PSY 5108 Week 7 – Assignment: Validate Appropriate Internal and External Mental Health Policies

I am writing this letter to express my support for the Medicaid Expansion policy, which is based on Medicaid eligibility covered by the Affordable Care Act. Expanding Medicaid eligibility would enable uninsured individuals and people with low-income have insurance, leading to access to healthcare services. Medicaid Expansion would also give eligibility to persons who receive Medicaid benefits. Before going deeper to discuss the importance and benefits of Medicaid Expansion, I would to give you a brief background and the origin of the policy.

Background of Medicaid Expansion

Medicaid Expansion policy originates from the Affordable Care Act (ACA) introduced in 2010 by the Obama administration purposely to make healthcare more accessible and affordable. Since its inception, the ACA has necessitated and increased coverage for a majority of Americans mostly those who had been left out by the national insurance scheme (Lin et al., 2021). Through cost-sharing reductions and premium tax credits, the law lowered costs for low-income individuals and families so that they can access and afford healthcare services. The ACA law sought to provide coverage to millions of uninsured Americans. Apart from expanding coverage to accommodate low-income people, the law also declared continued coverage for adults living with their parents until they reach 26 years. To ensure that insurance is available and affordable to more people, ACA required that states adopt the Medicaid Expansion policy to ensure that individuals in their states especially from low-income families receive comprehensive health coverage.

The Medicaid Expansion recommends that states provide coverage for adults 65 years and below with incomes 138% of the federal poverty level. Under the Medicaid Expansion program, states that adopt Medicaid Expansion receive financial incentives from the federal government in the form of enhanced federal Medicaid funding (Begovich & Atherly, 2019). The federal government covers up to 90% of the cost incurred for individuals newly enrolled under the Expansion Program. For states that have not adopted the expansion program, they continue to receive the normal federal funding that covers only populations that were eligible for Medicaid pre-expansion. Since the introduction of ACA and Medicaid expansion, there have been millions of enrollees, for example, 10 million in 2019, and recently in 2022, 21 million enrollees (CBPP, 2020). Currently, only 12 states, Texas included, have not adopted the Medicaid Expansion program. In any state that has not adopted the expansion program, 2 million people remain ineligible for any form of medical insurance coverage as they cannot afford premium subsidies available in the marketplace and their income is too little income to meet the eligibility requirements. Hence, a large population in these states has no access to affordable healthcare, creating health disparities and the risk of poor health outcomes.

Importance of Medicaid Expansion

One of the importance of Medicaid Expansion is in promoting health access for individuals and families with income below the poverty line. Healthcare is extremely expensive in America and without insurance, most people cannot afford to pay for their healthcare costs. With the Medicaid Expansion program, individuals who would have remained uninsured can now access health services and get treated for various conditions. Research shows that since the introduction of Medicaid Expansion, low-income people have experienced greater access to healthcare services. According to findings by CBPP (2020), these individuals have access to a personal physician, making it easy to go for check-ups, attend appointments for management and monitoring of chronic conditions, access medically assisted treatment, receive preventive care, as well mental health services. Ideally, the Medicaid Expansion program has increased access to primary care services, leading to improved patient outcomes (Brown et al., 2021). Access to healthcare services is an important component of Universal Health Coverage (UHC), which seeks to ensure that individuals can access the quality care that they need, including when and where they need the care.

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Health disparities are one of the major problems impacting the health system today. Health disparities exist between low-income earners and the wealthy, which are sadly represented by ethnic populations owing to income inequalities. For example, people of color have poor health outcomes compared to Caucasians, creating a health disparity between the two groups. According to reports, Texas has the worst health disparities among racial groups as Latinos and Black Americans are likely to encounter delays in treatment and receive no preventive care, putting them at risk of serious complications and preventable chronic conditions (Carballo, 2021). During the COVID-19 pandemic, studies showed that Hispanics and Blacks were 70% more likely to contract the infection compared to Whites in Texas (Xavier & Rasu, 2021). The Medicaid Expansion program targets an extension of eligibility to cover low-income individuals and families so that they can access health services as needed. Subsequently, it contributes to a decrease in the health disparities between the rich and the poor. Studies reviewing states that have adopted Medicaid Expansion reveal that the policy has played a significant role in mitigating the racial health gaps by increasing coverage for uninsured Blacks and Latinos (Baumgartner et al., 2020).

