Affordability and Eligibility Literature Review

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Running head: AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US Affordable Health Insurance amongst College Students in the U.S Name Institution Affiliation Date 1 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US Background and Introduction Background Information College students in the U.S. are supposed to take healthcare insurance seriously since they fall at risk of illness and financial constraints like the rest of the population. The largest populations of college students are young people vulnerable to situations which demand for healthcare coverage. The cost of care in the U.S. remains high, and such efforts as ACA, which are beneficial to vulnerable populations has decreased value in the current administration (Jones et al., 2018). Some healthcare requirements for students include STIs and unexpected pregnancies, drug and substance abuse complications, vulnerability to illness and accidents. Also, about 20% of youth in the U.S. have a chronic medical condition (Lemly et al., 2014). The college students in the U.S. thus have high healthcare demand like the rest of the population. The number of young adults joining community colleges, private and public universities is increasing. The health statistics of young adults in the U.S. are thus reflected in the college population. The special healthcare requirement for college students is also high in the U.S. For instance, many students want to learn about diet, supplements, and massage (Nguyen et al., 2016). College students are a vulnerable population since, in the event of emergency medical expenses, they lack financial capabilities to meet these expenses. College students also have increased preference in using complementary and alternative medicine (CAM). In most students healthcare center (SHC) is the standard medical care. Nguyen et al. (2016) found that the majority of college students who seek medical care use CAM and more, so try CAM when covered under insurance (Basch, Kernan, & MacLean, 2019). 2 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US The number of college students with a chronic medical condition is high. Many SCH only can provide primary care and in the management of some acute conditions. According to Lemly et al. (2014), most of the institutions (or SCH) also lack a proper system for the identification of youth with chronic medical conditions (YMC). Chronic health conditions for college students in the U.S. can lead to increased health risks and disruption of education. The prevalence of risk behavior, such as intensive alcohol use in colleges, also make YMC highly vulnerable to health problems. Poor diet and lack of sleep among college students also intensify health problems. The low capacity of the SCH to provide adequate care is thus a critical challenge to college students diagnosed with chronic medical conditions. College students also fall at risk of ineffective transition medicine. This refers to the planned and coordinated movement of children, adolescents, and young adults to adult healthcare systems. When students are moving to college, there is little regard to this change process as a critical factor for healthcare transition. This leaves students at high risk of inadequate healthcare, especially upon seeking services in SCH. The use of parents' healthcare plans was extended to 26 years, but payment for the use of SCH is not included. This presents critical financial challenges to college students and especially those with chronic conditions. College students in the U.S. are also at high risk of mental health problems. The number of students seeking mental health treatment is high (Eisenberg et al., 2011). Students hold skepticism on the effectiveness of treatment received from student health centers. Compared to adolescent young adults have high risks of substance abuse, which increases the risks of mental illness. Most of the mental disorder arises at 15-24 years making mental treatment critical among college students (Eisenberg, Golberstein, & Gollust, 2007). Young adults in college are also transitioned to adults’ roles, followed by withdrawal of support (Park et al., 2006). The young 3 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US adults with mental health problems in foster care are left to navigate on their own. In college, as such, students struggle to balance educations with social and economic demands; they fall into the risk of mental health issues. Some of the college students also have declining insurance coverage and are unable to receive adequate services. Some of the services available such as free campus mental health and near-universal health insurance, are absent in the general population, yet the services help-seeking is low. This arises from the various barriers such as stigma, concern on privacy in addition to financial constraints. Introduction This research study will explore how a college student can access to affordable health insurance as a requirement to address health issues affecting them. The out-of-the-pocket cost of healthcare services is detrimental for college students and would make them forego services. According to James et al. (2018), college students have low knowledge of health insurance (low health insurance literacy), which affects their healthcare utilization. With many changes occurring on affordable health insurance in the last two decades, many college students are unaware of the best options available to them. Non-white students are at the highest risk of low health insurance literacy leading to a lack of confidence to use the health insurance plans. By use a literature search, the study will help acquire insight into affordable health insurance by providing a comprehensive literature review on the topic. According to Nobles et al. (2019), knowledge of insurance plan type and options can be challenging for college students in the U.S. and hence. The enactment of the patient protection and affordable care act (ACA) all individuals in the U.S. have gained some responsibility to find, compare, choose and use health insurance (McLeod, & Adepoju 2018). In this case for college students the concern is to understand the health insurance which meet the health needs and enhance effective cost control. 