Health Care in the United States


Healthcare has always been in a constant state of flux, accelerating in the last two decades due to increasing costs, limited access to care and demands for quality. The paper is a scholarly discussion of forces that drive healthcare today, and your personal and professional experiences within the healthcare system. The content includes:

Overview of the history of healthcare insurance in the US.
Review and commentary on current healthcare policy finances and insurance reimbursement in regard to Medicare, Medicaid, private insurance and exchanges.
Discussions of access to quality care and disparities in underserved populations in regard to the Patient Protection and Affordable Care Act of 2010 (PPACA).
Presentation of specific examples to explain the relationship of current healthcare policies to your personal and professional experiences.


Health Care in the United States

The U.S. health care system continues to undergo numerous changes in terms of levels of access to care, rising costs, the pursuit of better quality. Major concerns have been raised in recent times particularly in regards to limited access, rising costs, and poor quality (Politzer et al., 2001). This issues can best be highlight through an analysis of the history of health care insurance in the United States. Focus should particularly be on the effects of policy changes relating to Medicare, Medicaid, as well as private insurance and exchanges. Discourse on health care should also take cognizance of the latest wave of change that has been occasioned by the enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA) (Rosenbaum, 2011). It is imperative for personal and professional experiences to be brought to bear on the analysis of contemporary changes in the country’s health care system. This paper discusses these issues with a view to create a better understanding of the U.S. health care system particularly in terms of disparities and access to quality care.


During the last two decades, many policy changes in the U.S. health care system have been put in place mainly with a view to improve outcomes and enhance access to a wider population (McGlynn et al., 2003). In 1997, for example, the Balanced Budget Act provided for several provisions relating to health benefits, leading to the formation the Medicare+Choice program. The law established the option of private health care insurance plans in addition to Medicare supplement policies. Medicaid was also modified to promote state flexibility, and a health insurance program targeting children was formed. Other health care changes that were instituted in the late 1990s include provisions for insurance coverage for patients undergoing reconstructive surgery following a mastectomy, restrictions on the disclosure of personal health information by financial institutions, and the acceptance of electronic signatures for easier administration of compensation, human resource, and benefit systems. Although these measures have been geared towards reducing disparity in health care access, many underserved populations continue to experience limited access to quality health care. At the same time, health care costs have continued rising drastically throughout the 2000s.

These challenges greatly contributed to the commencement of a political debate that culminated in the enactment of the Patient Protection and Affordable Care Act of 2010 (PPACA). The main driving force for the enactment of this law was the reduction of disparities mainly in terms of limited access to quality care by underserved populations across the country. Full implementation of the PPACA, commonly known as Obamacare, commenced in January 1, 2014. This is the time when the employer and individual responsibility provisions contained therein took effect. It was also the time when Medicaid expansions took effect. Similarly, this implementation timeline also marked the commencement of operations for health insurance exchanges at the state level.  An equally important development was that access to small-employer and individual group subsidies became a reality. These developments were preceded by a series of intermediate steps provided for under the PPACA.


One of the far-reaching implications of Obamacare is in regards to health care financing and insurance reimbursement through Medicare, Medicaid, private insurance, and exchanges. Following the enactment of this law, new rules and provisions on cost-sharing and premium subsidies in the health insurance industry are in place. The law has strengthened existing health insurance coverage systems and at the same time established new, affordable forms of employer-provided health insurance coverage. This has essentially led to the restructuring of Medicaid to ensure that all legal American citizens have health insurance cover. Parallel reforms have been introduced under Medicare as well. Cost-reduction efforts are being made mainly through constraints on Medicaid and Medicare spending, tax shelter, and new taxes on all high-cost health insurance plans. At the same time, new Medicaid options aimed at promoting community care and protecting spouses of persons with serious illness from facing impoverishment have also introduced. Towards the same objective, the PPACA also creates a voluntary insurance program designed to cover the long-term health care needs of the underserved population.  

            There is a strong relationship between the introduction of these health care policies and my personal and professional experiences. For example, increased access to health care by millions of hitherto underserved Americans has started putting pressure on the existing health care workforce (Islam & Nadkarni, 2015). I have encountered numerous situations whereby I am compelled to work longer hours in order to address the health care needs of the rising number of citizens whose access to health care facilities has been eased by the subsidies provided for under the PPACA. I sympathize with these citizens because they are being compelled to contend with rapidly increasing waiting times, reduced time with caregivers, limited access to health care providers, and decreased satisfaction. In conclusion, workforce problems are likely to constitute the next major hurdle to be overcome in the pursuit of affordable, accessible, and quality health care in the United States.


Islam, N. & Nadkarni, S. (2015). Integrating Community Health Workers within Patient Protection and Affordable Care Act Implementation. Journal of Public Health Management & Practice, 21(1), 42–50.

McGlynn, E., Asch, S., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A. & Kerr, E. (2003). The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine, 348, 2635-2645.

Politzer, R., Yoon, J., Shi, L. & Hughes, R. (2001). Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care. Medical Care and Research, 58(2), 234-248.

Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health Reports, 126(1), 130–135.

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