Adhering to the principles of social justice and the provision of human rights, the United States aspires to provide all individuals with affordable, accessible, and effective health care, irrespective of their social, economic, or racial status. Over the last decade, the United States has progressively taken measures, such as the Affordable Care Act (ACA), Healthy People 2020, and others, to eradicate health disparities and inequities (Kominski, Nonzee, & Sorensen, 2017). Nonetheless, despite these deliberate state interventions, economically disadvantaged populations and ethnic minorities are still facing disparities in access to health care that lead to their lower health insurance coverage, shorter life expectancy, and higher morbidity and mortality rates compared to persons with higher income.
Meager access of economically disadvantaged people to health care is associated with such socioeconomic determinants as their low income, poverty, and unemployment. Impoverished persons do not possess the financial resources required for health maintenance, preventive measures, minimization of exposure to illnesses, timely treatment and diagnostics, and health insurance (Baron et al., 2014; Kominski et al., 2017). Moreover, according to Griffith, Evans, and Bor (2017), roughly 20% of economically vulnerable persons do not receive treatment and avoid health care because they are unable to settle medical bills (p. 1506). Annual visits of the poor to healthcare settings comprise 5.4 times while visits of richer populations account for 9.3 times (Berkowitz, Traore, Singer, and Atlas, 2015, p. 408). The aforementioned facts testify to income-related inequalities in health care access.
Income-caused disparities in access to health care influence all gender and age categories of impoverished Americans. Both in children and adults, the prevalence of chronic diseases and mortality rates are two to three times higher in the low-income populations in comparison with economically advantaged individuals (Berkowitz et al., 2015). Today, there are nearly 39 million low-income workers in the United States (Baron et al., 2014, p. 540). Occupational injuries and illnesses in low-wage laborers “are frequently not covered by their employers’ workers compensation programs” (Baron et al., 2014, p. 541). What is more, approximately 70% of low-income people live in contaminated regions with hazardous waste facilities (Baron et al., 2014, p. 541). Being coupled with financial insolvency, these conditions contribute to the emergence and development of chronic and inextirpable diseases in poor individuals.
Health care disparities are extremely noticeable in ethnic and racial minorities. Assari (2018) accentuates that ethnic minorities are more exposed to health inequities than other poor populations in the United States (p. 118). A larger decline in life expectancy and higher incidence of various diseases are observed in African Americans and Latinos due to their material deprivation, exposure to environmental risks, and associated stressors (Griffith et al., 2017; Assari, 2018). Moreover, underemployment, low-wage jobs, and inadequate education diminish opportunities to improve living conditions and receive relevant medical services for representatives of ethnic minorities, thus, increasing their susceptibility to diseases and risks of premature mortality (Assari, 2018). Therefore, economic factors exert significant influences on their access to health care.
Although recent research and statistical data produce evidence of income-based inequalities in health care access, there are numerous optimistic evaluations of the state of affairs. Advocates of the current situation in health care access claim that disparities and inequities have significantly reduced since the ACA was adopted (Kominski et al., 2017). In 2010, roughly 50 million individuals were uninsured, involving mostly impoverished persons (Griffith et al., 2017, p. 1503). Indeed, since then, insurance coverage of low-income populations has considerably increased; approximately 20 million previously uninsured Americans have been provided with coverage (Kominski et al., 2017, p. 489). The ACA implementation has made health care, medical visits, and medications affordable to many economically disadvantaged people. In conformity with statistical evidence, the percentage of low-income persons “avoiding care due to cost fell by 7.5 percentage points” (Griffith et al., 2017, p. 1506). The given facts testify to a decrease in economically based health disparities.
However, despite this positive shift in insurance coverage, impoverished individuals still possess inadequate access to medical aid. Cost-sharing reductions under the ACA provisions are only available to those who choose a Silver plan, which is not affordable to most economically disadvantaged persons (Kominski et al., 2017, p. 490). Disparities and inequities are evident, encompassing irrelevant access to preventive services, chronic disease management, “resource utilization, and patient centeredness of care” (Berkowitz et al., 2015, p. 403). While life expectancy and self-reported health status increased in some low-income social groups, they remain persistently low in others, including ethnic minorities (Assari, 2018). The lowest rates of insurance are registered in African Americans and Hispanics (Kominski et al., 2017). The ACA implementation cannot completely ensure equal access to health care for all social groups in the United States. These trends refute enthusiastic claims concerning compelling improvements in health care access for poor Americans.
Summing up, the elimination of income-generated and ethnicity-related health disparities is one of the overarching health policy objectives in the United States. Although deliberate programs and initiatives are pursued by the government, income is the major barrier to the attainment of high-quality and holistic care for economically disadvantaged people. Thus, given the importance of healthy populations for national prosperity, further improvements are required to meet the health needs of the poor.
Assari, S. (2018). Health disparities due to diminished return among black Americans: Public policy solutions. Social Issues and Policy Review, 12(1), 112-145. Web.
Baron, S. L., Beard, S., Davis, L. K., Delp, L., Forst, L., Kidd‐Taylor, A.,… & Welch, L. S. (2014). Promoting integrated approaches to reducing health inequities among low‐income workers: Applying a social ecological framework. American Journal of Industrial Medicine, 57(5), 539-556. Web.
Berkowitz, S., Traore, C., Singer, D., & Atlas, S. (2015). Evaluating area‐based socioeconomic status indicators for monitoring disparities within health care systems: Results from a primary care network. Health Services Research, 50(2), 398-417. Web.
Griffith, K., Evans, L., & Bor, J. (2017). The Affordable Care Act reduced socioeconomic disparities in health care access. Health Affairs, 36(8), 1503-1510. Web.
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38, 489-505. Web.