4 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US The expansion of health insurance coverage for students to the age of 26 was an opportunity to provide health insurance for college students. College students have not been primary health insurance policyholders and hence health insurance information is both complex and confusing. Making decisions on affordable health insurance is further confusing and require comprehensive literature search. The current study provides a foundation for an education program to increase college students' knowledge on affordable health insurance plans within the country. The general assumption that individuals at the age of 15-30 years are at lower risks of illness than the older adults is wrong and hence there is need for college students in the U.S. to have adequate insight on the available, affordable health insurance and find, compare, choose and utilize a health insurance plan. Purpose of the Study The purpose of this study is to provide a comprehensive literature analysis of the ways to access affordable health insurance amongst college students in the U.S. This will involve an analysis of the characteristics and the benefits of different insurance plans which can be affordable to college students. This covers both undergraduate and graduate students taking a course in community colleges, private or public universities. The concern is also for those students who are either unemployed or are in part-time employment and hence do not have an employer-based health insurance coverage plan. These are also young adults (18-30) years vulnerable to financial challenges to meet out of the pocket cost of healthcare or those who cannot conveniently pay for regular health insurance plans. This study reflects on such plans as ACA focused on enhancing health insurance coverage for vulnerable populations. In this case, this study will focus on college students in the U.S. as one of the vulnerable populations who are unable to have healthcare plans. The study is 5 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US based on the fact that the state of different health insurance plans is constantly changing, and hence the college students' current knowledge of affordable health insurance is inaccurate. When students were enrolled in school fulltime, and past 22 years, they were not eligible to use parents' health plans, but with ACA, the coverage is extended to 26. There are also changes in the affordability of premiums irrespective of the individuals' medical history. This is important since most college students in need of using specialized services and complementary and alternative medicine (CAM) may need to receive subsidies for premium plans. The knowledge on whether eligibility to use parents' health plans can be confusing. This study also aims to explore Medicaid opportunities for students with limited incomes. These are students primarily who are not eligible to use the parent's healthcare plans or do not have access to other health insurance plans such as a spouse. The literature review also explores the current state of student health insurance plans and the most critical benefits which they can provide to the students. This study also focuses on providing a comprehensive analysis of the benefits from each of the available, affordable health insurance plan for students to be able to compare them and utilize the most appropriate plan which will meet their health need. The study is mainly focused on affordability as the most important message to college students in the U.S. Although the implementation of affordable health insurance for students can vary from one jurisdiction to another, this study aims to provide a comprehensive view based on national statistics. This study uses a qualitative research method on available literature to respond to the main research questions. Focusing on ACA as a primary step toward affordable health insurance in the U.S., this current study will be limited to literature from 2010 to the present. Reliability and validity of data are among the most critical element of a qualitative research design and hence scholarly materials and government publications will be used to complete the purpose of this 6 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US study. The most recent data published during Trump administration will also be highly prioritized in order to account for the changes in affordable healthcare resulting from the political climate. This current study will also focuses on research studies which were conducted independently by accounting for the credibility of the sponsors. By the end of this analysis, this study should be able to provide college students in the U.S. with accurate information about affordable health insurance, which can be reliable in making a health plan investment that will meet the student needs and reduce financial burden. Research Questions This study focuses on some specific research questions relating to affordable health insurance amongst college students in the U.S. General Research Questions 1. What can insurance plans be affordable to college students in the U.S.? 2. Are the affordable health insurance plans in the U.S. available to the college students, and what are their major restrictions? 