Essay Sample on Retaining Medicaid and CHIP to Expand Children's Healthcare Access

Introduction

The elements of the current system that would be retained include Medicaid and Children Health Insurance Program (CHIP) because they have helped to expand health cover, improved access to healthcare, and outcome among the children. Medicaid and CHIP have led to the expansion of health coverage substantially among the children (Wherry et al., 2016). CHIP provides health coverage at a low cost to the children whose family's disposable income is high but does not qualify for Medicaid. In some areas, it provides health cover to pregnant women. CHIP coverage works in tandem with the Medicaid program of the state. Since the enactment of CHIP, the rate of uninsured children has drastically decreased by almost 50% (Johnston et al., 2017). Both Medicaid and CHIP have played a critical role in reducing disparities in coverage that significantly affect children from low-income households. A high population of children from low-income families has benefited from these programs, and their overall health has improved.

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Both programs have improved access to care among US children. Individuals with Medicaid and CHIP enjoy the benefit of having better access to preventive and primary care and unmet health needs compared to the children who are not insured (Johnston et al., 2017). The insured children have better access to specialists as well as dental care. Also, children under Medicaid and CHIP have more visits to the emergency department than others. It may be contributed partly by barriers to timely access to primary care like lack of after-hours care. A majority of physicians that provides care to the children participate in both programs, but the participation of dentist is low (Wherry et al., 2016). Most of the dentists who participate can limit the treatment to the patients covered by Medicaid or CHIP.

The expansions of Medicaid and CHIP have improved the health outcome of the beneficiaries. It includes reductions in child mortality and avoidable hospitalizations. Evidence shows that health improvement has resulted in educational gains (Wherry et al., 2016). The well-being among the children has reduced school absentee related to illnesses, which has translated to improvement in academic performance. Therefore, both elements would be retained to continue expanding health coverage, increase access to health care, and improve health outcomes among the children.

Elements to Change

The element that would be changed is the Affordable Care Act (ACA). Even though ACA has changed the US healthcare system by increasing the number of insured people, it has faults that need to be addressed. In the early years, ACA faced a myriad of challenges. When it started the rollout of online insurance, it encountered technical problems. Underfunding led to an increase in premiums (Crowley & Bornstein, 2019). Actions that may have a detrimental effect on ACA include regulations of expanding the insurance products that do not need regulations by the market law. It exempts the contraceptive coverage for organizations that have moral or religious objectives. There is also uncertainty about the reduction in cost-sharing payments. Medicaid waivers require individuals to either work or get engaged in the community. Such a requirement may force the sick and individuals from low economic backgrounds out of the program. The law also encounters the problem of premium tax credit limits. Despite the number of uninsured individuals remaining steady for a long time, the population of the uninsured is projected to rise. A majority of the uninsured persons are the elderly and individuals from economically disadvantaged families (Blumberg et al., 2018). There is a need to increase the number of insured people every year to ensure they receive various healthcare benefits. Universal healthcare cannot be effectively achieved without addressing the issues facing ACA. The reforms are necessary to realize a robust healthcare system affordable for everyone regardless of the economic status.

Payment of Healthcare

The legislature should enact a law to allow the development of a public insurance plan to increase coverage options for the enrollees. The participation of the insurers has reduced in some areas. In 2018, eight states had only one insurer providing coverage (Crowley & Bornstein, 2019). To expand both choices and increase competition, people qualified for the market-based coverage ought to have an alternative to enroll in an insurance program of public health. Based on its viability, general insurance could be available to any person seeking coverage (Blumberg et al., 2018). The public insurance plan can be used as a foundation to achieve universal healthcare coverage.

The law should be amended to ensure cost-sharing is reduced as well as out-of-pocket limits. The idea is to reduce the financial burden of the patients and prevent them from seeking essential care. The premium tax credits need to be set to cater up to 80% value gold plans instead of 70% silver plans (Kaiser Family Foundation, 2020). Currently, ACA has imposed an out-of-pocket limit under all coverage plans. The ceiling was required to be decreased by 66% for the families with disposable income less than 200% of FPL and 50% for households with an income that ranges between 200 and 300% of FPL (Kaiser Family Foundation, 2020). According to ACA, the actuarial value plans should not be increased by these reductions beyond the set limits for payments in cost-reduction. Cost-sharing relief ought to be available to people with low and moderate incomes.

The regulations of the employer's responsibility need an amendment to increase coverage. The least value coverage ought to include diagnostic tests, physician services, hospitalization, and pharmacy (Blumberg et al., 2018). The above services should also be covered in the minimum essential coverage. Failure of the employer to comply should be liable to penalties for the employer mandate. Employees who are not under minimum value coverage ought to have market coverage access with the support of premium tax credit (Crowley & Bornstein, 2019).

Innovative Ideas

One of the ideas is the improvement of health insurance design. The strategy would increase coverage by making healthcare more affordable by insurers (Blumberg & Holahan, 2017). Some of the market plans offered do not have deductible others restrict access to some services before the application of the deductible. Encouraging these designs by marketplaces would provide benefits to the enrollees. However, such models have some risks. Imposing a lower cost-sharing on people who have the least medical demands, higher-cost sharing must be imposed elsewhere as compensation mechanism (Kaiser Family Foundation, 2020). If providing services to the people with low medical needs tends to attract others into the marketplace, the coverage cost would reduce for all the participants in the market. Another idea is to allow those seeking coverage to use health reimbursement account in purchasing the insurance. The law should protect employees from being discriminated against by employers (Kaiser Family Foundation, 2020). All the employees should be treated equally to avoid high-cost employees from being dumped into the marketplaces. The legislation would ensure that employees are not disqualified from receiving benefits of premium subsidies in the market. The strategy would allow even low-salaried employees to seek coverage and hence increasing the number of people under the insurance cover.

References

Blumberg, L. J., & Holahan, J. (2017). Strengthening the ACA for the Long Term. New England Journal of Medicine, 377(22), 2105-2107. https://mfprac.com/web2019/07literature/literature/Misc/ACA-LongTerm_Blumberg.pdf

Blumberg, L. J., Holahan, J., Buettgens, M., & Wang, R. (2018). A Path to Incremental Health Care Reform: Improving Affordability, Expanding Coverage, and Containing Costs. file:///C:/Users/pc/Downloads/rwjf450565.pdf

Crowley, R. A., & Bornstein, S. S. (2019). Improving the Patient Protection and Affordable Care Act's Insurance Coverage Provisions: A Position Paper From the American College of Physicians. Annals of internal medicine, 170(9), 651-653. https://annals.org/aim/fullarticle/2731120/improving-patient-protection-affordable-care-act-s-insurance-coverage-provisions

Johnston, E. M., Gates, J. A., & Kenney, G. M. (2017). Medicaid and CHIP for children. Washington (DC): Urban Institute. http://www.urban.org/sites/default/files/publication/91321/2001371-medicaid-and-chip-for_children-trends-in-coverage-affordability-and-provider-access_0.pdf

Kaiser Family Foundation. (2020). Explaining Health Care Reform: Questions About Health Insurance Subsidies. https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/

Wherry, L. R., Kenney, G. M., & Sommers, B. D. (2016). The role of public health insurance in reducing child poverty. Academic pediatrics, 16(3), S98-S104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034870/