Poverty, Public Health, and Healthcare in the United States

Understanding Poverty in America

Defining Poverty and Its Scope

Political conflict over poverty in America begins with disagreement over its nature and extent, and then it proceeds to disputes over its causes and remedies. While many anti-poverty programs are largely regarded as federal programs, many allow states to set their own eligibility criteria and benefit levels, and are a blend of federal and state government funds. The official poverty rate in the U.S.A. has ranged between 11% and 15% in recent years. This official definition of poverty includes all those Americans whose annual cash income falls below that which is required to maintain a decent standard of living. The official poverty rate varies considerably among the states; poverty in some states, such as Mississippi, New Mexico, and Louisiana, is over 20%. Inasmuch as minority populations tend to experience poverty in greater proportions than others, it is not surprising that Southern states with larger African American populations and Southwestern states with larger Hispanic populations have higher poverty rates.

Demographics of Poverty in the U.S.

Poverty is most common among female-headed families. The incidence of poverty among these families is over 30%, compared to about 6% for married couples. African Americans, Hispanics, and Native Americans experience poverty in much greater proportions than whites. Chronic poverty is also more pervasive among minorities. The aged in America experience less poverty than the non-aged. The aged are not poor, despite the popularity of the phrase “the poor and the aged.” The poverty rate for persons over 65 years of age is below the national average. Moreover, the middle-aged are much wealthier than younger Americans.

Local Government's Role in Public Health

Public health and sanitation are among the oldest functions of local government. Keeping cities clean is still one of the major tasks of cities today, a task that includes:

• Street cleaning
• Sewage disposal
• Garbage collection
• Provision of a clean water supply

Often these services are taken for granted in the U.S., but in many developing countries of the world, health and sanitation are still major concerns.

Key Government Health Programs

Medicare: Health Coverage for Seniors

Medicare provides for prepaid hospital insurance for the aged and low-cost voluntary medical insurance for the aged under federal administration. It includes:

• A compulsory basic health insurance plan covering hospital costs for the aged.
• A voluntary but supplemental medical program that will pay doctors' bills and additional medical expenses, financed in part by contributions from the aged and in part by general tax revenues.

Medicaid: Supporting Low-Income Individuals

Each state operates its own Medicaid program. Unlike Medicare, Medicaid is a welfare program designed for needy persons; no prior contributions are required, and recipients of Medicaid services are generally welfare recipients.

Medicaid Expansion Under Obamacare

Obamacare provides for nationwide expansion of Medicaid eligibility. People with family incomes up to 133% of the federal poverty level will qualify for Medicaid. This expansion will be particularly beneficial for childless adults under age 65, who in many states did not previously qualify for Medicaid.

U.S. Healthcare Coverage and State Reforms

Approximately 86% of the population of the United States was covered by either private health insurance or government health insurance, including Medicare and Medicaid. However, about 14% of the population had no medical insurance. For many years, the state, rather than the federal government, took the lead in healthcare reform. Inasmuch as states cannot run deficits in the same fashion as the federal government, considerable effort was made in the states to contain Medicaid costs. State managed care programs vary widely, but most resemble private health insurance organizations, known as Health Maintenance Organizations (HMOs). The states pay HMOs a fixed amount for each person enrolled. These organizations have financial incentives to limit costs by monitoring patient care, often requiring primary care physicians to first obtain permission before referring patients to specialists or before performing specific procedures.