3. Are the affordable health insurance plans available to the U.S. college students appropriate to meet the healthcare needs of this population? Specific Research Questions 1. What is the current state of ACA in the U.S., and how have the changes influenced college student access to affordable health insurance, which is appropriate for the health needs of this population vulnerable to acute and chronic illness and with high demand for highly specialized services such as complementary and alternative medicine? Significance of the Study 7 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US The current study has implications for a wide range of population and fields, including research, student population, parents, and college administrators. This study has significant implications for the literature on affordable health insurance among specialized populations. The study also has some significant implications for U.S. college students regarding their health insurance plans. In general high health insurance literacy has significant implications on healthcare utilization. Although the issue of health insurance among college students in the U.S. has been explored, this study provides a comprehensive analysis from the perspective of healthcare vulnerability and the availability of affordable care. One of the most critical significances of this study is to promote a high level of healthcare utilization among college students by promoting healthcare insurance literacy, which is simple, clear, and comprehensive. When a student chooses a health insurance plan, there is a significant level of prediction that they would effectively utilize healthcare. Although choosing healthcare insurance has been reported by some researchers as not a strong predictor of effective health utilization, there is a strong relationship between the two elements. According to (McLeod and Adepoju (2018), when students lack confidence in choosing healthcare insurance, there are significant challenges in their efforts to utilize healthcare. This study will, therefore, provide college students with health insurance literacy, which is up to date, influencing a choice for an appropriate healthcare plan. Most of the current information is not up to date, and hence these populations are not confident about making healthcare insurance plan decisions. The study will also help boost the success of the insurance marketplaces enhancing leveraged access to quality care. Most of the students will benefit from using specialized services, including mental health. The current study will also provide college students with a variety of affordable health insurance plans, thus helping compare to make choices on the most appropriate plan. Also, the study will 8 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US provide insight on managing health insurance. The capacity of the student to compare and manage health insurance is reported to significantly predict healthcare utilization (McLeod, & Adepoju, 2018). Most of the previous literacy materials report on one of the affordable health insurance plans. This study will reflect on the strengths and weaknesses of all the affordable health insurance plans available to students. Based on the findings of this study, college students will make individual and group decisions about insurance plan most appropriate to their needs and then commit to healthcare utilization. Having access to premiums and cost-sharing plans can encourage students to seek healthcare services for a wide range of conditions otherwise ignored. The study provides insight into all students on how ACA affects them. This study will include an analysis of all the provisions given by ACA, which will be beneficial to the different student populations. This includes college student eligibility to use parent or spouse health insurance plans while accessing subsidies for premium services. Another benefit is on student eligibility for Medicaid when they have no access to other healthcare plans. This information will particularly benefit the most vulnerable college student, such as low-income households. Since the enactment of ACA, each individual, including college students, received a responsibility to find, compare, choose, and utilize a healthcare plan based on its appropriateness to their needs. However, one of the limitations of this study in fulfilling the benefit of comparison and management of a health insurance plan is failing to include the demographic characteristics on the availability of affordable health insurance. This study focuses on affordable health insurance among all college students in the U.S. without an account of their race or state jurisdiction. For ensuring all students will benefit from the findings of the research, this analysis will connect the various 9 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US insurance plans to eligibility characteristics. The study also includes an analysis of Medicaid insurance plans, which account for eligibility for low-income households. The study will also benefit U.S. college students and other populations by providing insight on how ACA affects them. The constant campaign on universal care has created an assumption that ACA is an intervention which only benefits individuals without an insurance cover. In other words, there are individuals whose interpretation of universal care is only promoting the accessibility of care among the minority groups. One important aspect of universal care is promoting access to quality care. Although the term quality of care can have different meanings in different contexts, this study highlights the opportunities for college students to leverage healthcare services. The study specifically provides all provisions of ACA for college students to