Annotated Bibliography
Augustine Gyekye
Overview.

The Affordable Care Act which is often shortened as Obamacare is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. The introduction of the Affordable Care Act (ACA) in 2010 has resulted in a tremendous impact on the citizens in the United States and on the health sector to be specific. This is evident in the transformation of the quality, access and cost of healthcare. Even though Obamacare has increased the coverage of health insurance, a percentage of the population are still uninsured. I intend to assess the impact of the ACA on the access to healthcare delivery and the factors that contribute to this impact.
Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Acts Impacts on Access to Insurance and Health Care for Low-Income Populations. Annual Review of Public Health, 38(1), 489-505. doi:10.1146/annurev-publhealth-031816-044555
In this article, the authors address how the Affordable Care Act (ACA) has modified the access to health insurance right from its inception and its progress on the health care for low-income populations. They examine how several States that expanded Medicaid under ACA has enhanced the effectiveness of Medicaid and its contribution to improved coverage access for 20 million newly insured people. According to the authors, the low-income population has been the primary beneficiary of the ACA but challenges still persist.  The authors demonstrate how the low income population continue to be uninsured because their States refuse to expand their Medicaid program, coupled with other challenges of the cost of coverage, limited awareness of coverage expansions and eligibility, and a complex enrollment process. They conclude that there should be no dynamism in the implementation of Medicaid expansion and ACA across the states. This article will enrich the discussion on coverage and post ACA evaluation in the mini literature review.

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Garrett, B., & Gangopadhyaya, A. (2016). Who Gained Health Insurance Coverage Under the ACA, and Where Do They Live? Retrieved from https://www.urban.org/sites/default/files/publication/86761/2001041-who-gained-health-insurance-coverage-under-the-aca-and-where-do-they-live.pdf
This article examines the Affordable Care Act (ACA) coverage of the citizens in diverse locations. The authors comment that since its inception, the ACA has sought to describe the individual demographics based on coverage by the law and how legislative enactment affect the insurance of the individual. The authors also address the changes in health insurance coverage among people from different race, ethnicity, and cultural background from 2010 to 2015. They assert that the gains in coverage had a higher increase in States that expanded Medicaid than other States that did not expand Medicaid. The authors use the American community survey (ACS) to compare the uninsured rate for the nation, individual states in 2010 and 5015. According to the authors, the actual 2015 uninsured rate was 7% lower than it would have been in 2010 if coverage patterns that existed in 2010 remained constant in 2015. Based on their findings, the authors demonstrate that the coverage increases as a result of changes in the size and demographic composition of the population. They conclude that Congress is now repealing ACA but embarking on a partial repeal will cause more people to be uninsured than previously, which will reduce the access to health care.

This article will be useful in the discussion of the factors that cause a decrease or increase in insurance coverage and also the areas that experience such change in the insurance coverage.
Adepoju, O. E., Preston, M. A., & Gonzales, G. (2015). Health Care Disparities in the Post–Affordable Care Act Era. American Journal of Public Health, 105(S5). doi:10.2105/ajph.2015.302611
In this article the authors discuss four key areas that enhance inconsistencies in health care insurance. The authors address the fact that only 27 States and the District of Columbia have decided to expand their Medicaid programs. They also address the issue of States that did not expand their Medicaid program and how these States are faced with high uninsured and poverty rate and until steps are developed to expand Medicaid, their health insurance disparities will continue to widen. The authors address how the adoption of the integrated service delivery models has changed the health system. They also emphasize that both the low income population and wealthier families underuse the preventive services. According to the authors, the ACA has provided a private health plan to solve the issue of underused preventive services both by the low income population and the wealthier families. The authors identify a language assistance and heath literacy as the key shortfalls for the ACA since these issues determine the rate at which people are insured. To solve this problem of health disparity, the new phase of health reform should discard these four issues and adopt the Culturally and Linguistically Appropriate Services (CLAS) model for improving access to health care delivery.
This article has a link with the Impact of ACA on Low-Income Populations specifically the issue of States that expanded Medicaid and the States that refused.

