Another section of this December 2021-January 2022 issue of the ASAHP newsletter TRENDS has a list of three obtainable resources electronically that pertain to: health care disparities; uneven allocation of health insurance deductibles and premiums among consumers in different states in the U.S.; and how usage of telehealth services by Medicare beneficiaries varies around the nation based on ethnicity and urban-rural residence patterns. Policymakers at the national level often discuss where the locus of control might best be centered in dealing with such matters. The federal government has enormous resources at its disposal to respond to a wide range of health problems. As an illustration, although 21 major federal agencies in more than 100 offices are spread around the U.S. to combat the COVID pandemic, it remains highly challenging to develop an effective administrative structure to coordinate all these entities to prepare for and respond to this disease. Another potential downside is that any effort resembling a one-size national approach may lack the necessary heft to meet the kinds of various situations that exist around the nation.
Perhaps even more importantly, centralization of authority rests on a major assumption that effective action can be taken in the face of an enormous amount of administrative diversity that exists within states, counties, cities, and towns. Whenever a health problem arises, health departments at each of these levels have different capabilities in the form of possessing suitable amounts of key staff and the resources necessary to produce desirable outcomes. These governmental units also differ significantly from one another based on the kinds of consumers being served. Demographic factors, such as age, race/ethnicity, degree of health insurance coverage, and urban-rural residential patterns all play a determinative role in how successfully local health problems can be addressed. One-size remedies promoted nationally often tend to lack more customized interventions needed to deal with the wide variability that characterizes local jurisdictions.
Expansion Of Health Insurance Coverage
On the plus side of noteworthy developments, the Biden Administration’s American Rescue Plan has made it possible for millions of more consumers' to become eligible for health care coverage that began January 1, 2022 through the Affordable Care Act (ACA) Health Insurance Marketplaces. The effort started on November 1, 2021 and had a closing date of January 15 this year while managing to outpace previous years’ enrollment. Total nationwide plan selections include more than 14 million consumers (15% of the total) who are new to the Marketplaces for 2022 and returning consumers (85% of the total) who have active 2021 coverage and made a plan selection for 2022 coverage or were re-enrolled automatically.
Rural Health Care Developments
The Agency for Healthcare Research and Quality (AHRQ) released an updated Chartbook on Rural Healthcare that discusses how rural area inhabitants face difficulty obtaining timely, high-quality, affordable services. Approximately 60 million Americans live in rural communities that often are a considerable distance from needed resources, which can add to the burden of obtaining care. Census Bureau data show that about 20% of the population lives in rural or nonmetropolitan areas, although about 85% of the total U.S. land area is classified as rural. Ten million rural residents identify as Black, Hispanic, American Indian/Alaska Native, Asian American/Pacific Islander, or mixed race. One in five rural residents belongs to one or more of these groups. Regrettably, availability and collection of robust data on health outcomes of these population groups remain limited. Also, compared with urban counties, their rural counterparts differ in fundamental ways, such as having a higher prevalence of adults with multiple chronic health conditions (e.g., arthritis, diabetes) (34.8% vs. 26.1%).
COVID-19 Effect On Health Care Expenditures
The COVID-19 pandemic has had a dramatic impact on the nation’s health sector in 2020, driving a 9.7% growth in total national health care spending as it rose to $4.1 trillion. This figure is one of many health care expenditures presented in the 2020 National Health Expenditures (NHE) Report, prepared by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). Medicare spending totaled $829.5 billion in 2020, representing 20% of total health care spending. Medicaid spending grew faster in 2020, increasing 9.2% to $671.2 billion compared to 3.0% growth in 2019, primarily driven by increased enrollment due to the pandemic.