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Madie Minch

Dr. Elizabeth Hudson

PS 1010 Discussion

30 March, 2017

Policy Paper

Health Equity

This semester my group has been focusing on health equity; meaning the issue that not all

populations within the United States are able to access the same quality of health care. We have

found that this gap between those with health care and those without has been caused primarily

by the policies in place, such as Medicare and Medicaid, which do not effectively provide for all

of those who are unable to afford health care and/or insurance on their own. In the following

essay, I will be focusing on how the government has made small efforts to supply basic needs for

its citizens on a timely basis and altogether made substantial steps towards closing the gap;

specifically, on the federal and local government levels where it becomes clear that health care is

not getting the attention it needs from policymakers.

The Uninsured in Michigan- A Profile, a report drawn up by Governor Rick Snyder and

James K. Haveman, looks at the rates of uninsured citizens based on their age, level of education,

race, and marital status for Michigan as well as the United States in general. This report shows

that the group of people least likely to be uninsured overall are white couples with children under

the age of 18 (12.4 percent uninsured throughout the United States and 7.9 percent uninsured in

Michigan). While this percentage is relatively low, it seems to be an anomaly when compared to

the rest of the data. The rate of uninsured citizens between the ages of 18 and 64 (the age group

least likely to be uninsured) has been on an upward trend not only in Michigan but across the
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whole of the United States since 2001. While a higher work status correlates with a decrease in

the rate of the uninsured, there is still an overwhelming 14 percent uninsured rate of all citizens

in Michigan and an even higher 17.4 percent uninsured rate across the United States as a whole.

And this is nothing compared to the uninsured rate of the Hispanics which lies at a horrifying

19.9 percent in Michigan and 32.2 percent throughout the United States. This is made even more

of a gross separation when compared to the Whites 13.7 percent and 13.4 percent respectively

(Snyder and Haveman). All of the data presented here leads me to the same question: how can

this happen when the government has already employed Medicare, Medicaid, and the ACA? It

turns out that these policies are not as effective as they were originally designed to be. Each of

these policies is focused on bringing affordable care to those living in poverty. However, people

living just barely above the poverty line are still unable to afford insurance plans but still do not

qualify for these programs. The only programs working towards a solution on this specific issue

are those like the Voices of Detroit Initiative.

Against all of these daunting statistics is a small, local effort made by the Associate Dean

on the Medical School here at Wayne State University. Dr. Herbert Smitherman helped in the

foundation of the Voices of Detroit Initiative (1998) which was a project to move under

deserved patients out of emergency rooms and into doctors offices. When asked what inspired

him to take on this momentous task, Smitherman points out that Since about 1997, weve lost

about sixty percent of our primary care physician capacity [in Detroit], and later in the

interview, more bluntly, that People are literally having strokes and heart attacks because they

cant get access to a very simple medication. Those enrolled in the program, seventy-five

percent of which are covered by Medicaid or not at all, would receive access at a primary care

physicians office for drastically decreased prices in return for allowing Smitherman and his
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associates track the progress of their care. (Gold and Smitherman, 2011). While this initiative has

had over a decade to influence the Detroit Metro Area and should have been able to help

alleviate the problem at the very least within the Detroit Area, only 55,000 people have been able

to benefit from the program, leaving over 150,000 uninsured patients to continue their struggle in

Wayne County alone (calculated from data given Snyder and Haveman 2013). While it seems

that not a lot of progress has been made on this particular front, this initiative is certainly a step

in the right direction and continues to work towards providing more affordable health care to

uninsured citizens.

Being uninsured is not the only reason health equity does not exist. During my

experience completing service hours at A Place to Grow Chiropractic in Rochester Hills with Dr.

