BHA-FPX 4112 Assessment 3 National Health Insurance in the United States

BHA-FPX 4112 Assessment 3 National Health Insurance in the United States

National Health Insurance in the United States Sample Paper


  • The United States does not have a universal health insurance coverage
  • Nearly 92% of the population had insurance coverage in 2018.
  • About 27.5 million people (8.5% of the population) have no access to insurance coverage, thus are uninsured (Keisler-Starkey & Bunch, 2021 BHA-FPX 4112 Assessment 3 National Health Insurance in the United States).
  • Medicare and Medicaid Acts of 1965 remain the only government-initiated insurance programs accessible to the public.
  • US citizens can access private insurance coverage in the form of employment-based plans, direct purchase, and TRICARE.
  • Alongside Medicaid and Medicare, the Civilian Health and Medical Program of Hd Department of Veterans Affairs is a public insurance coverage.
  • The US spends almost twice the OECD average expenditures for healthcare ( Nunn, Parsons & Schambaugh,  2020).

BHA-FPX 4112 Assessment 3 National Health Insurance in the United States

The Impact of Medicare and Medicaid

  • The US government enacted Medicare and Medicaid in 1965 through the social security act
  • Before 1965, only employees accessed employer-sponsored health insurance introduced in 1920s
  • Medicare ensures a universal right to healthcare for persons aged 65 and older
  • Medicaid provides cover to low-income families, the visually impaired, and individuals with disabilities.
  • Medicaid and Medicare inspired the enactment of Children’s Health Insurance Program (CHIP) of 1997.
  • The Affordable Care Act (ACA) of 2010 required states to expand  Medicaid to address the problem of uninsured population.

Impact of Medicare and Medicaid Continued

  • Medicare and Medicaid policies have significantly reduced the number of uninsured and underinsured populations.
  • Some states operate the Children’s Health Insurance Program (CHIP) as an extension of Medicaid.
  • Many states expanded Medicaid in 2014 to incorporate additional provisions, including:
  • Extending coverage to young people.
  • Expanding Medicaid eligibility to accommodate the uninsured population.
  • Open health insurance marketplace (Tikkanen et al ., 2020).

The Feasibility of Expanding Medicare and Medicaid

  • Every American should have equal access to affordable healthcare services regardless of their socio-economic or demographic diversities
  • Over 28.7 million people (8.9 % of the total population) have no access to health insurance covers .
  • The number number of uninsured people is set to increase to 37.2 million by 2028 due to affordability issues and complexities in the US insurance markets.
  • Expanding Medicare and Medicaid would fulfill the triad goals of accessibility, affordability, and equity (Shrank et al., 2021)
  • Expanding Medicare and Medicaid will enable states to collaborate with the national government to strength insurance marketplaces to provide people with multiple options.

The Implications of National Health Insurance

  • The national health insurance has implications on care accessibility, utilization, technological advancements, cost, and economic growth.
  • The United States does not have universal health insurance cover.
  • Not all Americans are eligible to Medicare and Medicaid insurance covers-an aspect that limit accessibility and care utilization.
  • Medicaid expansion has ushered an era of technological advancements to accommodate increased demand and enhance processes (Suennen et al., 2021).
  • An absence of a universal health care results in poospending patterns, increasing the cost of care and hampering economic growth (Zieff et al., 2020).

Pros and Cons of National Health Insurance in the US


  • Medicaid expansion provide opportunities for increased insurance coverage
  • Medicare and Medicaid address health disparities by promoting accessibility, equity, and affordability (Shrank et al., 2021).
  • Medicaid expansion facilitates technological advancements (Suennen et al., 2021).
  • National government’s involvement in controlling national health insurance reduce competition for private insurance providers, reducing the likelihood of manipulating consumers.


  • Lack of competition in Insurance marketplaces hamper the cost-effectiveness of Insurance premiums

Pros and cons of National Health Insurance Cont’d

  • Lack of a universal health insurance exacerbates disparities within social determinants of health
  • The United States spends far more per Capita on health care than other wealthy countries without the plausibility of improving care (Crowley et al., 2020).
  • Variations in deductibles, copayments, premiums, and coinsurance among insurance providers increase their costs, limiting affordability.
  • Healthcare reimbursement models for the national health insurance remain a primary concern.
  • Policymakers in the healthcare sector should reform the national insurance by changing reimbursement models and encouraging market competitiveness.

Necessary Reimbursement Changes for the National Health Insurance

  • Up to today, the US uses the national health insurance model to fund the Medicare coverage.
  • Private insurance and out-of-pocket models are common reimbursement models in US.
  • The Bismarck system (social insurance model) applies to the employer-sponsored insurance in the country.
  • Policymakers should change these models to accommodate advanced reimbursement systems such as the single-payer model, capitation, and the bundled, value-based payment system.

Operational Changes for Transitioning to Universal Healthcare Insurance

  • Transitioning to universal health care significant upfront cost rated to physical and infrastructural change (Zieff et al., 2020).
  • Healthcare professionals should collaborate with hospital insurers, patients, and governments to ensure effective transitioning.
  • The state and federal government should collaborate to address healthcare disparities.
  • Transforming outpatient specialist care is essential for enhancing care coordination and address disparities.
  • Capitating payment for healthcare insurance is a step towards achieving value-based purchasing system (Shrank et al., 2021).


  • Every American should have access to affordable and quality care
  • Medicaid and Medicare are the primary public insurance coverage that cater for older adults, low-income families, and people with disabilities.
  • The absence of a universal health insurance leads to high premiums, coinsurance, and copayments, contributing to inequalities and inaccessibility.
  • The country should transform the existing reimbursement models to accommodate advanced options such as single-payer model, capitating payment, and value-based purchasing.
  • These options require interdisciplinary and stakeholder collaboration.

BHA-FPX 4112 Assessment 3 National Health Insurance in the United States References

Also Read: BHA-FPX 4112 Assessment 2 The Supply and Demand of Health Care