Introduction
Financial barriers to healthcare are a significant public issue that limits access to quality and efficient healthcare services. This social determinant of health significantly affects populations living below the poverty line (Bindman, 2020). The healthcare quality provided to marginalized groups in the United States varies widely. Racial and ethnic minorities, the economically disadvantaged, and patients with terminal illnesses are all people who are potentially at risk of mortality due to the high costs of healthcare. Poverty greatly impacts healthcare access for low-income earners (Benitez, 2022). For instance, due to financial barriers, impoverished individuals often lack access to adequate healthcare services. The reason is that out-of-pocket funding for medical care can be unaffordable for those living in poverty. This factor can lead to delayed or disregarding medical care, resulting in poor health outcomes (Borgschulte and Vogler, 2020). Therefore, policies such as the Medicaid expansion program are essential in bridging the gap in health disparity among people affected by social determinants of health, including poverty.
Medicaid Expansion
A social policy in healthcare in the US that addresses economic restrictions in access to care is the Medicaid expansion. Medicaid expansion is an important policy initiative that aims to provide health insurance coverage to more individuals and families. It has been made possible through the Affordable Care Act (ACA), which expanded eligibility requirements for Medicaid to include people with incomes up to 138% of the federal poverty level, including adults without children (Lin et al., 2021, p. 1). It is designed to ensure that individuals who would otherwise not be able to afford health care can receive the necessary treatments and preventative care they need (Blavin and Ramos, 2021). The reason is that it is comprehensive coverage that does not discriminate since people from diverse groups, including age, gender, ethnicity, and religion, can benefit from the program as long as their financial status is below the poverty line (Buchmueller, Cliff, and Levy, 2020). This factor indicates that the program benefits most people by increasing access to quality individualized care.
Medicaid expansion is funded by both federal and state governments and is administered through state programs. The primary objective of Medicaid expansion is to reduce the number of uninsured individuals in the US and improve the quality of healthcare provided to those most in need. Evidence of Medicaid expansion in 2014 indicated a drastic fall in the uninsured rate, from 18% to 12% (Lin et al., 2021, p. 1). There was a net gain of 16.9 million people covered by health insurance between 2013 and 2015 due to state and private sector efforts to enhance coverage (Lin et al., 2021, p. 1). This factor indicates that through the policy, more people have gained access to affordable healthcare services, improving wellness.
This policy functions by expanding access to healthcare so that individuals who would not have been able to access care due to financial constraints can now receive treatments and preventative care. This policy provides more comprehensive coverage, including prescription drugs, mental health, and preventive health services (Brown et al., 2021). Medicaid expansion has been shown to impact individuals’ health outcomes positively. Studies have shown that individuals who are enrolled in Medicaid are more likely to receive preventive care and screenings and are more likely to have better health outcomes overall (Benitez, 2022). Additionally, Medicaid expansion has been shown to reduce economic barriers to care, as individuals are more likely to seek medical attention when the cost is not a barrier.
The expansion of this coverage has supported the reduction of mortality rates in the country through comprehensive financial aid among geriatrics living below the poverty line. As Broaddus and Aron-Dine (2019, p. 2) mentioned, the expansion of Medicare coverage has enabled 19200 lives to be saved due to increased access to care. The consequences of non-implementation of this policy in other states have also been highlighted since it increases significant mortality rates. As highlighted in the figure below, there has been a downward trend in the mortality rate from 2014 to 2017 since the implementation of this policy, considering that people can access quality care for their needs.
The program significantly benefits the economy’s stability since it enhances revenue collection by the federal and state governments. Expanding Medicaid has been linked to increased healthcare jobs, as more people can access healthcare services (Cross-Call, 2018). It focuses on reducing the number of uninsured individuals in the US to improve the quality of care provided to those in need and to reduce economic barriers to care (Brevoort, Grodzick, and Hackmann, 2020). The insurance program also enhances the economy by facilitating effective compensation and employment in the health industry (Lee, Dodge, and Terrault, 2022). In addition, expanding Medicaid can help reduce the uncompensated care that hospitals and other healthcare organizations have to provide (Scott et al., 2021). This increment can help reduce financial burdens experienced by providers and allow them to focus their resources on providing better care.
Restrictions of Medicaid Expansion
Despite its potential benefits, Medicaid Expansion does come with some restrictions. The new Medicaid Expansion has placed restrictions on the number of people eligible for coverage. The federal government requires that states cover individuals below the age of 65 with incomes at or below 138% of the federal poverty level (Aron-Dine and Broaddus, 2019, p.1). This limit requires single individuals should make less than $17,236 a year, and a family of four must make less than $35,535 a year to qualify for the program (Aron-Dine and Broaddus, 2019, p.1). In addition to the income requirement, Medicaid Expansion requires that individuals be pregnant, disabled, elderly, or have dependent children (Han, Lai, and Yu, 2020). Adults who do not have dependent children are not eligible for coverage, and individuals with incomes above the poverty line are not eligible for coverage.
