Abstract

The impact of poverty on individual patient is wide and far reaching; Medicaid program, the government funded and administered program that provides health care for these individuals have had to cut down on the types of covered services and the frequency for some services for the beneficiaries. As a result, cases of dire medical needs going unmet are, sadly no less common these days.

Poverty status is determined by comparing total annual income to a set of dollar values called thresholds that vary by family size, number of related children, and age of householder. If a family’s before tax money income is less than the dollar value of their thresholds, then that family and every individual in it are considered to be in poverty. For people not living in families, poverty status is determined by comparing the individual’s total income to his or her threshold (U.S. Census Bureau). The poverty thresholds are updated annually to allow for changes in the cost of living using the Consumer Price Index (CPI-U). They do not vary geographically.
SAIPE’s dependent variable is the estimates of poverty from the American Community Survey (ACS), a continuous survey with people responding throughout the year. Since income is reported for the previous 12 months, the appropriate poverty threshold for each family is determined by multiplying the base-year poverty threshold (1982) by the average of monthly CPI values for the 12 months preceding the survey (U.S. Census Bureau). The impact of poverty on individual patient is wide and far reaching; Medicaid program, the government funded and administered program that provides health care for these individuals have had to cut down on the types of covered services and the frequency for some services for the beneficiaries. As a result, cases of dire medical needs going unmet are, sadly no less common these days.
Consider Patty Poole, a 42-year-old woman living in Endicott, New York, who suffers from chronic lymphedema, a nasty condition in which lymph nodes swell and tissues fill with undrained fluid. By the time she received the diagnosis in February, one of her legs had swelled to several times its normal size, and her skin was so badly infected that she had to be hospitalized to control the infection before a surgeon could operate on her. She urgently needs a $900 compression garment to keep the swelling under control, but Medicaid no longer covers the cost.
Also consider Jamie McBride and her family are scrambling to make ends meet on a fraction of what they earned in happier times. Her partner, Felipe, is in community college in Albuquerque, training for work in sheet-metal technology. She stays home raising her two young daughters and earns $100 a week providing childcare for her sister’s kids. Jamie has gone without a functioning pair of glasses since she broke her frames in 2009. When she went to get them repaired she was told that because of Medicaid cuts she now has to wait three years instead of one before her insurance will cover replacements. To repair the frames herself would cost $50, which she can’t spare. So for now she squints.

Over the past couple of years, Medicaid administrators and legislators around the country have been penny-pinching wherever possible to prevent their overstretched systems from snapping. Some cuts have already kicked in; many more will do so in 2012. But these short-term savings come with consequences that will have long-term costs: fewer services, lower-quality care, less access to doctors, more difficulties in getting impoverished residents enrolled. The crisis is particularly acute—and self reinforcing— because surging poverty is raising the number of Americans who qualify for Medicaid.
The elderly is a commonly used label for population 65 years old and over. Some people in this age group have significant financial and health problem while others do not. Some are still a part of the paid work force while some engage in volunteer work and care of children.
The life expectancy of the U. S population has increased significantly with advancement in technology. According to Shi and Singh (2010), the fact that life expectancy almost doubled from 1900 to 1965 was as a result of advances in social conditions – improved sanitation, nutrition, and living conditions – rather than advances in medical treatment. The continuing rise in longevity since then, however, has been largely attributed to advances in medical technology as well as continued improvement in living conditions (pg 103-104).
From 1990 to 2020, the elderly population is projected to increase to 54 million persons. The growth rate of the elderly would be more than double that of the total population during this period. With age, there is a general physical and in some cases mental decline. Health related issues that are as a result of age include but not limited to;
• Reduced circulatory system function and blood flow
• Reduced lung capacity
• Reduced immune system function- making them more susceptible to infections
• Lessened and weakened hearing leading to deafness.
• Diminished, and decline in eyesight leading to blindness.
• Reduced mental/cognitive ability.
• Depressed mood
• Greater susceptibility to bone and joint diseases such as osteoarthritis and osteoporosis reducing or restricting their movement.
• Memory Loss is common due to the decrease in speed of information being encoded, stored, and received. It may take more time to learn new information.
Alzheimer's disease, the most common form of dementia, is found in old age
Williams and Torrens (2008) stated that the services available to provide assistance to those with long-term disability and chronic conditions have grown significantly during the past three decades. However, the population needing long-term care has also grown, and the greatest burst of expansion is anticipated with the aging baby boom generation. (pg 217 & 218).
U.S Census Bureau projects that by 2020, about 1 in 6 American will be elderly. As a nation, The United States is not prepared to provide extensive long-term care that is effective, efficient and affordable. The challenges to clinicians, administrators, policy makers, and payers demand attention. For the foreseeable future, the individual and family will remain those ultimately responsible for coordinating the long-term care of a person with chronic illness and functional disability Williams and Torrens (2008).

References

ABRAMSKY, S. (2012). The Medicaid Stress Test. Nation, 294(1), 27-30. Available from: Academic Search Complete, Ipswich, MA. Accessed June 3, 2012.
Shi, L., & Singh, D.A. (2010) Essentials of the U.S. Health Care System (2nd Ed.). Sudbury, MA: Jones and Bartlett Publishers.
U.S. Census Bureau (2011) Small Area Income and Poverty Estimates (SAIPE): 2010 Highlights. http://www.census.gov/did/www/saipe/data/highlights/files/2010highlights.pdf Retrieved: June 3, 2012
U.S. Census Bureau (1993). We The American Elderly. U.S. Department of Commerce Economics and Statistics Administration. Bureau of the Census http://www.census.gov/apsd/wepeople/we-9.pdf Retrieved: June 3, 2012
Williams, S., & Torrens, P. (2008) Introduction to Heath Services (7th Edition). Albany, NY:
Delmar Cengage.