Dear Editor,
As US President Barack Obama heads toward re-election, I want to discuss the Obama health reform law, which was a significant accomplishment in his first term. It was not easily achievable, given the rising conservatism in the society and the political conservatives’ distaste for income redistribution, and in the case of health reform, removing health inequities in the society.
In 2010, about 50 million Americans (16.3%) had no health insurance, and this number is rising. There are three uninsured groups in the US: foreign-born residents not US citizens; young persons aged 19-25; and low-income families with a yearly household income of less than $25,000.
According to the Kaiser Foundation, the average annual health insurance premium for family coverage in 2010 was $13,770. And also in 2010, the government provided health insurance to 31% of Americans, and this percentage is rising. The last US Census indicated that 9.8% of children under 18 had no health insurance coverage. These aforesaid statistical data came from CNN Money (2011).
According to the US Census Bureau, important demographic trends in the US include ubiquitous urbanization, from 28% in 1910 to 89% in 2000, with more than 50% of the US population living in suburbs. Circa 2000, about 50% of the population was aged 35.3 years; those aged 65 and over numbered 35 million in 2000, and excepting seven states in the West, all the states in the US had more females than males circa 2000.
Uninsured and poor people are unable to benefit from improved health outcomes, thereby increasing the health inequities between those with resources and the poor and uninsured. Here are some good and poor health outcomes. Between 1994 and 2004, the US reduced death rates from cardiovascular disease by 24.7%, and actual deaths due to cardiovascular disease by 8%. And smoking prevalence fell from 42.4% in 1965 to 19.8% in 2007. In 2004, the Centers for Disease Control and Prevention (CDC) indicated that the US ranked 29th among 37 countries in infant mortality; in 2005, the US was rated at 24th among 30 OECD countries for a life expectancy of 77.8 years; and in 2007, the US Census Bureau and the National Center for Health Statistics reported that the US ranked 42nd among 200 countries in overall life expectancy.
Let us look now at the epidemiologic profile of the US in 2008 based on WHO data. Life expectancy at birth for males was 76 years and for females 81 years; the adult mortality rate per 1000 adults aged 15 to 59 was 107; the under-5 mortality rate per 1000 live births was 8; HIV prevalence per 1000 adults aged 15-49 was 6; and the prevalence of tuberculosis per 100,000 population was 3.
Against this background, US President Barack Obama set out in 2009 to address health inequities in the US and to reduce the uninsured numbers. The question as to how resources will be distributed to reduce health inequalities became significant as well as contentious.
I will source some of my data from the healthcare.gov website (US Department of Health & Human Services). The Patient Protection and Affordable Care Act was the law of the land in 2010.
This law specifies that low-income Americans, ethnic minorities, and other underserved populations frequently contract higher disease rates, have less treatment choices, and experience reduced care. They also tend to have less health insurance than others. The law will reduce health inequalities through preventive care. Medicare and a few private insurance houses now cover the cost of recommended preventive services as check-ups, cancer screenings, and immunizations. Funding now is provided to community health teams to respond to chronic disease. This law indicated that this funding is critical as minorities tend to have higher rates of diabetes, heart disease, kidney disease, and cancer. Infant mortality and post-birth complications afflict minorities and low-income populations; in this regard, funding is now available for home visits for pregnant women and newborns.
The law makes available diversity and cultural competency training for health professionals; health initiatives now have to utilize language services and outreach in underserved communities; and to advance communication between the patient and health professional, particularly among uninsured Hispanics. More financing is obtainable for community health centres providing services to 1 in 3 low-income persons and 1 in 4 minority persons. This new funding will bring on board 16,000 new primary care providers. And young people can now remain on their parent’s health insurance until age 26.
This law also eliminates insurance discrimination against sick people who are unable to acquire insurance, or where in the past they were asked to pay increased premiums. This law eliminates discrimination against women who oftentimes in the past were asked to pay increased premiums. And the law provides tax credits for those unable to pay insurance premiums.
It is clear that the Obama healthcare reforms will eventually expand and strengthen the primary care system through greater focus on community health centres, increasing the number of primary care providers, and the repositioning of physician payment methods vis-à-vis Medicare and Medicaid. The Obama health reforms add up to reducing health inequities in the US
Yours faithfully,
Prem Misir
