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Arts & Science Program

First-year Arts & Science Capstone Project: Molly Gomes

Molly Gomes

Winter 2024 Capstone Project Title: Disparities with health insurance in emergency care under the Affordable Care Act (ACA) in the United States

Project Description: Cost is a well-known barrier to accessing healthcare and disproportionately burdens low-income populations. The passage of the Affordable Care Act (ACA) in the United States in 2014 introduced several changes designed to increase health coverage for low-income people, including the creation of subsidies for private insurance and expansion of insurance known as Medicaid. Policymakers who crafted the law believed that expanded health coverage would provide greater access to primary and preventive care, potentially leading to a reduction in the use of higher-cost services, including emergency departments. Yet, many low-income people and families with Medicaid continue to face challenges with insurance providers, limited coverage for medications and administrative problems associated with enrolling in Medicaid. These disparities in health insurance coverage can lead to inequalities in emergency and affordable care, resulting in the potential for worsened health outcomes.

The 1C06 Capstone experience: I chose this topic for my capstone project because I recognize that insurance is a significant contributor to social inequalities in accessing timely emergency care and can inform more patient-centred policies in the future. Although the provision of Medicaid has significantly improved financial status for many, I was particularly surprised that Americans with newly qualified health insurance use the emergency department (ED) more frequently than they did before for non-urgent reasons. Individuals who were previously uninsured may have postponed necessary care because of financial constraints and view the ED as an option for receiving health care that is always accessible rather than primary care services. I found it interesting to learn that Medicaid beneficiaries could not always get care from their chosen provider as it was not widely accepted, and thus may seek out EDs for their healthcare needs. Given that accessibility plays a significant role in differences in utilization, it is key that this be taken into account in a time when millions of individuals will be newly enrolled in health insurance without having a strong relationship with their primary care provider.

Key Takeaways: One of the biggest takeaways I had from my capstone project is that the introduction of Medicaid under the ACA has resulted in a neoliberal agenda that aims to dismantle social programs and replace them with privatized alternatives. The government turned to federal and state exchanges to achieve their goal of expanding the health insurance market, where individuals could shop and choose among various insurance policies in their states. This approach consists of neoliberal notions that include consumer choice and the effectiveness of the private over the public sector in tackling social problems. From the body of literature I have read, neoliberal assumptions have been embedded into the ACA based on the idea that Medicaid beneficiaries will choose medical services more prudently since all private option schemes generally include premium charges which low-income families are unable to pay out of pocket. I have learned that the private options tend to add layers of bureaucracy and administrative complexity for Medicaid beneficiaries which are not only confusing to the newly eligible individuals, but also result in greater non-health related costs.

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