Insurance and its Effect on Access to Healthcare

By Shubhreet Bhullar

Socioeconomic status is defined as the social standing or social class of an individual, according to the American Psychological Association (APA). Socioeconomic status delves beyond salary and net worth and includes facets ranging from education and occupation to caste and social/political connections. As the APA states, having a lower socioeconomic status negatively affects various aspects of their lives - resulting in a relatively poor mental health. Moreover, there is a correlation between having a lower socioeconomic status and overall (physical and mental) health and well-being, significantly due to the inequitable access to healthcare.

There are many different types of insurance plans, each with four levels of care - Bronze, Silver, Gold, and Platinum. Although these metal levels have nothing to do with the quality of care received by patients, they determine how the costs are split up between the insurance and the patient. As one might infer, a more expensive (platinum) plan results in the patient paying less in healthcare payments later on.

Furthermore, there is a correlation between occupation/salary and the level of insurance. Most Americans with insurance receive this insurance through their employer. The cost of insurance payments are so high that individuals and families must depend upon their employers to provide this insurance for them. Employer provided insurance is often less expensive at the onset but results in larger copays when receiving care. With these lower levels of insurance, individuals with a lower socioeconomic status struggle to pay their healthcare copays themselves - prompting them to avoid going to clinics and hospitals.

According to one of the leading Health Insurance Economists Amy Finkelstein, those with lower socioeconomic status who have lower levels of health insurance tend to pay more money in healthcare payments than those who pay for their own higher level healthcare insurance. This is due to the fact that those who would pay more for medical treatment based on their insurance avoid going to the hospital and seeking care, resulting in their medical conditions to significantly worsen - which would result in more severe health conditions and increased treatment costs. In fact, according to CNBC, 41% of American adults have healthcare treatment induced debts and 12% of Americans have debts greater than $10,000.

For reference, the median life savings of Americans aged 55-64 is $6,400 and $3,250 for Americans aged under 35. Healthcare-related debt often bars Americans from accessing healthcare due to financial strains. However, this challenge is significantly harder for those with no insurance or with Medicare or Medicaid insurance - as they struggle to even access proper healthcare. According to Dr. Rambur, a nursing and health policy professor at the University of Rhode Island, many eligible applicants are barred from receiving medicare by a number of factors that typically prey on decreased health literacy - yet another factor associated with having a lower socioeconomic status. Furthermore, many clinics and hospitals do not accept individuals who do not have insurance or are on medicare or medicaid. While there are many places where these individuals can receive treatment, the quality of treatment is questionable. According to Dr. Caballo of the International Socioeconomics Laboratory, 62.9% of black and 70.9% of white medicaid patients received breast cancer screening when presenting with symptoms of breast cancer - whereas patients with ‘proper’ insurance would be able to readily access such screenings and tests. Although there are objective laws that define the quality of care that is to be given independent of insurance status, such observational studies often display contradictory actions. Furthermore, race factors into the quality of care, as black patients were less likely to be screened for breast cancer.

In conclusion, despite healthcare quality laws, the level of insurance that patients have affects not only their ability to access healthcare, but also the quality of care that they receive. Many individuals with a lower socioeconomic status struggle to pay for a quality insurance plan and end up paying more out of pocket for their care. Despite being barred due to socioeconomic means from receiving access to quality healthcare, patients can receive economically feasible, acceptable quality care and treatment from Federally Qualified Health Centers (FQHCs) - which are available to anyone regardless of insurance or documentation status. It is important for more resources like these to be available to anyone, so that all individuals can receive the healthcare they need.

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