Health insurance under the federal Affordable Care Act

Kentucky has changed how it is offering health care coverage by requiring its citizens to use the federal health exchange to shop for coverage rather that kynect. This means that its citizen would have to enroll in Medicaid or shop for health insurance under the federal Affordable Care Act, meaning that about 500,000 of Kentucky’s citizen will have to switch over. Advocate of this move believe that it will allow Kentucky to save a substantial amount of money while still allowing citizens to enroll in qualified health plans. Opponents of this movement think that it will cause confusion and coverage loss for those who switch over, such as dental and vision. It is also question whether or not money will be saved because healthy people will be required to pay monthly premiums. Other problems are the lockout of coverage for people who do not pay and would be require to volunteer 20 hours a week just to be able to keep Medicaid coverage. However Governor Bevin defends his plan by saying that the lock out feature and volunteering will just make Kentucky’s citizen more responsible.

The advocate are speaking more from the social gospel characterization because they do believe that everyone should receive some type of health insurance even though it is not the best. Everyone should take of everyone. The opponents seem to be speaking from the puritan side because they feel like it is your own personal responsibility and decision to take care of your health insurance. They seem more individualistic.

State government, California specifically has been a major player in the implementation of the 2010 ACA by giving consumers a tax credit through the market place.

2#-There are a myriad of obstacles that Robert Banes faced while receiving care for his health problems. Robert is a poor minority, who lacked the resources to fund his medical treatment. Aside from his socioeconomic status and the issues that pertained to that, in regards to his treatment options, the article talked about Robert’s failure to acknowledge his disease, as well placing it at the forefront of his priorities, and his Doctor’s, for lack of better words, lack of empathy to his terminal illness. In the article, he stated that while Doctor’s did tell him about the extent to which the disease was and would take a toll on his survival, he said that that is as far as it went; doctor’s basically told him, you’re dying, but failed to go into detail on how to combat or alleviate the issue.

I would argue that Robert had various avenue’s that he could have reached out to for help, however, it seems to be that he was just uninterested in getting the help. While his lack of interest in his own health was indeed a contributing factor to his health problems, his SES played a significant role in his health problems as well. As we know, poor people do not have the money to pay for health care, let alone have a stable job that can pay for their health care benefits. Having a poor diet, and being uneducated are also contributing factors when weighing the options one may have to address their basic needs or more serious needs of their health.

As previously mentioned, SES is a significant contributing factor when addressing health care issues. As a poor black man (minority), he faces many social disadvantages, such as, doctors’ unwillingness to cover his disease, extensively, due to his ethnicity and income status. In the article, the author mentioned how blacks, more than whites, have reported receiving little to no explanation of the health issue that they have to deal with. With that being said, if one’s doctor seems uninterested in your health outcomes, why would you be worried or interested, especially if it seems to be a non-issue, based on your conversation with the doctor; in Robert’s case he said he felt fine, even though his kidneys were slowly failing on him. On the other side is Robert’s personal lifestyle choices. He is addicted to cocaine, and smokes cigarettes from time to time. Knowing that he has a terminal illness, one would assume that he would cut these two unhealthy habits out of his life, yet he does not. While personal lifestyle choices are solely placed on the individual, we also have to realize that social disadvantages out weigh personal lifestyle choices. That is, generally those who are poor tend to have some sort of addiction, perhaps this is to cope with societal woes, and they lack a healthy diet. This goes to say that not all of the blame should be place on the individual, but society as well.

With the enactment of the ACA (2010), based on my knowledge of the program, I believe that Robert could in fact benefit from this new health care system, however, the extent to which is unknown. That is, the ACA does help those who do not have the means to pay for health care, to have their basic needs met, it would still not change his situation as far as the life and death circumstance. Yes, with the enactment of the ACA this gives Robert various pathways to prolong his life, however, he himself even mentioned in the article that he was uninterested in “dealing” with the issue, because he viewed his dialysis treatment as a set back. Essentially, he did not see the point in looking at his situation negatively, but instead as something that is just a part of life.


