Running Head: HEALTH CARE POLICY ISSUES

Health Care Policy Issues

Kelly Erazo
National University

HEALTH CARE POLICY ISSUES

Introduction
Although the Affordable Health Care Act (ACA) has implemented policies that have affected
many individuals already, there are still issues that need to be address through additional health
care policies. The most critical current policy issues are Medicaid expansion, high out-of-pocket
costs even for the insured, and value-based purchasing. These policy issues focus on access, cost,
and quality of care, all which are highly important for health care delivery.
Access to care
A current policy to increase access to care is occurring through the expansion of Medicaid.
Currently, there are 27 states plus Washington D.C. that are expanding Medicaid (Where the
states stand on Medicaid expansion, 2014). States have the option to expand or not expand
Medicaid in their state, allowing some individuals to benefit with the expansion while others
cannot. However, even if a state has chosen not to expand Medicaid, individuals are still
encouraged to apply (Medicaid expansion & what it means for you, 2014). Medicaid is being
expanded to cover adults under the age of 65 who make up 133% of the federal poverty level
(FPL), regardless of their age, family status, or health (Medicaid expansion & what it means for
you, 2014). This voluntary expansion of Medicaid is intended to reduce the number of uninsured
individuals in the U.S., although there is still a large number of uninsured patients that Medicaid
does not cover.
Cost of care
Health insurance is designed to alleviate patients of the high costs of medical services, which is
only beneficial to the insured population, leaving the uninsured with high out-of-pocket medical
costs. However, with the continuation of rising costs, even the insured are having trouble

HEALTH CARE POLICY ISSUES

affording health insurance. Schoen et al. present some key findings that demonstrate this issue.
According to Schoen et al. (2013), about 40% of both insured and uninsured individuals in the
U.S. spent $1,000 or more out-of-pocket during the year on medical care, without counting
premiums. These numbers demonstrate the inefficiency of having health insurance when the
premiums and costs are so high that the insured pay almost the same amounts out-of-pocket as
uninsured. Additionally, Schoen et al. (2013) found that nearly one-quarter (23%) of U.S. adults
either had serious problems paying medical bills or were unable to pay them. Thus, cost of care
is a large issue for the insured just as for the uninsured.
Quality of care
The issue of quality of care is being addressed through a new strategy called value-based
purchasing. Value-based purchasing is defined as a demand side strategy to measure, report,
and reward excellence in health care delivery (Value-based Purchasing: A Definition, 2014). By
focusing on the quality services by the provider rather than the quantity of services, providers
will be motivated to improve their health care delivery and thus create a competitive atmosphere
based on quality rather than quantity. Patients will focus more on seeking highly-valued services
to receive the best medical treatment currently available.
Conclusion
Current health policy issues are focusing on improving the delivery of health care through factors
such as the expansion of Medicaid and value-based purchasing. However, patients are still
incurring high medical costs, whether they are insured or uninsured. This demonstrates the lack
of a large health policy that will cover all, if not almost all, of the U.S. individuals. By allowing
the states to voluntarily expand Medicaid, there is a lack of equality among all states to cover

HEALTH CARE POLICY ISSUES

their residents, and therefore the number of uninsured patients continues to exist and increase.
Access, cost, and quality are essential topics for policymakers to include in future health policies.

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5
References

(2014). Medicaid expansion & what it means for you. HealthCare.gov. Retrieved from
https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/
(2014). Value-based Purchasing: A Definition. National Business Coalition on Healths Valuebased Purchasing Council. Retrieved from http://www.nbch.org/Value-based-PurchasingA-Definition
(2014). Where the states stand on Medicaid expansion. The Advisory Board Company. Retrieved
from http://www.advisory.com/daily-briefing/resources/primers/medicaidmap
Schoen, C., Osborn, R., Squires, D., and Doty, M. M. (2013). Access, Affordability, and
Insurance Complexity Are Often Worse in the United States Compared to 10 Other
Countries. Health Affairs Web First. Retrieved from
http://www.commonwealthfund.org/publications/in-the-literature/2013/nov/accessaffordability-and-insurance