Running head: HEALTH POLICY, POLITICS AND PERSPECTIVES 1 HEALTH POLICY, POLITICS AND PERSPECTIVES 4 Health Policy, Politics and Perspectives Student’s Name Institutional Affiliation Why Are So Many People Uninsured and Underinsured? The Obamacare (Affordable Care Act) introduced sweeping change to the health care system in the United States. The act expanded comprehensive health insurance coverage to millions of U.S citizens. It made it possible for anyone with health challenges to get coverage by banning insurers from charging more or denying coverage because of preexisting conditions. Despite these changes, the number of uninsured and underinsured people have increased. Clark and Carter (2019) explain that more than 30 million people remain uninsured as of today with the number of Americans underinsured also increasing by the day. Another 31 million adults remain underinsured (Davis, 2019). Coverage gains are stalling in most states and regions because of a number of contributors some of which are analyzed and explained in this paper. Firstly, deductibles are a growing contributor and cause of the number of uninsured and underinsured people across the United States (Davis, 2019). Deductibles have been a growing concern and contributor of insurance and underinsurance because a good number of insured Americans than even before have health insurance plans having deductibles. Equally, Clark and Carter (2019) explain that more people have deductibles that are high relative to their average annual incomes. The proportion of privately insured adults who have had previous insurance plans without deductibles have also reduced significantly. Deductibles have outpaced growth in the income of several families and therefore represent a greater proportion of this income. It is estimated that more than 15 percent of American adults who have insurance coverage throughout the year have deductibles that are high relative to their family income (McLean, DeLong & Moyer, 2020). The effects of deductibles and the trend on family income have increased the rates of underinsurance and insurance significantly. The challenge of high deductibles relative to family incomes have been reported to be widespread in Texas and Florida in comparison to the national average. Secondly, low income is cited McLean, DeLong and Moyer (2020) as being a great contributor of the high number of the uninsured and underinsured. Adults who have health problems are also at a greater risk of being underinsured. Whereas there has been an improvement in the proportion of low-income individuals who are underinsured, the number is still significantly high. Despite the reduction and the decline in the numbers that have been recorded over the last ten years, people with lower income are still underinsured and uninsured at rates twice higher than the people with higher average incomes. Adults with health problems also experience underinsurance at greater rates. People with health proble ...

1. Running head: HEALTH POLICY, POLITICS AND
PERSPECTIVES
1
HEALTH POLICY, POLITICS AND PERSPECTIVES
4
Health Policy, Politics and Perspectives
Student’s Name
Institutional Affiliation
Why Are So Many People Uninsured and Underinsured?
The Obamacare (Affordable Care Act) introduced sweeping
change to the health care system in the United States. The act
expanded comprehensive health insurance coverage to millions
of U.S citizens. It made it possible for anyone with health
challenges to get coverage by banning insurers from charging
more or denying coverage because of preexisting conditions.
Despite these changes, the number of uninsured and
underinsured people have increased. Clark and Carter (2019)
explain that more than 30 million people remain uninsured as of
today with the number of Americans underinsured also
increasing by the day. Another 31 million adults remain
underinsured (Davis, 2019). Coverage gains are stalling in most
states and regions because of a number of contributors some of
which are analyzed and explained in this paper.
Firstly, deductibles are a growing contributor and cause of the
number of uninsured and underinsured people across the United
States (Davis, 2019). Deductibles have been a growing concern

2. and contributor of insurance and underinsurance because a good
number of insured Americans than even before have health
insurance plans having deductibles. Equally, Clark and Carter
(2019) explain that more people have deductibles that are high
relative to their average annual incomes. The proportion of
privately insured adults who have had previous insurance plans
without deductibles have also reduced significantly.
Deductibles have outpaced growth in the income of several
families and therefore represent a greater proportion of this
income. It is estimated that more than 15 percent of American
adults who have insurance coverage throughout the year have
deductibles that are high relative to their family income
(McLean, DeLong & Moyer, 2020). The effects of deductibles
and the trend on family income have increased the rates of
underinsurance and insurance significantly. The challenge of
high deductibles relative to family incomes have been reported
to be widespread in Texas and Florida in comparison to the
national average.
Secondly, low income is cited McLean, DeLong and Moyer
(2020) as being a great contributor of the high number of the
uninsured and underinsured. Adults who have health problems
are also at a greater risk of being underinsured. Whereas there
has been an improvement in the proportion of low-income
individuals who are underinsured, the number is still
significantly high. Despite the reduction and the decline in the
numbers that have been recorded over the last ten years, people
with lower income are still underinsured and uninsured at rates
twice higher than the people with higher average incomes.
Adults with health problems also experience underinsurance at
greater rates. People with health problems are at a greater risk
of being uninsured or underinsured because they have higher
costs of health care in comparison to healthier individuals. For
instance, individuals with chronic illnesses are likely to be
underinsured because of the high costs of care associated with
their conditions. McLean, DeLong and Moyer (2020) estimate
that among adults who are insured throughout the year, about 30