make decisions, including exploring for subsidies to receive premium services. For instance, college students below 26 years benefiting from a parent healthcare plan can be confused about how ACA affects them. Other than the extension of eligibility to use ACA, this study highlight other opportunities available to the college students to leverage the quality of healthcare services without out of the pocket costs. The study will also advance the literature on low literacy on ACA among other U.S. populations. Since enactment of the ACA researchers have explored individuals' knowledge and attitude on ACA. For instance Trout et al., (2018) found that students with individualized education programs have low health literacy. Ghaddar, Byun, and Krishnaswami, (2018) on the other hand report low literacy on ACA especially among minority groups making individuals to remain uninsured. This study add to this literature by providing insight on the need for education programs which is based on what the population would need to learn. In this case, the study provides an ACA campaign which is based on responding to the needs of the college student in 10 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US the U.S. The information on ACA is complex and continues to be complex as several implementation changes are made in different federal administrations. Unless comprehensive up to date analysis of the benefits is availed to a specific population, the impact of ACA may remain low in the future. The study also responds to some of the key research gaps in the current literature. For instance, the study will account for the changes in the implementation of ACA as proposed and enforced in the Trump administration. The study has significant implications for the health market. The study will highlight the need for providing affordable healthcare insurance amongst college students in the U.S. While most of the stakeholders in the health insurance respond to the ACA provisions for minority groups such as the elderly, minorities' college students are not in the priority list for vulnerable populations. Most of the academic studies explore college students as a subset of the general young adult population. However, this study presents U.S. college students as having unique health needs. For instance, the study will explore the implication of the availability of affordable health insurance to college students' access to CAM. The literature on college students' increased demand for CAM is limited, and hence a healthcare policy in the institutions is based on standard care in the general population. These study findings will also inform the need for SCH to improve the nature and quality of services as an effort to increase healthcare utilization among a wider scope of the student population. The study also focuses on college students as a vulnerable population to healthcare problems while facing social and economic challenges in their transition from dependence to parents to independent adults. The study will thus promote and emphasize on the accessibility to affordable health insurance among vulnerable populations. 11 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US References Basch, C. H., Kernan, W. D., & MacLean, S. A. (2019). Improving understanding about dental health issues in college students. Journal of prevention & intervention in the community, 47(1), 25-31. Eisenberg, D., Golberstein, E., & Gollust, S. E. (2007). Help-seeking and access to mental health care in a university student population. Medical care, 594-601. Eisenberg, D., Hunt, J., Speer, N., & Zivin, K. (2011). Mental health service utilization among college students in the United States. The Journal of nervous and mental disease, 199(5), 301-308. Ghaddar, S., Byun, J., & Krishnaswami, J. (2018). Health insurance literacy and awareness of the Affordable Care Act in a vulnerable Hispanic population. Patient education and counseling, 101(12), 2233-2240. James, T. G., Sullivan, M. K., Dumeny, L., Lindsey, K., Cheong, J., & Nicolette, G. (2018). Health insurance literacy and health service utilization among college students. Journal of American College Health, 1-7. Jones, D. K., Gusmano, M. K., Nadash, P., & Miller, E. A. (2018). Undermining the ACA through the executive branch and federalism: what the Trump administration’s approach to health reform means for older Americans. Journal of aging & social policy, 30(3-4), 282-299. 12 AFFORDABLE HEALTH INSURANCE TO COLLEGE STUDENTS IN US Lemly, D. C., Lawlor, K., Scherer, E. A., Kelemen, S., & Weitzman, E. R. (2014). College health service capacity to support youth with chronic medical conditions. Pediatrics, 134(5), 885-891. McLeod, A., & Adepoju, O. (2018). Toward a Health Insurance Literacy Model: What Do Young Consumers Know about Insurance?. Perspectives in Health Information Management. Nguyen, J., Liu, M. A., Patel, R. J., Tahara, K., & Nguyen, A. L. (2016). Use and interest in complementary and alternative medicine among college students seeking healthcare at a university campus student health center. Complementary therapies in clinical practice, 24, 103-108. Nobles, A. L., Curtis, B. A., Ngo, D. A., Vardell, E., & Holstege, C. P. (2019). Health insurance literacy: A mixed methods study of college students. Journal of American College Health, 67(5), 469-478. Park, M. J., Mulye, T. P., Adams, S. H., Brindis, C. D., & Irwin Jr, C. E. (2006). The health status of young adults in the United States. Journal of Adolescent Health, 39(3), 305-317. Trout, A. L., Lambert, M. C., Epstein, M. H., & Avery, M. (2018). Health literacy of students with and without individualized education programs: a brief report. Exceptionality, 26(1), 35-45. 13
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Running head: LITERATURE REVIEW

