The Uninsured And Underinsured Health And Social Care Essay




One of the foremost social and economic problems that are not only facing the United States, but also the majority of other countries globally is healthcare. While there exists numerous issues that contemporary healthcare ought to handle, the most widespread problem is the costs of health insurance. The increasing health insurance costs together with the rise in medical care costs are affecting the majority of families in the globe. Lack of the ability to pay medical treatment bills impacts not only those who are uninsured, but also those people who recompose medical coverage. In 2008 June, published statistics indicating that almost 50 million Americans do not receive cover from insurance companies. On the other hand, the statistics showed that 25 million American citizens are underinsured. This implies that their reimbursement for medical coverage has extremely high rates and they encounter difficulties paying medical bills. The majority of these people possess a main health issues, as well as the sum of money owed to medical services is extensive (Lo Sasso & Byck, 2010). This has led to significant attention on the underinsured and uninsured from state levels to national levels. The aim of this paper is to discuss the prevalence of the underinsured and uninsured in the United States of America.

The number of people lacking medical insurance coverage is one of the major concerns of the United States medical care reforms. The person who has no medical insurance is termed as uninsured, irrespective of other insured objects not related to health. In 2009, 50.7 million people, which is 16% of the total population were without medical insurance in the United States. Furthermore, the non-elderly uninsured population is continuously increasing since 2000. The uninsuarance rate causes still remain an issue of political dispute. The rise in the costs of insurance has resulted to a trend whereby few employers offer medical insurance, and the majority of employers are supervising costs by needing higher contributions from the employee. The majority of the uninsured people are the unemployed or the working poor. On the other hand, some of them are health; however, they choose not to be insured (Philis et al., 2004).

Among these people, there is a group that due to serious illness and chronic medical conditions does not have the potential to shift insurance companies and resource for superior premiums. Therefore, in order for these people to reserve coverage, they ought to accept to recompense higher premiums, co-payments, and deductibles while simultaneously, their out-of –pocket expenses keep getting higher and higher. Another statistics shows that in the last four years, the amount of people who are underinsured has risen by 60% whereby the largest percentage is signified by families whose income is under the poverty level. However, the underinsured middleclass group families are growing rapidly (Voorhees et al, 2008).

According to Shaw et al. (2011), there are several general concepts that ought to be considered when categorising a person as underinsured; however, they range from one person to the other, and also depend on the circumstances. According to research, a person who is under insured’s expenditure is more as compared to one in every seven people who lack medical insurance in the United States. There are several factors that play part in determining if a person has a likelihood of getting health coverage. Young adults, ethnic and racial minorities, individuals, and males living under poverty are represented disproportionately among those who are uninsured.

In the United States, about 35% adults are uninsured or underinsured. Both the uninsured and the underinsured adults have likelihood to assume essential medical care as compared to those having adequate medical coverage. On the other hand, financial stress rates from underinsured people are identical to the uninsured. The uninsured and underinsured population continues to grow, the hardships of taking care of medically needy patients has declined majorly on community health clinics, university referral or state-supported hospitals, as well as other government-supported medical care facilities (Saha & Shipman, 2008).

Low income workers as compared to higher income individuals have a less likelihood to be given medical coverage by their employer or the spouse’s employer, and are less capable of buying it. Since the Second World War when price and wage control started, as well as cemented by the exemption of income tax ruling in 1954, the majority of working Americans have gotten their medical insurance from employers. The current trends show otherwise in that there is a continuous decrease in the decline of employer sponsored medical insurance benefits. For instance, in 2000, the percentage of small companies that offered medical benefits was 68. However, with time, the number has considerably dropped. In 2007, only 59% of small companies offered medical benefits. On the other hand, larger companies seem to maintain a constant trend, 99% in 2000 and 2007. However, on average consideration of all firms of every size, there is a considerable decline in the number of workers being offered medical insurance (Martin et al., 2007).

According to research published in 2008, people who have an average health have a low likelihood of getting insured when they possess a large group medical coverage. On the other hand, they have a high likelihood of getting insured if they possess a small group insurance cover, and most probably become uninsured when they possess individual medical health. However, people who have fair or poor health, their likelihood of loosing medical coverage are bigger from individuals with small group coverage as compared to those people with an individual insurance. This can be attributed to the combination of high costs in the market, as well as coverage renewability. Usually, individual medical coverage costs more when purchased in cases when a person becomes sick, however it offers superior protection as compared to group insurance against huge premiums for a person who is already insured. Moreover, people who are health have a high likelihood of dropping individual medical coverage as compared to less expensive and subsidized coverage that is employment based; however, group medical coverage leaves them being more vulnerable to losing or dropping all or any medical coverage. Approximately, 25% of uninsured people are qualified for public medical coverage; however, they are not enrolled. This can be attributed to various reasons such as lacking programs or enrollment awareness, reluctance that occurs as a result of stigma related with public medical coverage, poor enrollees retention, as well as administrative procedures that are burdensome (Voorhees et all, 2008). In 2009, research indicated that lack of medical coverage is related with more than 45,000 deaths annually. This implies that as the number of uninsured and underinsured continues to rise, the death also continues to increase.