Glied, S. G., Ma, S. M., & Borja, A. A. (2015). How Will the Affordable Care Act Affect the Use of Health Care Services? Retrieved from https://www.commonwealthfund.org/publications/issue-briefs/2015/feb/how-will-affordable-care-act-affect-use-health-care-services
This article discusses the impact of the 2014 expansion coverage on healthcare access. The authors emphasize that everyone having health insurance, whether Medicaid or private insurance have quality access to health care. They adopt a methodology to use two datasets which are the National Health Interview Survey(NHIS) limited use data and the Behavioral Risk Factor Surveillance System (BRFSS) to directly measure how ACA’s first open enrollment impact health care access. The authors assert that Medicaid coverage expansion and establishing State marketplaces has caused the number of uninsured Americans to reduce and enhanced access to health care for those who gained coverage. They also elaborate on how access to health care changed across a State’s population. The authors conclude that gaining insurance coverage through the ACA decreases the probability that a person will report not receiving medical care.
This article will be important to discuss the impact on health care before the ACA and the impact on health care after the ACA.
Hall, M. A., & Lord, R. (2014). Obamacare: What the Affordable Care Act means for patients and physicians Retrieved from https://sph.umich.edu/sep/overview/pdf/Hall 2014.pdfThe article focuses on using empirical studies to demonstrate how ACA’s major impacts on patients and physicians. The authors explore the main features of the ACA and the influence these characteristics have on the accessibility and coverage of health insurance. They also elaborate on the things that the Affordable Care Act covers and what it does not cover.  According to the authors, there is a misconception of ACA as a socializing medicine or a socializing insurance and point out how this leads to people being uninsured. The authors also examined that there is a positive relationship between the access to health care and marketplace enrollment. The authors argue that undocumented individuals are not eligible to Medicaid, hence, these individuals will not have the chance to be insured with a different private insurance firm. In addition to this, the authors stress on how narrow networks and increase in patient cost sharing have caused the Affordable Care Act to alter the public sector. The authors conclude that paying much attention to the structure and content, if the ACA has reduced the number of uninsured people with no increase in medical cost, then it can be said to be successful.
This article will very helpful in the conclusion of my literature review.
Wilensky, G. R. (2012). The Shortfalls of “Obamacare”. New England Journal of Medicine, 367(16), 1479-1481. doi:10.1056/nejmp1210763
This article focuses on the three (3) major challenges of the Affordable Care Act in terms of access, quality, and the cost of healthcare insurance. The authors state how ACA expands coverage to a quantifiable number of the uninsured with less emphasis on the other two problems which remain promises and aspirations. They also address how this techniques cause people not to insure themselves until they need health insurance. According to the authors, in as much as ACA expands coverage, it pays the least attention to structural organizational challenges. According to the authors the amount charged when an individual refuse to get insured is minimal and does not deter the people from being insured. The authors conclude that reforms characterized by more incentives and with much focus on value instead of volume should be adopted.
This article will be helpful to discuss the rate at which access to healthcare delivery has been detrimental to the ACA and the Appalachian region. This will be useful in my mini literature review.
Nguyen, K. H., Trivedi, A. N., ; Shireman, T. I. (2018). Lesbian, Gay, And Bisexual Adults Report Continued Problems Affording Care Despite Coverage Gains. Health Affairs, 37(8), 1306-1312. doi:10.1377/hlthaff.2018.0281
In this article, the authors present the access to health care insurance, personal doctor routine check-up as well as health outcomes for Lesbian Gay Bisexual adults and compare them to their Straight peers. They use the Behavioral Risk Factor Surveillance System and the Pearson test to extract a clear distinction of Lesbian Gay Bisexual (LGBs) and Straight non-elderly adults based on demography. The authors also address the challenges faced in the course of the survey and how to overcome these limitations of increasing the insurance coverage. The analysis proved that the rate at which LGBs and straight peers are uninsured is homogeneous. According to the authors, the comparison of previous studies and their findings suggests that more insured LGB adults reported avoiding medical care due to cost and worse outcomes as to that of straight peers. Also, they observe that the availability of health insurance through ACA expansions and LGB outreach efforts reduced uninsured rates in LGB adults in comparison to their straight peers. The sexual orientation is frequently overlooked it concerns issues of health.
This article will help in the discussion of the dimensions of sexual orientation and its influence on health care access in my paper.

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