(3) (2003):1267+ This article looks into the concept of homelessness and its prevalence as the spotlight of a momentous policy transformation. This article enumerates how homelessness has become a significant social issue. This article stresses to improve the economic ability of the poor people in America so that they may not remain as poor in near future .The author also cautions how drastic cuts in subsidized and public housing –actions that in the long-term will act against federal policy to end chronic homelessness. Chester W.Hartman. Challenges to Equity: Poverty and Race in America. M.E Sharpe, 2001. In his book, the author discuss on poverty, race, the environment, education and democratic functions. He also examines the fundamentals of injustice in America. This book examines about the recent antipoverty strategies, to promote education to fight against poverty, by fostering opportunities, putting a full stop to isolation, the need to further the true democratic setup and allowing poor to participate in the country’s political system. Donenberg, Jon. "Medicaid and Beneficiary Enforcement: Maintaining State Compliance with Federal Availability Requirements." Yale Law Journal 117.7 (2008): 1498+. The author states that Medicaid is the scheme which aims to provide health care benefits to low-income Americans. It is a contract between the federal government and individual state governments. States are faithfully implementing the federal Medicaid scheme and in tune with the provisions of federal Medicaid laws and appropriate CMS rules. The author gives very brief description about how Medicaid is functioning in detailed manner with useful information on the subject. Glasmeire, Dr.Amy K. “The Nation we’ve Become” 26 February 2007. Poverty in America. 18 February 2009 < http://www.povertyinamerica.psu.edu/>. This is a useful website. It contains many articles on poverty in America. In this article, the author criticizes the government policy on imposing low tax on high income group and hence laying foundations for income inequality. He criticizes that government welfare programs makes the people lazy and to select not to work and enjoy the benefits offered by the government. James Jennings et al. Understanding the Nature of Poverty in Urban America. Greenwood: Greenwood Publishing, 1994. This research study spotlights on eight pivotal topics on nature of poverty in urban America. The social isolation and the poverty of minority groups in major American cities is the single most serious issue of the contemporary American society. The main aim of this research study is to summarize and publicize some of the vital findings and major concepts of the massive literature on urban American poverty. Tomsic, Trinity D. "Managing Medicaid in Tough Times: States Are Struggling with Soaring Medicaid Costs. Some Are Using Short-Term Solutions, Others Have Launched Bold Reforms." State Legislatures June 2002: 12+. In this article, author describes how managing Medicaid has become tough times for the states now. He also narrates how states are under pressure with increasing costs. Some states are employing short-term solutions whereas others have instead introduced gallant reforms. Wiggins, Kenneth R. "Medicaid and the Enforceable Right to Receive Medical Assistance: The Need for a Definition of "Medical Assistance"." William and Mary Law Review 47.4 (2006): 1487+. In this article, author overviews of Medicaid program. He also analyses various case laws pertaining to Medicaid. He also briefly explains that Medicaid is an enforceable right under section 1983. The author stresses that court should clearly come out with remedies that enforceable rights offers. Read More