The majority of Americans have a private medical insurance. However, citizens of the majority of wealthy countries have a national medical insurance. This makes the Americans defend the situations of their worsening health systems with the notions that their medical care system is private while for the other countries, the medical care system is public. However, these kinds of notions make it difficult to understand the prevalence of private health hospitals and practices in other countries, as well as the dominance of United States tax-financed medical care. Americans pay more taxes per capita to finance medical care as compared to other countries’ citizens in the world. Usually, the main role of the American government in financing medical care is hard to understand due to the fact that about a third of the taxes roam through private insurers. This implies that what originates in form of taxes paid by individual households become recycled privately in CMS accounts. Insure firms do not only siphon profits and overhead in due process, but they also inflict massive paperwork costs and burden on providers. As compared to other nations, medical care in the United States need not increase under that national medical insurance due to administrative savings that would offset roughly that elevated costs of medical care for the current underinsured and uninsured persons. The fact that national medical insurance could not cost the United States citizens more, it implies that taxes could recompense a huge health care costs share and those private patients and insures would end up paying a lesser share. However, the United States government currently spends much more on medical care as compared to other countries in the world. However, this could imply that national medical insurance will need a lesser increase in tax (Philis et al., 2004).

According to Saha and Shipman (2008), the number of Americans who are underinsured and uninsured is one of the major medical problems that politicians try to avoid, and the problem is getting worse with time. The politicians are victims of public medical policy that is confused. This can be attributed to the fact the medical community leaders have not fully faced up the medical problem. American politicians, and to a huge degree, the main health societies seem to be incapable of deciding what the responsibility of the society in medical care ought to be to people who are incapable of purchasing basic medical coverage. On the other hand, the mishmash of the rising number of Americans lacking medical care insurances, as well as the reaction from the public to the managed medical care abuses has revived the debate about the reform for future health care.

Health care insurance in the United States has evolved over time. The United States attempted to make medical insurance a compulsory in 1917 when the proposal to offer medical cover for employees earning less that $ 100 dollars per month, as well as their families got defeated in the Congress. The insurance premium was paid by the government, workers, as well as employees. In 1935, Social Security Act aimed to be combined to national medical insurance, but failed. In 1939, a bill was introduced to assist state medical insurance programs, but failed to pass the Congress. In 1965, due to intense public pressure, the Congress passed the Medicare and Medicaid Acts, which became the first main step to national medical insurance. In 1970, in spite of the introduction of several medical bills, they all failed to pass. The last main effort was made in 1993 by President Clinton towards natioal medical insurance. This was an attempt primarily developed by private insurers and corporations in the United States. It was much thrust and sudden for the public and; therefore faced opposition due to the concepts of controlling the policies by the federal government, as well as the costs. This proposal pointed out several aspects such as the need of health security from the public, the significance of primary care and preventive medicine, mental health services parity, and the necessity for long-term care. This resulted to the action of the federal government in particular areas like HIV, breast cancer, children medical care, diabetes; however, there existed no need to reinitiate a different national medical care approach. The main problems with these programs were the difficulties encountered in effective monitoring of the program, and determining how quality care can be measured. The United States has tried several options such as indemnity insurance that proved to be expensive, charity care that proved to be unreliable and uneven, and health care management that proved to be confusing, and therefore, with ranges of care and plans multiplicity, the underinsured and uninsured are still left with no substantial health care (Martin et al., 2007).

America is the only main industrial country that has not offered essential medical insurance for all its population. It is also the only wealth nation that has a concern largely with the private health care market. After the Second World War, all the other main industrial nations developed national medical insurance. Presently, 100% of the population in Japan, Sweden, Britain, and Canada are covered by national medical insurance, 99% in France. However, in America, about 40% of the entire population has national medical coverage (Medicaid, federal employees, Medicare), 15% of the population is uninsured in which 18% of them are below 65 years, while the rest are medically covered by other insurance and managed health care. In 1996, statistics showed that Japan spent 6.9%, Britain 7.1%, Canada 10.3% while the U.S spent about 14%. In the majority of the countries, the national expenditure relate to population medical coverage for essential medical care such as Medicare and Medicaid (Slater et al., 2005). The United States stand out as the country among the industrialized nations with the highest share of health care expenses with its citizens paying out of their pocket. Research also indicates that there will still be a huge family and patient exposure to health care expenses in the future.