The Medicaid Expansion program under the ACA is important for providing opportunities for preventive care. The US Preventive Services Taskforce recommends that individuals undertake preventive health services such as annual comprehensive medical examinations, cancer screening, dental examination, eye examination, and screening for chronic conditions and sexually transmitted diseases for those at risk. Initially, these services were not covered, but with the introduction of ACA, the expansion of coverage extended eligibility to preventive services. Preventive services such as screening help in the prevention of conditions and identifying diseases while still in early and treatable stages (Begovich & Atherly, 2019). For example, cancer can be successfully treated if diagnosed during the initial stages, leading to positive health outcomes. Without preventive health, most cancers are diagnosed when in stage four, which is too late for hopes of positive treatment outcomes (CBPP, 2020). Therefore, the importance of Medicaid Expansion is that it promotes a proactive response to health, which supports health promotion and positive population health outcomes.

Moreover, ACA provisions require insurers to provide coverage eligibility even for preexisting conditions. Before the introduction of the ACA, health insurers would charge more for preexisting conditions such as asthma, cancer, diabetes, and high blood pressure both in adults and the pediatric population. However, with the Medicaid Expansion program, health insurers cannot deny coverage for pre-existing conditions and they are not allowed to place limit restrictions on them (Begovich & Atherly, 2019). This is important because a high population of Americans are suffering from chronic conditions, which are often pre-existing before initiating health coverage. Chronic conditions are highly prevalent in low-income populations, yet they are locked out of insurance coverage because of preexisting conditions (Lin et al., 2021). Hence, they require health insurance coverage more than those on the high-income ladder. With the Medicaid Expansion, individuals and families can effectively manage chronic pre-existing conditions for better health outcomes and the well-being of populations.

Medicaid Expansion is also important as a strategy for economic stimulus. When states take up the Medicaid Expansion program, the federal government provides 90% coverage for Medicaid costs. The additional funding provided by the federal government allows states to free their funds for growing the economy (Begovich & Atherly, 2019). Equally, the expansion program has been shown to increase employment opportunities that contribute to economic growth. For example, a study estimates that Medicaid expansion can result in the creation of additional 1 million jobs nationally. Among the newly created jobs, Texas alongside Florida would be the largest beneficiaries. Similarly, Medicaid expansion is associated with a $350 billion boost from 2022 to 2025 in 14 states (Ku & Brantley, 2021). Furthermore, Medicaid Expansion contributes positively to economic growth because it is associated with poverty reduction. States that have adopted the program have shown a reduction in the number of people below the federal poverty line. This could be associated with better health outcomes that allow individuals to be more productive and work hard to increase their incomes.

Medicaid Expansion results in positive long-term outcomes for children in terms of health, academics, and general life outcomes. For example, Medicaid for Black children results in a 7-15% decrease in rates of hospitalization by the age of 25, which means even fewer hospitalizations in adulthood (Brown et al., 2020). Coverage also leads to decreased rates of disease-related mortalities for black children, which means longer and healthy lives for this population. For instance, African Americans have the highest prevalence of premature births, low birth weight, and infant mortalities, but with access to affordable and high-quality healthcare, these premature mortalities decrease (CDC, 2021). The outcome is raising a healthy population of children who can actively participate in class and social activities for positive growth and development. For example, expanded coverage that leads to positive health outcomes is associated with low rates of absenteeism and reduced likelihood of high school dropouts. According to Brown et al. (2020), expanded Medicaid coverage during childhood has a direct link with a high rate of college enrolment.

Example of How Lack of Health Insurance Affects a Community

A local example of how lack of insurance contributes to poor health outcomes and other problems is demonstrated by the health outcomes for the Black population. According to statistics on health information, African Americans are 2 times more likely to die from heart disease compared to whites. Similarly, African Americans have a 50% higher chance of developing blood pressure than other racial groups. Equally, African Americans have the highest prevalence of diabetes and other chronic conditions including cancer (CDC, 2021). Moreover, African Americans are likely to die at younger ages compared to whites for all causes. Heart disease, stroke, and cancer are the leading causes of death for African Americans, yet, these are lifestyle conditions that can be prevented or effectively managed with early intervention to minimize complications that cause high mortalities. Further, young African Americans are affected by health risks and social factors at a younger age compared to other racial groups, for example, poverty, unemployment, smoking, lack of home ownership, obesity, and inability to visit a medical doctor because of the high costs (CDC, 2021).

The poor health outcomes for the Black American community are primarily attributed to the negative social determinants of health, among them, poverty, low income, and unemployment, making healthcare costs too high to afford. With high healthcare costs, individuals and families remain uninsured due to income eligibility restrictions and at the same time, unable to pay for the healthcare costs from their pockets (Begovich & Atherly, 2019). This locks them out from opportunities to seek medical consultation at the early stages of a disease, screening, better management of chronic conditions, and other proactive health measures that would make a significant difference in their health outcomes and overall population health and wellbeing.