3. percent of those in poor or fair health or those having chronic
conditions are more likely to be underinsured than healthier
adults.
Lastly, the high cost of health insurance and job-related issues
cause a high number of uninsured adults (Clark & Carter, 2019).
The high cost of insurance is cited by nearly all the uninsured
individuals as being the commonest contributor of them lacking
insurance (Clark & Carter, 2019). The job-related reasons for
lack of insurance include lack of employment or
underemployment.
References
Clark, D. E., & Carter, D. W. (2019). Racial disparities exist
among burn patients despite insurance coverage. The American
Journal of Surgery, 218(1), 47-50.
Davis, K. (2019). Uninsured in America: problems and possible
solutions. Bmj, 334(7589), 346-348.
McLean, R. M., DeLong, D. M., & Moyer, D. V. (2020). The
US Health Care System Is Ill and Needs a Bold New
Prescription. Annals of Internal Medicine, 172(2_Supplement),
S1-S2.
Reply to the following two classmates’ posts. In your reply
posts, include your analysis of the impact on quality of care
generated by these generated by these coverage gaps and the
non-financial barriers to access described in your readings and
in your own research. Each reply should be 200 to 300 words.
Post # 1: Michael
When we discuss access to health care, we are primarily
referring to health insurance (Harvard University, 2014a). Thus,
when we are referring to gaps in health care, we are referring to

4. gaps in insurance coverage. In the U.S., gaps in health
insurance significantly affect vulnerable sub-populations, which
include women, children, low-income (and homeless), migrants,
the mentally ill, elderly persons who retire prior to age 65,
people living in rural areas, and persons with HIV/AIDS (Shi &
Singh, 2019). Prior to the passage of Affordable Care Act
(ACA), persons with pre-existing conditions were considerably
affected by denial of health insurance coverage (Levitt, Damico,
Claxton, Cox, & Politz, 2017). Less emergent gaps, although
not less significant or potentially financially distressful, include
access to long-term care, dental, and caregiver support
(Reinhard, Feinberg, Houser, Choula, & Evans, 2019; Shi et al.,
2019). Since the passage of the ACA, a new gap in coverage has
emerged and that is the underinsured (Collins, Bhupal, & Doty,
2019). Despite the ACA’s ability to reduce the number of
Americans uninsured, significant gaps persist, especially for
lower income earners and racial/ethnic minorities (Sommers,
McMurtry, Blendon, Benson, & Sayde, 2017).
In the United States, ethnic minorities are more likely to lack
health insurance than whites, particularly in the western and
southern areas (Shi et al., 2019). Per Shi and Singh (2019),
people who are uninsured have a higher prevalence to having
poor health. A couple of possible reasons for this are the
uninsured tend to avoid accessing preventative services
resulting in more expensive emergency health services and the
uninsured tend to postpone obtaining essential prescriptions due
to cost concerns (Shi et al., 2019). For those who assert that the
poor bring it upon themselves and argue that society should not
share the cost of their health misfortunes, Shi and Singh (2019)
assert that Americans paid $85 billion in uncompensated care in
2013. Aside from the moral and ethical implications, ignoring
these health care disparities among these vulnerable populations
incurs a cost of approximately $1.5 trillion to the entire system
every three years (Murphy, 2020).

5. Collins et al. (2019) report that the most significant
deterioration in health quality and comprehensive insurance
exists among Americans with employer-based plans. Collins et
al. (2019) claimed that 45%, or 87 million, Americans qualify
as under-insured. Per Collins et al. (2019), under-insured is
defined as those who spend more than 5% of their annual
income on out-of-pocket costs, not including their premiums.
Due to rising deductibles, co-pays, and other out-of-pocket
expenses, covered Americans are increasingly avoiding
obtaining necessary medical attention when ill, did not fill a
prescription, skipped prescribed tests and treatments, and failed
to follow through with follow-up appointments or seeing a
specialist (Collins et al., 2019). Now we are back to the
beginning of this conversation where avoiding obtaining early
medical interventions due to lack of money results in seeking
more costly emergent care, which is, in turn, affecting the
shared pocketbooks of all Americans (Murphy, 2020). However,
these exorbitant costs could be better controlled if states
expanded their Medicaid programs and better informed the
public, including those insured by their employers, of their
options (Collins et al., 2019; Murphy, 2020).
References
Collins, S. R., Bhupal, H. K., & Doty, M. M. (2019). Health
insurance coverage eight years after the ACA. The
Commonwealth Fund. Retrieved
from https://www.commonwealthfund.org/publications/issue-
briefs/2019/feb/health-insurance-coverage-eight-years-after-aca
Harvard University. (2014a). Topic 3: Access, Quality and Cost.
Retrieved
from https://courses.edx.org/courses/HarvardX/PH210x/1T2014/
courseware/6ce98f482d6247c3aa65e260ea95bb3d/dc71cfef2575
48e28e5345af205c6000/1?activate_block_id=i4x%3A%2F%2FH
arvardX%2FPH210x%2Fvertical%2F642e414f4862439fa0da074
bf1d0f320

