Implementation abuse disorder services, maternity and newborn care, preventative


The enactment of the ACA provided a unique
opportunity to address the underlying social, economic, and physical factors
which affect racial and ethnic groups’ access to and utilization of health care
services. Under the ACA, one major provision related to the law’s impact on
health disparities is Medicaid program expansion.

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Medicaid expansion was meant to play a
significant role in reducing disparities, by increasing access to care for all
and decreasing the number of uninsured. This provision also resulted in the
establishment of health insurance marketplaces, a platform where consumers can research
and compare coverage plans and apply any subsidies they are eligible for. Marketplace
insurance is required to provide coverage for the ten essential health
benefits: emergency services, outpatient care, prescription drugs, laboratory
services, hospitalization, pediatric services (including oral and vision),
mental health and substance abuse disorder services, maternity and newborn
care, preventative and wellness services, and rehabilitative and habilitative
services and devices (“Essential Health Benefits”). Regulations for the
marketplace insurance plans protect the consumer from discrimination based on
pre-existing conditions.

The main implementation challenge for
Medicaid expansion was the Supreme Court’s ruling that states could not be
mandated to expand their Medicaid program. The result is differential access to
care among states. Currently, 19 states have decided not to expand their
Medicaid programs. Unfortunately, racial and ethnic minority groups are the
populations most negatively impacted from this ruling because a significant
portion of the non-expansion states are in the south and southeastern regions
of  the US and these regions have the highest proportions of people of
color (Population Distribution by Race/Ethnicity, Kaiser Family Foundation,
2016). These regions also have the highest proportions of uninsured individuals
(Distribution of the Nonelderly Uninsured by Federal Poverty Level (FPL),
Kaiser Family Foundation, 2016).  Thus,
the people who are in these non-expansion states are not being supported to
obtain access to quality health services because of locality.

As an unintended consequence, the
non-expansion states will benefit far less in the ACA provisions for Medicaid.
Despite this challenge, the Kaiser Family Foundation reports that 15.1 million
people have gained coverage from Medicaid expansion, including 11.9 million who
were newly eligible through the ACA. There are 277,000 Maryland residents who
enrolled as a result of the expansion (Medicaid Expansion Enrollment, Kaiser Family
Foundation, 2016). It is an unintended consequence that the Medicaid expansion
would be a counterproductive effort as it could actually be further exacerbate
disparities, even though its intent is to decrease disparities.


Community Health Centers—What is the new
ACA funding being used for?



Need to fix intro to include all three
parts (#2 community health, #3 improving workforce)


It has been over seven years since the ACA
was created. In some aspects, it might be too early to fully assess the law’s
effectiveness on the health care delivery system, but in other ways, this is a
good time to reflect on the progress made thus far and consider any
modifications that can be applied.  The ACA’s most significant impact on
changes to health disparities since its implementation has been the decrease in
the number of uninsured, from 44 million in 2013 to 27.6 million in 2016 (“Key
Facts About the Uninsured Population”, Kaiser Family Foundation, 2017).
Antonisse et. al reported the larger increases in health care coverage came
from states that expanded its Medicaid program under the law (2016).

For racial and ethnic minority groups, the
ACA not only sought to increase healthcare access, but it also contained
several provisions to address barriers to affordable quality care. Among these
provisions include support for community health centers and improving the
existing workforce by creating opportunities to diversify personnel, as well as
strengthening cultural competency. Reducing health disparities is an important
issue given that racial and ethnic groups, specifically Blacks and Hispanics
experience negative health outcomes at a disproportionate rate compared to
non-Hispanic White Americans. As discussed previously, barriers for these
groups to access care is linked to underlying causes from issues in dimensions
of access.

Health care reform is a convoluted,
multifaceted initiative that continues to be a critical topic of our times. As
the most significant health care legislation since Medicaid and Medicare was
established, the ACA is a major step to improving access to care by making
affordable quality care available to low-income individuals. With respect to
implementing provisions that support health disparities reduction, the ACA is
living up to its promise and most provisions discussed earlier are in progress.
Combating health disparities should be an important goal for the government and
I agree with the policies that have been implemented toward this goal. In order
to maintain progress towards reducing health disparities, the government must
develop innovative solutions to assist low-income individuals who reside in
Medicaid non-expansion states and fall in the coverage gap because racial and
ethnic groups account are disproportionately represented among uninsured adults
in the coverage gap (Garfield and Damico, Kaiser Family Foundation, 2017). Han
et. al. found that health outcomes for low-income adults in non-expansion
states, who are disproportionately represented by Blacks and rural residents, to
be worse compared to their counterparts in expansion states. Additionally,
low-income residents in the non-expansion states had less annual care
utilization and medical expenditures, but significantly higher out-of-pocket
expenditures compared to counterparts in expansion states (2015). Ultimately,
the ACA need not be repealed or replaced, but recognized as a key step to equal
care access for all. It is not the end goal, but a stride in the right