10.5 Health Equity is Social Justice
Kathryn Burrows and Kimberly Puttman
As we examine the social structures of health and healthcare in the US and worldwide, we see that governments influence health outcomes. In this policymaking step of the social problems process, governments decide who gets insurance, how people have access to clean water, or whether to fund initiatives related to reproductive health. We’ll see that laws, policies, and practices related to health care and health access affect the social problem of health.
Changing US Healthcare Policy
US healthcare coverage can broadly be divided into two main categories: public healthcare, which is funded by the government, and private healthcare, which a person buys from a private insurance company. The two main publicly funded healthcare programs are Medicare, which provides health services to people over sixty-five years old and people who meet other standards for disability, and Medicaid, which provides services to people with very low incomes who meet other eligibility requirements. Other government-funded programs include The Indian Health Service, which serves Native Americans; the Veterans Health Administration, which serves veterans; and the Children’s Health Insurance Program (CHIP), which serves children.
Private insurance is typically categorized as either employment-based insurance or direct-purchase insurance. Employment-based insurance is health plan coverage provided in whole or in part by an employer or union. It covers just the employee or the employee and their family. Direct purchase insurance is coverage that an individual buys directly from a private company.
The number of uninsured people is far lower now than in previous decades, but that doesn’t mean everyone has the healthcare they need. In 2013, and in many years preceding it, the number of uninsured people was in the 40 million range, or roughly 18 percent of the population. The Patient Protection and Affordable Care Act (ACA), is a law that provides numerous rights and protections that make health coverage more fair and easier to understand, along with subsidies (through “premium tax credits” and “cost-sharing reductions”) to make it more affordable. When it was implemented in 2014 it allowed more people to get affordable insurance (Patient Protection and Affordable Care Act – Glossary N.d.).
The Affordable Care Act (ACA) was a landmark change in US healthcare. Passed in 2010 and fully implemented in 2014, it increased eligibility to programs like Medicaid, helped guarantee insurance coverage for people with pre-existing conditions, and established regulations to ensure insurance premiums collected by insurers and care providers went directly to medical care (as opposed to administrative costs). It also included an individual mandate, which required anyone filing for a tax return to either acquire insurance coverage by 2014 or pay a penalty of several hundred dollars. Other provisions, including government subsi