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The Role of Health Insurance in Accessing Care

Benefits of health insurance on access to care

Health care is a cornerstone to the development of a nation. In this sense, governments and policymakers develop laws and policies to ensure the health of their people. In the U.S., Medicaid is a health insurance program that ensures the majority of people access care. Health insurance ensures that people access health care services. Notably, individuals who have health insurance have greater access to healthcare services than those who are uninsured. For example, breast and colorectal cancer patients receive a timely diagnosis, unlike patients who lack insurance (Zhao et al., 2018). With timely diagnosis, the disease can be treated, and reduce cancer mortality rates.

The second benefit of health insurance is that greater access to healthcare services results in improved health outcomes. When a patient’s disease is diagnosed on time, it is possible to treat it before it advances. For example, cancer is the leading cause of death in the U.S. However, with an increase in the number of insured citizens, the rate of pancreatic cancer deaths has declined in states that expanded Medicaid (Barnes et al., 2021). These results stem from an individual accessing a doctor who makes diagnoses and treats the disorder.

Evaluation of barriers to healthcare access

Factors that hinder access to health care include high healthcare costs and poverty among the people. Costs as a barrier to health care costs are essential in the context of the United States. The U.S. healthcare system is relatively expensive, and this makes people sacrifice spending on their health so that they can afford other needs (Kilchenstein, 2022). However, the high healthcare costs can be mitigated by expanding the health insurance programs. For example, Medicaid can be repealed to cover all costs linked to accessing healthcare services, including medications.

Poverty among low and middle-income individuals is the second factor that hinders people from receiving healthcare services. Health services come with multiple expenses that are deducted on a monthly basis, while others are paid from the individual’s pocket, such as transportation costs. If the patient cannot afford to pay transport costs, they will miss appointments, which is more crucial among patients who have cancer and have higher transport needs to attend therapy. However, the government can cushion the poor patients from this problem by investing in mobile clinics (Tzenios, 2019). The presence of mobile clinics eliminates long-distance movements by bringing alternative treatment sites near the patient’s home.

Summary of the Affordable Care Act and its provisions

The Affordable Health Care Act is the legal reform within the healthcare sector that ensures most citizens have health insurance. The act is important in ensuring that people access healthcare services amid systemic and structural barriers to healthcare access. Under this act, qualified citizens receive health insurance subsidies, and those who earn less than 138% of the poverty level receive insurance benefits (French et al., 2016). More so, the act uses innovative methods in healthcare delivery to lower costs.

To achieve these goals, the act has various provisions. One of these provisions states that employees working in large organizations for an extended period must receive mandatory health insurance from their employer. However, this provision is problematic because if an employer insures their employee, they cannot access tax credits. This is a problem because they need tax credits to access marketplace health insurance at lower prices even when they meet income requirements for receiving tax credits. As a result, these individuals miss out on the government’s support in accessing affordable health care.

The second provision under ACA is that an individual who is not insured by their employer has to purchase health insurance premiums from insurance providers. If these individuals fail to pay for their health insurance, they are penalized. For example, in 2016, more than four million people were likely to face penalties for failing to purchase health insurance (French et al., 2016). When penalties are applied, this becomes a greater financial burden to low- and middle-income individuals, exacerbating the challenge of high healthcare costs.


Barnes, J. M., Johnson, K. J., Adjei Boakye, E., Schapira, L., Akinyemiju, T., Park, E. M., … & Osazuwa-Peters, N. (2021). Early Medicaid expansion and cancer mortality. JNCI: Journal of the National Cancer Institute113(12), 1714-1722.

French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient Protection and Affordable Care Act (ACA): a systematic review and presentation of early research findings. Health services research51(5), 1735-1771.

Kilchenstein, D., Banta, J. E., Oh, J., & Grohar, A. (2022). Cost Barriers to Health Services in U.S. Adults Before and After the Implementation of the Affordable Care Act. Cureus14(2).

Tzenios, N. (2019). The Determinants of Access to Healthcare: A Review of Individual, Structural, and Systemic Factors. Journal of Humanities and Applied Science Research2(1), 1–14.

Zhao, G., Okoro, C. A., Li, J., & Town, M. (2018). Health insurance status and clinical cancer screenings among U.S. adults. American Journal of Preventive Medicine54(1), e11-e19.


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