There are several attempts that have been made by various bodies to address the issue of reinsured and uninsured. For instance, the current federal policies have accelerated to increase attained cost sharing through the establishment of health saving accounts (HSAs) that are tax protected. These accounts are only available to those people whose policies for insurance have minimum deductibles of $1,000 for every person. Moreover, the proposals for healthcare reform put forth by the president will also enhance such a plan. On the other hand, attempts to redesign the industry of health insurance have continued with little consideration of patients, as well as the ability of their families to recompense or the financial risk exposure consequences. Increasing cost sharing for patients might leave adults with medical cover without sufficient financial protection in case of sickness, and might lead to an increase of uninsured Americans. This implies that if insufficient protection creates a barrier to proper medical care, the trends in the market will undermine the main health insurance goal, which is to enhance access that is timely to medical care when required and to guard patients from expenses that will be catastrophic in relation to their income (Lo Sasso & Byck, 2010).

Usually, increase in patients cost-sharing has adverse effects on the patient’s access to timely medical care, which can be predominantly acute for population with low-income. Plans rarely create adjustment to the exposure of costs on the basis of income. Furthermore, by design, higher cost-sharing transfer the costs to the sicker population. Therefore, the combination of low income and poor health raises financial stress and access barriers risk (Shaw et al., 2011).

There are numerous factors that contribute to the rising numbers of underinsured and uninsured people in the U.S. One of the factors is that welfare reform initiatives limit the potential of the majority of low-income, unemployed people to gain access to medical coverage. Low income people might lack medical cover because of being unemployed, because insurance is not offered by their employers an unemployment benefit, or because they have inability to afford it. On the other hand, even those who have medical coverage might discover that their potential to gain access to essential medical care get inhibited by considerable requirements for cost-sharing (Schoen, 2011).

According to Schoen (2011), the establishment of healthcare policy leads to several impacts. Patients who have no medical care insurance or who have inadequate insurance experience hardships in accessing medical care and; therefore, are less confident, as well as less satisfied with the medical care quality they receive. In spite of the greater cost sharing proposal as a means to reduce the increasing medical care cost, and assist temperate the inflation of healthcare cost through encouraging patients to be more cautious healthcare services consumers, little attention is given to the disadvantages of the approach. Usually, insurance redesign advocates regularly envision coupling elevated deductibles with personally funded or employer funded HSAs, which can be employed to pay costs at the front-end. However, in the contemporary marketplace, policies for insurance seldom include patient costs sharing that are adjustable or out-of pocket limits.

There are several consequences that providers for health care, as well as individuals face for being uninsured. For instance, people who are uninsured possess a higher rate of not being able to meet medical needs, as well as are most likely to forego getting medical treatment. This implies that for the community of health care, the existence of a massive uninsured population causes several challenges. People who are uninsured have a high likelihood of using emergency rooms as compared to those who are insured as a usual care sources. This is because they either lack primary care access because their health problem is escalating (Martin et al., 2007).

The medical insurance industry plays a vital role in determining the number of underinsured and uninsured people. However, this industry is undergoing considerable change. Medical insurance companies and employers are searching for means to temperate premium rise by giving innovative insurance products, which in return transfer the medical care financial burden in an individual. On the other hand, insurance premiums and healthcare costs are increasing. The current trend in medical insurance companies indicates plans to have higher patient cost-sharing, deductibles and more benefits that are restricted. This implies that the shift could give rise to the patients whose disclosure to elevated medical expenses is higher as compared to their income; therefore, a great risk of finance for patients having insurance, but lacking the resources for finance to absorb shifts in costs (Slater et al., 2005).

Taking into consideration the analysis above, it can be recommended that the government policy makers in the United States ought to address the wants of the rising number of underinsured and uninsured patients through the conduction of periodic national state updates on the underinsured Americans, as well as monitor the effect of accessing medical care. On the other hand, policy makers must pay attention to health insurance adequacy, as well as the effectiveness of care that patients receive. Lack of attention will undermine the country’s productivity, health and financial security. On the other hand, the health care industry should take into consideration the condition of its patients and their family. There is need to advance with cautious in the process of changing the design of medical insurance plans so as to avoid placing patients, more especially the sick and the poor, at an elevated financial risk. The stakeholders needed to be involved to implement these recommendations include the government, insurer companies, as well as the medical society. This can be achieved by all the stakeholders working jointly. The fore mentioned recommendations will end up increasing effectiveness’s and timely service in medical care and also lower the number or uninsured and underinsured people.


The increasing health insurance costs together with the rise in medical care costs are affecting the majority of families in the world. The essay above has analyzed uninsured and underinsured in the United States. It is evident that the lack of the ability to pay medical treatment bills impacts not only those who are uninsured, but also those people who recompose medical coverage. It is recommended that policy makers ought to address the wants of the rising number of underinsured and uninsured patients through the conduction of periodic national state updates on the underinsured and monitor the effect of accessing medical care. Policy makers must pay attention to health insurance adequacy and the effectiveness of care that patients receive. Lack of attention undermines the country’s productivity, health and financial security. On the other hand, the health care industry should take into consideration the condition of its patients and their family.