Healthcare provision is a contentious issue with numerous ramifications for public policy on both the state and federal levels. Recent legislative battles over the American healthcare system culminated in the passage of the Affordable Care Act. This sprawling new law was intended to make health insurance more affordable and widely available.
While it did not establish a "single-payer" healthcare system modeled on the nationalized insurance providers found in some other developed countries, the Affordable Care Act did create a "mandate" intended to compel private citizens to obtain health insurance. Under the Act, most Americans will continue to secure health insurance through their employers or fraternal organizations. Others will continue to purchase single plans on the open market. However, Americans who don't currently carry health insurance will be required by law to obtain it in some form. The federal government reserves the right to fine certain private citizens who choose not to buy health insurance.
While it's difficult to gauge the exact number of Americans without health insurance at any given moment, most credible sources place this figure at between 40 and 45 million. In other words, one American in seven lacks even basic health insurance coverage.
Many consumers who do carry health insurance may do so through discount policies that don't provide adequate coverage in certain situations. These policies may have high co-pays for basic services or medicines. They many not cover emergency-room visits or cover most of the cost of "catastrophic" illnesses that require lengthy hospital stays. They may have a patchy network of primary-care physicians and medical specialists. According to some estimates, nearly 40 million Americans have "inadequate" health insurance.
Due to the complexity of the nation's healthcare system, the effects of the widespread lack of adequate health insurance coverage are difficult to quantify. Some groups claim that nearly as many Americans are killed by poor health insurance coverage as by incidents of medical malpractice. By more sober estimates, over 20,000 people die each year as a direct result of inadequate insurance.
Historically, "charity" or public hospitals have shouldered the burden of providing essential medical care for Americans who lack health insurance. However, many of these hospitals are being purchased by private medical systems or closing down due to age or inadequate streams of funding. As more Americans use the Affordable Care Act to procure health insurance, this trend may accelerate. Medical care for the remaining population of uninsured Americans could become even more elusive.