Was the introduction of the Affordable Care Act meant to expand affordable Medicaid coverage for millions of poor families in America? Accordingly, the Act is meant to provide health care to all Americans. This is outlined in the Act’s three main objectives of reforming the private insurance market to safeguard the needs of small group purchasers of insurance, to expand access to Medicaid for the working poor and revolutionize the way medical decisions are made. However, the poor continue to experience hardships in their attempt to access health care. This is one of the issues highlighted by Linda Tirado in her book Hand to Mouth: Living in Bootstrap America. In chapter 3 of her book titled “You Can’t Pay Doctors in Chickens Anymore”, Tirado shares various instances in which she was denied medical care as the result of being poor. Tirado’s experiences serve to show how the American poor have been denied medical care and thus, the notion of availability of health care to all Americans remains nothing but a myth. In light of this, this essay argues that America is yet to achieve health care provision to all its citizens as evidenced by the many obstacles preventing the poor from accessing health care.
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There exists a shortage of physicians, nurses, and other health care providers in the areas where the poor reside. This has made access of the poor to health care become extremely difficult, which refutes the claim that health care for all Americans has been achieved. Tirado’s struggle to find a hospital that would provide her with prenatal treatment implies that not many credible health care providers exist in her locality. She says “I did take a few stabs at finding a different clinic. The ones with open spots didn’t take Medicaid and the ones that accepted Medicaid were full” (Tirado 35). With this statement, it is clear that Tirado’s area of residency has very little variety in terms of health care facilities. This can obviously be attributed to the fact that it is a low-income area and, therefore, not profitable for many health care providers. Many hospitals and physicians move away from residential areas and instead set up their practices in more affluent neighborhoods (“Barriers to Care”). This is quite ironic as health care is being taken away from people who have actual health care needs. Since 2000, almost two thirds of the estimated 230 hospitals have been opened in wealthier and more affluent areas (OHSU). Therefore, this shortage of health care providers in the low-income areas further proves that health care provision for all Americans has not yet been achieved as this fact has prevented the poor’s access to health care.
Poor health care policies further act as barriers to the poor’s ability to access health care. For instance, the eligibility criteria used for the public insurance programs like Medicaid prevents many poor people from receiving any actual health care. Tirado provides such an example in her book when she says “I’ve researched some programs, looking for anyone who could help. Sometimes I’m too rich, because I have a job at all. Sometimes, I live in the wrong county, and the grant providing the fund is restricted to residents of the next county” (33). It is clear from this statement that Tirado and other poor people are at loss on what action to take in order to access health care. The policy used to make the rules on eligibility for Medicaid has completely alienated them (“Barriers to Care”). This is one of the reasons why so many Americans remain uninsured; thus, they have fewer means of accessing health care or no means at all. Many poor people find themselves in categories in which they earn too much to qualify for Medicaid or any other federal health care subsidy or they do not qualify for a subsidy because they are in the wrong state. This has further refuted the claim that health care provision for all Americans has come to be.
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Many medical care providers are unwilling to treat individuals with public health insurance a factor that has hindered the poor’s ability access to health care. This happens because being a public health insurance holder automatically categorizes one as poor (OHSU). Thus, even when these holders of insurance find health care providers who are willing to treat them, the care given is very inadequate. Tirado goes on to explain her interaction with the health care system. She says “ER visits usually involve waiting around for hours and then being handed a couple of ibuprofen for my trouble” (Tirado 34). This shows how little regard the poor are given in their attempt to access health care. Waiting for treatment for hours tends to discourage many to seek medical care, while being treated with very little human dignity also prevents many from seeking health care.
Nevertheless, those who might not agree with this position argue that through a number of activities, the government has managed to provide health care services for all people despite the nature of their status. This is the main claim presented by individuals who argue that health care has been provided to all Americans. Indeed, it can be said that the system has not entirely failed. Even Tirado admits this by saying: “Now I’m not saying that the system doesn’t work at all” (38). She explains that the system is able to meet the needs of many people fairly efficiently. Those supporting the notion that health care provision for all Americans has been realized quote the passing of the Affordable Care Act as the main way that this has been achieved. According to this claim, the ACA is being used to reform the private insurance market. This is done by introducing policies that require private insurance companies to offer comparable policies at the rate to all (Brennan et al.). This will make it possible for the poor to receive private insurance, enabling them with easy access to health care (OHSU). The ACT has also made it possible for public insurance coverage programs such as Medicaid to be expanded. Medicaid has been expanded to the previously uninsured working poor. This has increased the poor’s ability to access medical care (Blum). As the mechanics behind the achievement of health care for all Americans, these policies do not however represent the reality of the situation, as millions of low-income earners remain unable to access health care. The following arguments illustrate how health care for all Americans is yet to be realized.
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The status of being poor prevents one from getting any regular source of care. By lacking a regular source of care it automatically means that one will experience difficulty in obtaining health care when ill, will have reduced doctor visits and will certainly find it difficult to receive prescription drugs (Brennan et al.). For instance, Tirado shares her experience about not being able to find a good hospital and physician during her pregnancy with her first daughter. She explains what she has gone through the rest of her pregnancy without stepping in any medical facility until it was time for her to give birth. Thus, Tirado completely lacked doctor visits, which almost made it difficult for her to have her baby in the city hospital as the staff made inquiries about who her doctor was. Further, Tirado lack of a regular source of care also proved difficult for her to receive prescription drugs as she would be perceived to be a drug addict or as seller. The majority of low-income individuals are less likely to have a regular doctor, and as a result, they tend to use emergency rooms and clinics as their sources of health care (“Barriers to Care”). Tirado provides evidence for this when she says “When I was in acute pain, before I learnt better, I used to go to urgent care or the ER” (33).
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In conclusion, from the above discussion, it is clear that the claims provided by the counter argument that health insurance is available to all the American people are misguided. It is fair to acknowledge that the government has introduced numerous changes and practices to improve health care provision, but the sad truth remains that not all people have been the beneficiaries of this improvements. This is evidenced by the fact that the poor continue to experience barriers that prevent them from accessing health care services like primary care, dental, and emergency health services. These barriers have included inadequate health care policies, fewer numbers of health care providers in their localities, lack of regular sources of care, and rejection of public insurance holders. The evidence provided by Tirado further confirms this fact. The situation has become even more serious as these barriers have evolved beyond the ability of the poor to afford medical care to barriers based on discrimination and stigmatization due to their financial status. All these facts have served to prove that health care provision to all Americans is yet to be actually realized and a lot needs to be done to make it a reality.