Another significant issue is that the program does not cover all medical costs for those who qualify for coverage. In most states, the expansion only covers certain medical services, such as hospital stays, preventative care, and doctor visits (Liu et al., 2020). The reason is that the Medicaid expansions still do not cover prescription drugs, dental, vision, or mental health care services. In addition, some states have implemented “cost-sharing” provisions that require recipients to pay a portion of their medical expenses (Hamer et al., 2022). The Medicaid Expansion also limits the type of services that are covered. Most states only cover essential health benefits, such as physician visits, hospitalizations, and prescription drugs. Furthermore, some states have implemented work requirements or other restrictions that limit the number of people who are eligible for coverage. All these restrictions have made the viability of this cover questionable.
Analysis of the Benefits of Medicaid Expansion using the Root Cause Analysis
Root Cause Analysis (RCA) is a systematic process used to identify and analyze the underlying causes of a particular problem or event. It is a structured problem-solving method used to identify the primary factors contributing to a policy issue or problem in public health (Conger, Vrbanic, and Basic, 2020). RCA frameworks in public health policy are designed to analyze a given problem and identify the factors contributing to the issue. The RCA framework typically involves a four-step process. First, it involves defining the problem, gathering data, and understanding the relevant context. Second, it involves identifying the root causes by analyzing the data and considering the various factors that may have contributed to the problem.
The analysis involves developing solutions based on the identified root causes. The reason is that implementing the solutions focuses on addressing the underlying causes and resolving the problem. RCA frameworks in public health policy are designed to help policymakers better understand the causes of a particular issue and identify solutions that can be implemented to address the problem (Singh, Patel, and Boster, 2021). As Mazurenko (2018) mentions, policy analysis is integral in achieving viable reforms in health promotion and supporting public health. This approach is especially useful when developing policies related to complex, multi-faceted problems, such as chronic disease, mental health, and financial constraints in healthcare. Therefore, policymakers must use the frameworks to establish a strategic approach toward achieving the goal.
Policymakers looked at the Medicaid program and saw a gap that had detrimental effects on people’s health. Some consequences of high medical care costs include reduced access to health care, high rates of uninsured individuals, high mortality rates, and significant economic effects (Cooper, Sharfstein, and Thornton, 2021). Therefore, a lasting solution must be established to eradicate the menace in healthcare. The reason is that the root cause of these problems was the high cost of medical care which restricted access to services. Expanded Medicaid coverage is linked to increased access to care and utilization of self-rated care, which enhances the quality. This framework provided a sustainable structure for implementing a new mechanism to promote better health outcomes.
Impact of Medicare Expansion on Population’s Health
Medicaid expansion has established significant strides in healthcare access by enhancing utilization, insurance coverage, the economy, and general positive health outcomes. As represented in the figure, the rate of the insured has increased with the Medicaid expansion to almost 40%, indicating that the expansion has been embraced due to the increased use. McMorrow (2021) revealed that Medicaid expansion had enhanced access to care for individuals living within the poverty line limit. The rate of uninsured individuals has declined from 38% to 24% by 2017, which indicates significant uptake or enrollment into the insurance policy.
Another significant effect of the Medicaid expansion is that it has reduced the unmet needs for medical care based on cost by 3% since its implementation, and this showcases integral (Crowley et al., 2020). In addition, the policy has enabled many people to access care from different sources or providers, enhancing patient outcomes. The reason is that 57.7% of Americans can access doctor’s services when unwell (McMorrow, 2021). Another consideration is that 72.5% of people residing in the US reported seeing a health expert for the past 12 months, indicating high utilization of medical services (McMorrow, 2021). All these factors indicate that Medicaid advancement has significantly increased access to medical care among diverse individuals.
The Implication of Social Policy for Effective Leadership and Management Strategies
Leadership and management strategies are essential for organizations to achieve their desired outcomes and objectives. Social policy is a set of guidelines that the government formulates to guide the activities of a society, such as how resources are allocated, what services are provided, and how citizens interact with each other (Hu et al., 2018). Leaders and managers need to understand the implications of social policy and how it can influence their strategies (Ercia, 2021). First and foremost, social policy affects the allocation of resources. It can dictate how much money organizations can invest in different areas, such as staff training and development or purchasing new technology and equipment. Therefore policies must be created with the needs and goals of the organization in mind and should be reviewed regularly to ensure they are still relevant and appropriate
Social policy can influence how organizations recruit and retain staff and the benefits and salaries they offer. As such, leaders and managers must ensure that their strategies align with social policy to optimize the use of resources. For instance, Medicaid reimbursement principles require healthcare organizations to ensure they maintain positive patient outcomes to maintain their reimbursement. On the other hand, the healthcare staff must also be paid their wages on time and appreciated for their commitment to enhancing motivation. Wage increments can foster a culture of collaboration and innovation and create a sense of belonging and purpose (Kino and Kawachi, 2018). Therefore, leaders must ensure that their facility provides quality services to enhance outcomes and maintain the stipend.