3-#    I stumbled upon the article in the New York Times named Gay Men and Lesbians Barred from Some Clinical Trails by Roni Caryn Rabin. This article states that fifteen percent of clinical studies are blatantly excluding gay men and lesbians from being a part of their study. They are no scientific rationale for why these exclusions are taking place. The studies that are excluding gay men and lesbian women, many are dealing with sexual function including erectile dysfunction, hypoactive sexual desire, and couples in general. Other studies that are non-sexual in theme includes asthma and how families cope with illness. This relates back to the article because there might be some breakthroughs in all of these studies but due to the exclusions gay men and lesbian women will not have access these treatments until a later date if at all. Though the articles talked about poor not being able to receive treatment because they could not afford the treatment, this in my opinion is one step worst because this is an intentional exclusion from somethings that gays and lesbians can benefit from too. Like the article gay men and lesbian women are suffering from their social environment where homosexual relationships are still controversial. Though there might be a reason for these exclusion purposefully not allowing So If they are suffering from one of these health problems they will have to deal with and suffer through it.

4#   -What characterizes the doctor-patient encounter, according to Freidson?

According to Friedson, they are multiple different things that could affect the doctor-patient encounter, but it all depends on the circumstances. Friedson points out that the doctors and patient ability to accommodate each other, health education of a patient, and the doctors high social standing which serves as a leverage to have power over patients are all that characterizes the doctor-patient encounters for good and bad.

A doctor must learn to accommodate the patient’s need but not too far where they stop being a professional, and then the patient must learn to meet the doctor when they cannot accommodate anymore. The patient having no health education can be beneficial because it may lead to patient following doctors order; but can also be detrimental due to them not being able to know when it is time to go to the doctor or being unable to tell doctors a full history of health. Being educated can be beneficial when both patient and doctor agree but detrimental when they do not. Lastly having a physician that uses their high social standing, which serves as a leverage to have power over patients, could “prevent perception of substantial resentment and resistances of patients” (20).

  1. What characterizes the development of medical practices, according to Stevens?

According to Stevens the characterization of medical practices come from certification of specialist, evaluation of techniques and standard examination, and continuous education. The development of medical practices that could go beyond that of general practices was built around the concept that doctors could specialize in specific areas of health or diseases. This helps create organizations in the medical practices to take place where the government was deficient. As specialization kept on growing specialty boards were created to help dictate how doctors should go along with their practices and punish those who did not follow the medical law. In a way stepping in where the government lacked.

  1. Stevens says, “Outside of the hospital, consumers still flock to specialists.” Why? And how do you think the proliferation of medical specialties has affected visits to the doctor?

Patients tend to want the best care generally so they tend to go to specialist because they feel like they know more that a general doctor would know since they have extra education specifically in their disease. I think having this proliferation of medical specialties affects visiting the general doctors negatively. The mistrust between doctor and patient probably has grown and having second opinions like a specialist look at you will most likely trump what a general doctor says.

  1. There is a geography to medical specialization, with most of them clustered in urban areas, and with specialties clustered in certain regions of the country. Is there a role for government in managing what kind of care options (i.e., medical specialties) are available to consumers, or is the status quo working for us?

There is a role for the government in managing what kind of care options is available. In urban areas a majority of the people living there are living at or below the poverty line and they are more likely to let their illness grow until it becomes severe where they do need care. Having these care near them is important so they can have access to it and the government does know this. From a business point of view having these specialties in an urban area is smart because most of their patients will be coming from those neighborhood where they are more likely to be reactive to their illness than preventative.

5#-In her article, Grace Budrys claims that the various types of medical institutes arise depending on what society needs. One such medical institute that seems to be everywhere is the urgent care clinic.

Patti Neighmond’s article, “Can’t Get in to See Your Doctor? Many Patients Turn to Urgent Care,” describes the popular phenomenon of urgent care clinics. Neighmond reports on a poll conducted by the Harvard T. H. Chan School of Public Health along with the Robert Wood Johnson Foundation and NPR that 20% of the public has a hard time making an appointment with their doctor when they need to, so they opt for the convenience and quality of the urgent care clinic., which in the majority of cases is open 24 hours a day, seven days a week.

In Hoffman’s article from this week, there were high statistics reported as to the number of people who visit an emergency room for non emergency-related cases. The reason, according to Hoffman, is either the fact that emergency rooms cannot legally deny access and that there was no health care professional available outside of regular physician office hours.

In her article, Neighmond points out that as much as 80% of patients who go to emergency rooms do not have emergencies., but these patients’ visits can run as much as $1,000 per visit. In comparison, a visit to the urgent care clinic usually runs $150 per visit.  The result is that urgent care clinics are cropping up all over the place. In her article, Neighmond puts the number at 7,000.

An interesting fact about these clinics is that there are basically two kinds: 1). a stand-alone clinic, which means that it is completely independent from any hospital, and 2). that it is part of a an integrated hospital system. The latter is very effective in that the clinic and the hospital all the share the same medical records, making treatment better.

The article was found at: