American healthcare can be improved by addressing its social determinants of health. This involves creating effective community health systems, eliminating obstacles to coverage for health insurance policies and expanding access to affordable housing options.
We can use programs that support state experimentation and waiver authority to enable states to experiment with innovative solutions within agreed national goals.
Focus on Social Determinants of Health
Health policy makers have become more cognizant of how patients’ well-being can be impacted by factors outside of a doctor’s office, known as social determinants of health. This encompasses everything from education access and neighborhood crime rates. Studies have shown that addressing such issues can result in reduced health care costs and better patient outcomes; one Robert Wood Johnson Foundation study discovered states with higher ratios of social spending relative to healthcare spending saw better patient outcomes.
States should go beyond healthcare in their efforts to improve residents’ lives and ensure everyone has an equal chance at good health. One way of doing this is promoting and supporting community-based approaches that address root causes of disparate health outcomes; another approach would be investing in community health infrastructure like creating a system for collecting and analyzing data on social determinants of health.
Affordable, stable housing is key to achieving health equity, as providing access to safe, healthy homes is proven to reduce asthmatic attacks and other respiratory conditions. Furthermore, investing in education has proven successful at increasing educational attainment levels among children and adolescents as they reach their full potential.
Reducing social vulnerability by decreasing poverty and improving economic conditions can alleviate stress which contributes to various health-related issues, including decreased quality of life, decreased work productivity and an increased risk for chronic diseases.
Though many organizations are taking steps to address social determinants of health, challenges remain. One such challenge lies within the Trump administration’s policies limiting access to public assistance programs and funding prevention and public health initiatives. To overcome such hurdles, states should collaborate in building an integrated healthcare system which addresses all aspects of wellbeing for a more equitable society.
To achieve this goal, governments should continue working collaboratively with national and international partners to design and implement innovative models that integrate health-related services with an emphasis on social determinants of health. They should also support research that investigates how social factors underlying individual and population health affect them and can be addressed accordingly.
Create More Access Points
American states should expand access points for Americans to interact with the health care system. They can do this by taking advantage of existing infrastructure like community health centers and expanding their reach through partnerships with hospitals, medical practices, school-based clinics, housing-health partnerships etc. These efforts must address local conditions that have an adverse impact on people’s health such as limited access to nutritious foods or safe transportation options and environmental hazards that impede interaction with care systems.
Many communities lack access to affordable healthy food, a condition known as “food desert.” By setting up new health access points such as mobile grocery stores, this barrier can be overcome. Furthermore, by working closely with community organizations such as food banks, health educators can promote healthier eating and active lifestyles within these localities.
Access points to health care are increasingly crucial, with rising costs making it increasingly difficult for millions of families to afford health insurance coverage. These costs are made more prohibitive by high deductibles requiring people to cover a portion of their care themselves before their coverage kicks in – leading to hospitalizations or early deaths as a result of forgoing necessary treatment.
America’s federal system enables its people to field-test different approaches to health reform, providing ideas time to gain momentum before being presented with an all-or-nothing political test on a national level. Western states used this tactic successfully when pushing forward women’s suffrage legislation, and state action and experience eventually broke down opposition against same-sex marriage. With appropriate leadership willing to build upon and adapt existing structures, structural change in our current health care system could occur more smoothly and sustainably than expected.
While landmark pieces of legislation like Medicare and the ACA have brought tremendous benefit to millions of Americans, inequities remain. With COVID-19 pandemic being in full bloom now, action must be taken quickly in order to address disparities and set in motion an equitable, efficient, comprehensive health care system. To start this process underway, strategic principles for action should be created that foster more cohesive policy outcomes that could garner national support. Click here if you want to learn more about the overall wellness of different US states.
Create an Option for Non-Expansion States
Millions of Americans’ health is at stake due to 12 states’ refusal to expand Medicaid. While multiple factors affect one’s wellbeing, accessing affordable coverage remains an enormous barrier. Without new patients coming in through safe net health service providers or hospitals will continue to face limited resources and lower Disproportionate Share Hospital payments with decreased capacities to invest in improving outcomes for healthcare.
The Affordable Care Act included provisions that allowed states to broaden Medicaid eligibility guidelines to adults earning up to 138% of federal poverty level (FPL), opening up coverage pathways for low-income individuals. As a result, uninsured rates in expansion states decreased substantially; however, remaining 12 states are experiencing coverage gaps without an immediate solution in sight.
Expanding Medicaid eligibility would enable these states to cover an estimated additional 5 million uninsured people; additionally, this expansion would result in a modest increase in employer-sponsored insurance while seeing a decrease in those covered through nongroup private plans.
However, these results don’t take into account that federal marketplace subsidies tend to be more generous in expansion states compared to nonexpansion states – meaning the cost of expanding eligibility in 12 of them up to 100 percent of FPL (with associated premium subsidy increases) could easily surpass this estimate of $27.2 billion.
To overcome this hurdle, some have advocated for creating a distinct public option in nonexpansion states that would enable existing marketplace subsidies from ACA marketplaces to extend to people earning below 100 percent of FPL, in addition to cost-sharing subsidies and cost-sharing reduction payments. While such policy might reduce uninsurance numbers in these states, expanding Medicaid eligibility might prove more cost effective.
However, this solution could provide the best hope for 2.1 million individuals currently in the coverage gap. Not only would it offer states financial relief but it would also address disparate health outcomes across the United States.
Allow States to Adapt and Innovate
The COVID-19 pandemic has exposed the huge inequities and gaps present within our American health care system, and shown how effective community health requires not only more access to medical resources but also increased attention paid to social determinants that can be controlled or changed for better community wellbeing. One way of ensuring these changes take effect effectively is for states to experiment with various approaches within a national framework – expanding health clinics locally or creating other points of access as well as focusing on social determinants or filling any gaps in Medicaid coverage or expanding health clinics or creating local points of access at once.
There is something quite extraordinary and magical about this momentous occasion of giving birth, this celebration. I will always keep this memory close at hand when the inevitable pain hits! State and local public health departments serve a key function: monitoring, detecting, and responding to disease outbreaks; conducting research on preventive measures; operating prevention programs; providing laboratory services; protecting food, drinking water and indoor air quality while managing costs for health care provision as well as protecting against environmental threats such as radiological threats, chemical spills, occupational safety risks or infectious diseases. Local and state health departments collaborate closely with federal health agencies like the Centers for Disease Control and Prevention (CDC), which leads efforts to control communicable disease outbreaks, promote mass immunization campaigns, develop public health emergency preparedness plans and oversee public safety emergency preparedness plans.
Public health agencies need to allocate their resources effectively in order to increase health outcomes, allocating funds to those most in need and responding swiftly to emerging threats. Unfortunately, many local and state health departments lack sufficient funding for this task, making it hard to meet such demands. This is especially problematic in states that have not expanded Medicaid coverage – where people living below poverty lines may lack health coverage and access to care.
To ensure people have access to health services they require, financial assistance must better align with individual circumstances and needs. This involves reducing vertical equity — caused by years of employer-based insurance that can disappear upon job changes — as well as creating horizontal equity by offering tax credits that provide equal assistance regardless of employment status or geography.
The Affordable Care Act’s expansion of Medicaid has provided coverage and access to care to many lower-income households. We must build on this success by making it easier for states to use funding flexibility within Medicaid to expand care in local markets while still meeting national goals.