Social policy can also affect how organizations interact with their customers and stakeholders. For example, organizations may be required to adhere to certain standards regarding customer service, or they may need to comply with certain regulations regarding the safety and security of their stakeholders (McInerney et al., 2020). Leaders and managers must know these requirements and ensure that their strategies align with social policy.
Effective management strategies require understanding the social policies in place and how they affect the operations of a business. For example, social policies can influence how a company hires, manages, and rewards its employees depending on the restrictions and loopholes available (Mechcatie and Rosenberg, 2018). These policies can also affect how a company interacts with its customers and suppliers. Social policies can also influence the type of products and services a company offers and how it markets them.
Effective management strategies should also consider the wider implications of social policy on the organization and its stakeholders. For example, social policies can influence how a company is perceived by its customers, suppliers, and the wider public. Currently, the Medicaid expansion program has attracted positive user reviews due to its capacity to cut out-of-pocket costs, making many people believe in and invest in the process (Staff, 2021). Therefore, effective management aligning with a policy can significantly affect a company’s reputation and ability to attract and retain customers, suppliers, and investors.
Various practical and ethical issues affect the Medicaid expansion program (Roy et al., 2020). One of the main practical issues is the cost of Medicaid expansion. Medicaid expansion is expensive, requiring states to invest additional resources and infrastructure to implement the new rules successfully (Stimpson et al., 2019). For example, states must ensure sufficient staff and resources to process applications and manage the program. Additionally, states must pay a portion of the cost of the expansion, which can be a significant burden on state budgets.
Another practical issue is access to care since the healthcare services serve a larger population, which can present challenges in ensuring sufficient provider capacity. Most people live below the poverty line, making them eligible for subsidized prices when paying for healthcare services. Therefore, the system becomes clogged with many beneficiaries requiring help, reducing its efficacy (Peng, Guo, and Meyerhoefer, 2020). Implementation is also a problem since states must ensure that they can implement the expansion within the time limit and that the expansion is implemented in a way that is compliant with Medicaid requirements and regulations (Rhodes et al., 2020). Additionally, states must ensure that the federal government properly reimburses them for the costs associated with the expansion. Furthermore, states must be able to manage the administrative burden of enrolling and tracking newly eligible individuals.
On ethical considerations, expanding Medicaid is a challenging requirement for many states. Although the expansion would provide coverage to millions of individuals who do not currently have access to health care, there are questions about whether the expansion is affordable for states and whether it is the most effective way to provide health care coverage (Tipirneni et al., 2021). Additionally, there are questions about how the expansion will impact existing Medicaid programs, such as whether it will provide adequate access to care and how it will affect the quality of care provided to existing Medicaid beneficiaries (Whitman et al., 2021). Furthermore, there are questions about how the expansion will impact access to care for those who are not eligible for Medicaid and cannot afford private insurance.
Implications of Medicaid Expansion
Medicaid expansion policy has significant implications for practice that directly affects healthcare providers, organizations, and patients. On the provider side, expanding Medicaid will increase the number of patients who need care and the services that providers can offer (Ward and Bridge, 2018). This factor will require providers to become more knowledgeable about the Medicaid system and the requirements for reimbursement to avoid discrimination and stigmatization (Lee et al., 2021). Providers will also need to become more aware of the eligibility requirements for Medicaid and the services that can be provided to Medicaid patients.
Organizations must adjust their interactions with Medicaid patients to provide the appropriate services and ensure they are properly documented. Additionally, they will need to become more familiar with the billing procedures associated with Medicaid to ensure that they are properly compensated for their services. At the patient level, expanding Medicaid will allow more patients who may not have been previously eligible to access services that they may not have been able to access before. This program can include access to primary and preventive care, mental health services, substance use treatment, and other services that can improve the patient’s overall health.
Conclusion
The expansion of Medicaid has positively impacted individuals, communities, and the overall economy of states that have chosen to participate. By increasing insurance coverage, Medicaid expansion has made healthcare more affordable and accessible to those who need it most. This program can improve overall health outcomes, as individuals can now access the care they need (Whitman et al., 2021). Expanding Medicaid coverage has also boosted state economies, as the increased demand for health services has created more jobs and increased economic activity. Rhodes et al. (2020) explain that Medicaid expansion has enabled states to support their healthcare systems better, providing resources to those in need while helping to reduce the financial burden of providing healthcare. Therefore, expanding Medicaid has been a beneficial step forward for individuals, communities, and the economy, especially those living below the poverty line.
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