1

Literature Review
Student’s name
Institution affiliation
Instructor
Date

LITERATURE REVIEW

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The significant objective of improved exposure affordability and eligibility is to escalate
adequate wellbeing facilities for the vulnerable, and the most important, college students in the
United States. As a consequence, the ACA’s influence on the excellent wellbeing has been
appraised through numerous measurements, for instance, access to health practitioners,
possessing a unique healthcare origin, affordability, as well as access to medications and
preventive healthcare strategic measures in order to make sure that the health status of college
students is at its best level (Nava, 2019). The expected outcome of enhanced reportage, access
and interface with the wellbeing upkeep coordination are developed health. Under this case,
wellbeing has often been evaluated through magnitudes of self-reported public and psychological
fitness, mortality, scientific pointers and diagnosed chronic conditions.
Understanding the wellbeing impacts of coverage Dorsey and Moran (2019) argue that
the current state of ACA in the United States is generally improving and with that, the vulnerable
have benefited the most, with college students having access to healthcare insurances. A lot of
college students have taken improvement of regular experimentations in order to outstanding
mental disabilities. A big number of college students possess an advantage of the normal
experimentations to overcome. After the ACA usage, an improvement in self-detailed wellbeing
was found among undergrads in general. Medicaid extension, specifically, was not related to
noteworthy changes in self-announced wellbeing among low-salary grown-ups following one
year. However, upgrades were seen following two years, most considerably among low-pay
families and understudies, a significant subgroup who have profited by extended Medicaid
qualification (Nava, 2019). Early assessments of Medicaid development have additionally
uncovered no relationship with changes in paces of self-announced or optimistic transmission
results for wretchedness, analyzed hypertension, or wellbeing practices, for example, corpulence.

LITERATURE REVIEW

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According to Dufour 92019), the ACA is termed to be the most substantial development
of fitness protection coverage in the United States subsequently to its implementation. As of
early 2016, statistics clearly illustrate that more college students possess health insurances
compared to about three years down the line, which is after the availability of the law’s foremost
necessities. Under this case, college students, as well as the low income families in general, are
the key beneficiaries. However, there exists a problem to those low-income families who are
living in specific states under which the states have refused to expand their medical programs
notwithstanding the accessibility of considerable federal finance or else because the states are
generally forbidden from ACA welfares. The most important side of it is that a higher percentage
of outcomes clearly show that the ACA is working, hence reducing the number of unsecured
college students, and hence improving access to coverage for the newly secured college students,
together with the health status of the low-income families across the whole nation. The changes
have influenced college students in a positive manner, whereby bigger populations already
possess health-related insurances, which is an advantage when it comes to the wellbeing of
college students (Mackert et al. 2017). Over the long term outcomes, further research has clearly
shown improvements when it comes to self-reported wellbeing status, better physical and mental
health effects. This is not only originating from better access to care but also come from related
reductions in terms of monetary stress or both college students and low-income families in
general.
As per the government survey, about 40% of U.S adults aged 18 years and above are
using some form of alternative and complementary medicine. According to the authorities, there
exist an argument that the establishment of strong primary care models, for instance, patientcentered medical strategic measures would automatically create a strong primary system in order

LITERATURE REVIEW

4

to help manage acute and chronic infections and have full control of cost (Jung & Shrestha,
2018). ACOs have encouraged providers to work more in a collaborative manner across the field
of continuum patient care so as to improve population wellbeing and control costs as well.
Notwithstanding the alternative broad-based attitudes to health that a variety of CAM may take,
the majority of CAM visits are associated with individuals suffering from neck and back pain.
However, statistics claim that CAM patients do not inform their medical practitioners about their
CAM use.
With an unmistakable thought and care, considerations of CAM suppliers in PMCH and
ACO activities are probably going to improve coordination and lessen administration replication.
This is significantly more than nearness of other related subordinate key measures, for example,
dentistry and optometry, whereby the issue of covering with conventional clinical
administrations is insufficient (Mackert et al. 2017). The legislature is starting CAM
administrations to help the moderate ri...


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