Personal Position

As a healthcare professional and a nurse who has one-on-one contact with various patient populations, I have seen first-hand the benefits of having access to affordable healthcare. Introducing Medicaid Expansion would make a big difference in health outcomes for various populations in the state particularly low-income populations, the uninsured, and vulnerable populations that have the worst health outcomes (Begovich & Atherly, 2019). This would be beneficial to the state through improvement in health outcomes, for example, Texas will rank lower in health disparities and other major chronic conditions affecting minority racial populations. As a patient advocate, I champion this policy because it would improve health outcomes for vulnerable and underserved populations due to increased access to affordable quality care. I support the introduction of the Medicaid Expansion policy in Texas to improve population health outcomes.

Conclusion

The ACA is a revolutionary act that introduced an expansion of health insurance eligibility to cover low-income earners, preexisting conditions, and other elements initially left out by the insurer. With the expansion requirement, states can ensure that the uninsured persons within their territories receive health coverage, enhancing access to high-quality and accessible healthcare. Studies have shown several benefits associated with the Medicaid Expansion program including a reduction in health disparities, promotion of health access, participation in preventive care, economic stimulus, and long-term positive outcomes for children. Given the evidence supporting the benefits of Medicaid Expansion, I urge you to consider introducing the policy in Texas as it would make a positive difference in health outcomes for populations.

It is my sincere belief that you will consider this issue.

Thank you for taking the time to read this letter. I am looking forward to any kind of response from you. Thank you.

Yours sincerely,

Name

Signature

PSY 5108 Week 7 – Assignment: Validate Appropriate Internal and External Mental Health Policies References

Baumgartner, J., Collins, D., Radley, D., & Hayes, S. (2020). How the Affordable Care Act Has Narrowed Racial and Ethnic Disparities in Access to Health Care. The Commonwealth Fund Issue Brief.

Begovich, J., & Atherly, A. (2019). Medicaid Expansion and Financial Security. Journal of Aging and Social Policy, 31(1), 1-18.

Brown, D., Kowalski, A., & Lurie, I. (2020). Long-Term Impacts of Childhood Medicaid Expansions on Outcomes in Adulthood. Review of Economic Studies, 87, no. 2: 792– 821.

Brown, E., White, B., & Jones, W. (2021). Measuring the impact of the Affordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach. Health Res Policy Sys, 19, 77. https://doi.org/10.1186/s12961-021-00.

Carballo, R. (2021, November 18). Houston Chronicle: Texas ranks among worst in the nation for racial health disparities. Retrieved from Lyod Doggett: https://doggett.house.gov/media/in-the-news/houston-chronicle-texas-ranks-among-worst-nation-racial-health-disparities

CBPP. (2020, October 1). The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion. Retrieved from Center on Budget and Policy Priorities: https://www.cbpp.org/research/health/chart-book-the-far-reaching-benefits-of-the-affordable-care-acts-medicaid-expansion

CDC. (2021, July). African American Health: Creating equal opportunities for health. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/vitalsigns/aahealth/index.html

Ku, L., & Brantley, E. (2021, May 20). The Economic and Employment Effects of Medicaid Expansion Under the American Rescue Plan. Retrieved from The Commonwealth Fund Issue Brief: https://www.commonwealthfund.org/publications/issue-briefs/2021/may/economic-employment-effects-medicaid-expansion-under-arp

Lin, Y., Monnette, A., & Shi, L. (2021). Effects of medicaid expansion on poverty disparities in health insurance coverage. Int J Equity Health, 20, 171. https://doi.org/10.1186/s12939-021-01486-3.

Xavier, C., & Rasu, R. (2021). Health Disparities of Coronavirus Disease 2019 in Texas, March-July 2020. South Med J., 114(10):649-656. https://doi.10.14423/SMJ.0000000000001308.

Being part of a professional field can include learning about policies that effect the workers within the field and the individuals they serve. Examine a policy either at a local (hospital, city, or state) or federal level, and then draft a letter either supporting that policy or advocating against the policy. Be sure to support your position with research.

The letter should include a background of the issue(s), an explanation of its importance, a local example of how the issue(s) affect the community, and your position on the issue(s). Please direct your letter to the appropriate individual who can act on the request. For instance, if you are advocating for a policy change within a hospital, the head of the hospital might be the most appropriate target audience of your letter. If you are asking for change at a federal level, your federal representative would be the appropriate target audience of your letter.

Length: 5-7 pages, not including title or reference pages

References: Include a minimum of three scholarly resources

Your letter should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards. Be sure to adhere to Northcentral University’s Academic Integrity Policy.