Sarah Whedon and Dr. Rodney Hulbert I noticed that many of the patients were still paying out

of pocket even after their insurance had been applied to the charge. After some questioning and

research, I found out that this was because not all insurance plans will cover chiropractic visits

completely (if at all) because they are not considered to be a more holistic approach to wellness

rather than truly medically necessary. Furthermore, if a plan does cover the visits in full it is most

likely that there is a limit to how many times (usually per month) that the patient will be able to

apply their insurance at the chiropractic. This may not seem like such a big deal but the patients I

observed were paying up to 40 dollars in addition to what their insurance covered even though

their conditions were perceived as medically necessary by the doctor himself, enough so that

several patients were scheduled to return as soon as three days later. The patients in Rochester

Hills are more likely than most to be able to afford to pay these extra fees but this is not true for

the rest of the population. A person for poorer backgrounds would not be able to pay for

treatment and would likely continue suffering their condition with no medical attention until, in
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the most threatening cases, it progressed to the point of worthiness of a trip to the emergency

room where the patient would be bombarded with ambulance fees and medical bills much more

expensive than earlier treatment would have been.

Michigan has attempted to combat this issue by introducing 144 community, non-profit

hospitals as of January 2010, which are funded by charities. In addition, the free clinics dispersed

throughout the state operate as part of or with sponsorship from a variety of organizations

including charities, local medical societies, church groups, medical centers, and local

government agencies. While this method of funding is effective in keeping the free clinics and

non-profit hospitals open to the public it also limits the services each clinic can provide (. This is

therefore an ineffective method of closing the health care gap because it does not address the

issue of equal quality health care options to those who are uninsured or unable to pay.

So, what would be an effective method? I think the government should intervene more so

than it has already done. According to Public Policy: Politics, Analysis, and Alternatives written

by Kraft and Furlong, the government has the ability to regulate (licensing, inspection,

enforcement of standards, application of sanctions) on the topic of health. It also has the ability

to tax and spend which would aid in creating funds to support free clinics and expand their health

care options or to offer uninsured citizens more affordable health care plans (Kraft and Furlong).

The city of Flint has been struggling with polluted water since April of 2014. The city has drawn

up a strategic plan that it will enact from 2016 to 2020. The third and fourth goals listed are The

City will provide a safe, secure, healthy, and clean environment in which to live, work, learn, and

play, and The City will provide dependable, quality, and sustainable water and sewer,

respectively. The local government is exercising its right to tax and has included a list of fees

related to water treatment such as a 50 dollar labor rate and a 100 dollar Water Service Turn-on
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Turn-off fee (Ambrose, Walling, Steele, and Henderson). Now in the year of 2017 we can look

back at this plan and see how well it was carried out and the effects it has had on the problem.

From the website flintwaterclassaction.com/news/ it shows that as of February 26th, 2017, lead

levels in Flints city water finally tested below federal-action level. But residents are still being

cautioned to use filters on their faucets, or to drink bottled water

This collection of small efforts made by local and state governments all combine into

something that gives substance to the movement to close the gap between those with healthcare

and those without. The policies and organizations set in place to combat this issue have been

working together for years and will continue to do so up until and after the gap eventually

disappears.
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Works Cited

United States of America. Michigan Department of Community Health. Health Planning and

Access to Health Care Section. Michigan's Health Care Safety Net Providers. N.p.:

Michigan Department of Community Health, 2010. Print.

United States of America. Michigan Department of Community Health. The Uninsured in

Michigan- A Profile. By Rick Snyder and James K. Haveman. N.p.: Michigan

Department of Community Health, 2013. Print.

United States of America. Setting a Sustainable Course for the City of Flint; Five Year Financial

Plan 2016-2020; Proposed Budgets for FY16 and FY17; Future Projections for FY18,

FY19, and FY20. By Gerald Ambrose, Dayne Walling, Dawn Steele, and Natasha L.

Henderson. N.p.: n.p., n.d. Print.

Kraft, and Furlong. Public Policy: Politics, Analysis, and Alternatives. N.p.: n.p., n.d. Print.

Graham, Bob, and Chris Hand. America: The Owner's Manuel. N.p.: Sage Publications, 2017.

Print.

Smitherman, Herbert. "A Success Story: Expanding Health Care Options For Detroit's Poor-The

KHN Interview." Interview by Jenny Gold. KHN: Kaiser Health News. N.p., 12 May

2011. Web. 27 Mar. 2017.

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