6. Levitt, L., Damico, A., Claxton, G., Cox, C., & Politz, K.
(2017). Gaps in coverage among people with pre-existing
conditions. KFF. Retrieved from https://www.kff.org/health-
reform/issue-brief/gaps-in-coverage-among-people-with-pre-
existing-conditions/
Murphy, M. (2020, January 28). Gaps in care: What you need to
know. Medical Scribe Journal. Retrieved
from https://www.scribeamerica.com/blog/gaps-in-care-what-
you-need-to-know/
Reinhard, S. C., Feinberg, L. F., Houser, A., Choula, R., &
Evans, M. (2019). Valuing the Invaluable: 2019 Update:
Charting a Path Forward. AARP. Retrieved
from https://www.aarp.org/ppi/info-2015/valuing-the-
invaluable-2015-update.html
Shi, L., & Singh, D. (2019). Delivering Health Care in America
(7th ed.). Sudbury, MA: Jones and Bartlett.
Sommers, B. D., McMurtry, C. L., Blendon, R. J., Benson, J.
M., & Sayde, J. M. (2017). Beyond Health Insurance:
Remaining Disparities in US Health Care in the Post-ACA Era.
The Milbank Quarterly, 95(1), 43-69. Retrieved from
doi:10.1111/1468-0009.12245
Post # 2: Molly
The purpose of this discussion is to analyze the major current
contributors to insurance coverage gaps. More than half of
Americans under age 65 receive health insurance through an
employer (Collins et al., 2019). Two major contributors to gaps
in coverage is loss of employment and the state does not expand
Medicare eligibility. This means "individuals have an income
above the Medicare eligibility but below the limit for
Marketplace premium tax credits” (Garfield et al., 2020). The
main contributor to no coverage is that individuals cannot

7. afford the insurance. All these factors contribute to the
insurance coverage gaps in America.
Loss of employment can be a form of being released from your
employer or voluntarily leaving your employer. Some jobs will
have different timings on when insurance coverage stops, for
example coverage could last one month after leaving your job.
Some jobs don’t activate health insurance coverage until 90
days into the job. Options for a person with a gap in coverage to
get coverage are through a spouse’s plan, COBRA, ACA or
individual insurance, short-term plans, and Medicaid
(Masterson, 2020). It is important to plan ahead to know when
your gap in coverage will be and get insurance accordingly,
although if released from your employer this could be a major
problem.
If states expanded their programs and adopt the Medicaid
expansion, 2.3 million adults with gain Medicaid edibility
(Garfield et al., 2020). People in the coverage gap are usually
people with limited family income and live below poverty level,
therefore these people will not be able to afford ACA coverage
(Garfield et al., 2020). For example, in 2020 the premium for a
40-year-old non-smoking individual purchasing coverage
through the Marketplace was $331 per month for the lowest plan
(Garfield et al., 2020). This is sometime half of an individual’s
income, which ends up relating to the reason of not getting
coverage because people cannot afford it. This is huge problem
for people because they will face barriers to needed health
services or if they do require and receive medical care, they will
have financial consequences (Garfield et al., 2020). If states
expand Medicaid eligibility this might prevent these problems.
As discussed earlier, another problem is no coverage due to not
being able to afford insurance coverage. Two of the contributors
discussed apply to this as well because if you do not have
employment you don’t have income and if you live below the
poverty level, income is low. Some of the worries with health
care costs are difficulty affording routine costs of insurance,
costs stop people from getting needed care or filling

8. prescriptions, and difficulty paying medical bills and having
consequences on families (Kirzinger et al., 2019). Twice as
many people with insurance from employers say cost-related
concerns are the most important feature to them when choosing
a health plan compared to coverage-related concerns (Kirzinger
et al., 2019). Ultimately this means people will only look at the
cost of health insurance and not worry if it covers what they
need medically. Health care coverage is extremely important
and when someone can’t afford it or has a gap in coverage this
is a critical time in their life.
References
Collins, R. S., Bhupal, K. H., & Doty, M. M. (2019). Health
insurance coverage eight years after the ACA. The
Commonwealth Fund. Retrieved
from https://www.commonwealthfund.org/publications/issue-
briefs/2019/feb/health-insurance-coverage-eight-years-after-aca
Garfield, R., Orgera, K., & Damico, A. (2020). The coverage
gap: Uninsured poor adults in states that do not expand
Medicaid. KFF. Retrieved
from https://www.kff.org/medicaid/issue-brief/the-coverage-
gap-uninsured-poor-adults-in-states-that-do-not-expand-
medicaid/
Kirzinger, A., Munana, C., Wu, B., & Brodie, M. (2019). Data
note: Americans’ challenges with health care costs. KFF.
Retreived from https://www.kff.org/health-costs/issue-
brief/data-note-americans-challenges-health-care-costs/
Masterson, L. (2020). How to get health insurance if you’re
unemployed or changing jobs. Insure.com. Retrieved
from https://www.insure.com/health-insurance/job-change-and-
obamacare.html