The assurance of affordable and equal access to health care is the overriding priority of every civilized nation. Nevertheless, issues related to health care disparities emerge in both developed and developing countries due to influences exerted by socioeconomic conditions (Braveman & Gottlieb, 2014; Griffith, Evans, & Bor, 2017). Similar trends are observed in the United States’ populations with different income statuses (Chetty et al., 2016). Despite efficient state interventions, such as the Affordable Care Act (ACA), in the United States, economically disadvantaged individuals have irrelevant health insurance coverage, lower life expectancy, and far worse access to health care services than those with higher income.
Insurance Coverage in Low-Income Populations
Socioeconomic indicators of income, wealth, and employment predetermine the insurance coverage level. Although rates of uninsured individuals have reduced significantly in the United States since the implementation of the ACA in 2014, there are still 12% of Americans without insurance within various social groups (Chen, Vargas-Bustamante, Mortensen, & Ortega, 2016, p. 140). Moreover, the enrollment in health-insurance exchanges varies across the United States because some states opted out of the Medicaid expansion (Griffith et al., 2017). In accordance with more recent research conducted by Griffith et al. (2017), 35% of low-income residents of nonexpansion states are uninsured, and 21% of poor individuals are uninsured in expansion states (p. 1508). Persistently high rates of uninsured Americans are mainly a reflection of their low economic status and inadequate incomes.
Aggravating racial and ethnic disparities in health care, inappropriate insurance coverage is apparent in low-income individuals from ethnic minorities. The lowest rates of insurance are identified in Latinos “compared with all other racial/ethnic groups” (Chen et al., 2016, p. 141). Although to improve ethnic minorities’ access to high-quality health care and insurance, under the ACA adopted in 2014, the U. S. Health Resources and Services Administration (HRSA) expanded the Community Health Centers Program and the National Health Service Corps. Income is considered a significant barrier to their insurance coverage (Chen et al., 2016). Poor Latinos, African Americans, Asians, and Native Americans are less likely to receive efficient care for their health needs than insured individuals with a higher income are.
Economically Disadvantaged Individuals’ Access to Health Care
Inadequate access to health care is one of the major social inequalities experienced by the United States’ low-income populations. Differences in welfare and living conditions generate reduced opportunities for needy individuals and decrease their abilities to cope with physical and emotional disorders. Approximately 20% of low-income people avoid care due to its cost (Griffith et al., 2017, p. 1506). The cross-sectional study pursued by Berkowitz, Traore, Singer, and Atlas (2015) has revealed that Americans living in poverty experience worse access to health care, including chronic disease management, “preventive service provision, resource utilization, and patient-centeredness of care” (p. 403). According to the research findings, economically vulnerable populations annually visit hospitals 5.4 times, while annual rates of visits of median-income individuals comprise 9.3 times (Berkowitz et al., 2015, p. 408). These statistical indicators testify to income-caused disparities in health care access. Thus, inequalities in welfare and living standards predetermine disparities in using effective methods of completing emerging health care needs.
Furthermore, the trends of health care disparities are specific to all age categories of poor Americans. For instance, in low-income household families, there are only 6.9% of children under 17 with good health in comparison with 30.4% of children with good health in high-income household families (Braveman & Gottlieb, 2014, p. 23). Diminishing the affordability of medications and screening, as well as the quality of preventive, primary, and routine care, low income elevates health risks for economically disadvantaged demographics.
Life Expectancy in Economically Disadvantaged Populations
The fact that economically disadvantaged individuals have inadequate access to the social and economic resources required for healthy lifestyles and environments and inappropriate access to various medical services is inextricably linked with their low life expectancy. Death rates are generally two to three times higher in the low-income population segment; life expectancy for unskilled workers is five years less on average than that of skilled professionals (Braveman & Gottlieb, 2014; Chetty et al., 2016). Moreover, low incomes and wages, inadequate education, and inappropriate living conditions reduce life expectancy in representatives of ethnic minorities (Braveman & Gottlieb, 2014). The dependence of mortality rates and life expectancy on income and the probability of a shorter life are formed because of prolonged accumulation of negative impacts of material deprivation and associated emotional responses. These trends manifest injustice and inequalities in health care, leading to huge losses of human resources that could be used for the benefits of American society as a whole.
Positive Changes in Low-Income Populations’ Health Care Access
Despite obvious inequalities in access to high-quality medical services specific to low-income individuals, there are still endeavors to embellish the current situation. Reassuring arguments include data on an increase in longevity of 2.34 years for men and 0.22 years for women from 2001–2014 (Chetty et al., 2016, p. 1758), higher insurance coverage for the economically disadvantaged under the ACA (Chen et al., 2016; Griffith et al., 2017), and reduced health disparities across the United States (Berkowitz et al., 2015). Low-Income populations’ access to health care has been ameliorated to some degree.
However, analyzing improvements in health care access and insurance coverage after the enactment of the ACA, Griffith, et al. (2017) claim that poor residents “had smaller gains, and the distribution of benefits was less concentrated in lower socioeconomic groups” (p. 1506). Furthermore, Chetty et al. (2016) admit that life expectancy in various income groups decreased in some areas while increasing in others. The given facts confute the statements of significant improvements in health care access for economically disadvantaged people. Therefore, while ensuring health equity and optimizing the public health system, the US federal policymakers and everyone involved in decision-making should eliminate avoidable and unjust divergences in health care between different social strata. The provision of health care and medical services should focus primarily on those who are unable to meet their basic health needs due to socioeconomic factors.
Summing up, the determinants of inequalities in health care are rooted in multiple spheres of public life. Therefore, it is essential to modify national policies in all these areas, assessing their effects on public health in general and the most vulnerable social strata in particular. Policies oriented towards the elimination of disparities in health care may significantly improve the health of poor Americans. In order to eliminate health disparities and mitigate their consequences, the United States’ health care system must adopt the most effective practices and adjust them to the healthcare needs of the most economically disadvantaged people.
Berkowitz, S., Traore, C., Singer, D., & Atlas, S. (2015). Evaluating area‐based socioeconomic status indicators for monitoring disparities within health care systems: Results from a primary care network. Health Services Research, 50(2), 398–417.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(1), 19–31.
Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical Care, 54(2), 140–146.
Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N.,… Cutler, D. (2016). The association between income and life expectancy in the United States, 2001-2014. Journal of the American Medical Association, 315(16), 1750–1766.
Griffith, K., Evans, L., & Bor, J. (2017). The Affordable Care Act reduced socioeconomic disparities in health care access. Health Affairs, 36(8), 1503–1510.