Healthcare Poverty Health Care Reform, Research Proposal

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As a result, millions of Americans remain unable to bear the heavy financial toll of medical expenses. Indeed, the problem of a lack of insurance for many is related to the problem of the cost of healthcare. So confirms the article by Consumer Reports (CR) (2008), which finds that "health-insurance premiums have grown faster than inflation or workers' earnings over the past decade, in parallel with the equally rapid rise in overall health costs. Industry spending on administrative and marketing costs, plus profits, consumes 12% of private-insurance premiums." (CR, 1) This reiterates the case that the undue imposition of costs by the healthcare industry -- a reflection of a free-market industry with little to no regulatory oversight -- has negatively impacted the accessibility and quality of healthcare for many of the poorest users.

Moreover, these users are most vulnerable to the long-term economic damages provoked by unexpected healthcare costs. So denotes the text by Kalinosky & Kohler (2005), which provides us with at least one preliminary suggestion as to the effectiveness of Obama's current policy orientation. Here, the article would indicate that one of the primary challenges facing working poor and lower middle class Americans would be that proceeding from the burden of healthcare expenses. Kalinosky & Kohler would point out three years prior to Obama's nomination that "the current U.S. official poverty measure does not explicitly account for medical care expenditures in either the poverty thresholds or the definition of family resources. It is sometimes assumed that in the United States, Medicaid and Medicare meet the medical needs of the poor and the elderly. Not all Americans have health insurance, however, and many of those who are covered by public or private health insurance have out-of-pocket expenditures or uncovered health care needs." (Kalinosky & Kohler, p. 1)

With respect to the study proposed here, this implies that the Obama administration has instigated a policy change that recognizes the relationship between healthcare costs for the uninsured or underinsured and flirtation with poverty Indeed, the text by Kalinosky & Kohler reiterates the claim that high medical expenses are often an inherent condition of poverty and vice versa. This suggests that at least some improvement may be on the horizon with respect to identifying the real correlation between the high cost of medical care and the cyclical persistence or deepening of poverty. Kalinosky & Kohler would go on to assert that "at least some degree of medical care is arguably a basic need for most (if not all) persons at some point in their lives. Furthermore, medical care needs are 'potentially related to destitution, morbidity, even early mortality' (Institute for Research on Poverty, p. 25). Thus, a poverty measurement that does not take account of medical care needs may ignore an important factor in poverty." (p. 1)

It is thus that the Obama Administrations reconsideration of what defines poverty may be seen as instrumental to creating and executing a research endeavor. According to the article by Haq (2010), the administrations new incorporation of medical expenses into the poverty threshold will multiply the number of impoverished Americans threefold. This stands both as a compelling fact in our studies and as a watchword for protecting the experimental integrity of a research design as it develops. To this latter point, we consider that the definition of 'poverty' is currently in flux. Moreover, the political future of the current healthcare legislation may itself be in flux. Therefore, we enter into a research endeavor with caution and recognition that changes in the nature of literature may reflect this relative political or legislative instability. Accordingly, we refer to Haq's report, which tells that under the new definition, "poverty rates will probably increase from 13.2%, or 39.8 million people, to 15.8%, or 47.4 million, reports the Associated Press. The new measure may bring about a more dramatic change in the senior citizen poverty rate because of rising medical expenses." (p. 1)

It is perhaps not a coincidence that the index of likely impoverished citizens is so close to the index of America's uninsured. Therefore, just as changes in political terminology may challenge the structure of the research design proposed, any stability in the current HCR package will converge with the new poverty threshold in order to reveal positive change or static results.

Methods:

The research proposal calls for a comparative study of the experiences of the insured and the uninsured in the United States in light of the new HCR package.

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This denotes that the independent variable is the individual citizen's possession or lack of insurance coverage. The dependent variable is the economic impact on the individual of the Obama HCR package. This calls for a quantitative research methodology. This method would first be grounded in an extensive review of the language and content of the HCR package itself. Here, researchers would examine the legislative package in order to gain a better understanding of its implications.

These implications would then be cast into a comprehensive the creation of a survey instrument intended to gather data from respondent regarding their economic experiences in light of specific changes brought on by the legislation. This calls for the design of a survey instrument to be distributed to respondents and constructed to deliver a quantifiable poverty threshold as this relates to one's healthcare status. 'Poverty threshold' is defined here as the deliverable of the quantitative studies, with higher scores indicating a higher threshold for medical costs and a less risk of poverty whereas lower scores indicate a lower threshold for medical costs before entering poverty status. The survey would be a 20 item Likert Scale survey. Here, the respondent is asked to circle the statement which best describes his or her feelings or experiences as they relate to each item. Accordingly, each response would garner a score leading to a composite score for each survey response. Scores would be distributed thusly:

5 = Strongly agree 4 = Agree 3 = Neutral 2 = Disagree 1 = Strongly disagree

The 'experiences' and 'feelings' which will be expressed throughout the 20 item survey will refer to the various economic implications of the package, including the degree to which it will raise healthcare costs for certain insurance holders; the degree to which it will reduce healthcare costs for the uninsured; the degree to which the uninsured will become insured; and more generally, the extent to which the burden is either evenly or unevenly distributed across the healthcare landscape. The nature of each statement would be consistent with the intention of stating affirmatively that the Obama healthcare legislation has reduced the risk of poverty to the uninsured without altering the experience of the insured. This is to indicate, for example, that the expected outcome of a survey where the uninsured respondent has not experienced any improvement is a low poverty threshold. This would confirm the hypothesis that the initiative has not done enough to improve the status of the uninsured American as this concerns the dangers of poverty. The uninsured respondent would be placed in the experimental group and the insured respondent in the control group, with no change expected in the experience of the latter. The control group is predicted to demonstrate a high poverty threshold during both pretest and posttest whereas the experimental group is predicted to demonstrate a low poverty threshold during the pretest. During the posttest, the poverty threshold of the experimental group will be used to draw conclusions regarding the impact of the Obama HCR package as this does or does not create protections against the dangers of poverty for those who are currently uninsured.

The posttest is to be conducted annually across a four-year period. This would be done in order to establish a more empirical understanding (rather than a speculative projection) of the near-term impacts of the legislation.

Implications for Social Policy Action:

The preeminent implication of the present research proposal is its intent to produce a comprehensive evaluation of the current healthcare legislation package that is free from political influence or interests and that considers the reform package as an intended response to medical-cost induced poverty. The study proposed proceeds from the theoretical constructs provided by what Cockerham (2004) calls 'medical sociology.' This perspective denotes that a society, country or community's public health realities cannot be understood separate from the various economic, politics, cultural, geographical and racial realities that implicate its distribution. Here, Cockerham makes the argument that "The link between medical sociology and sociological theory is crucial to the subdiscipline. Theory binds medical sociology to the larger discipline of sociology more extensively than any other aspect of the sociological enterprise." (p. 1)

This underscores the primary claim of the present research, which is that medical realities are both instigated by and can be a significant catalyst to other permeating sociological conditions. So is this shown by the literature review preceding.....

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