Let’s explore how United States health policies shape who gets care, how care is paid for, and what it means for health equity. By viewing policy through a public health lens, we’ll ask not just what works clinically, but what works equitably and systemically.
The foundations of United States health policy
Note
KFF (Kaiser Family Foundation) is a nonpartisan, data-driven organization that tracks United States health policy, insurance, costs, and access. Students should be familiar with it as a go-to source for clear, timely, and well-contextualized information.
Review all chapters: KFF Health Policy 101 series
- Introduction
- Medicare
- Medicaid
- The Affordable Care Act
- Employer-Sponsored Health Insurance
- The uninsured population and health coverage
- Health care costs and affordability
- The regulation of private health insurance
- Health policy issues in women’s health
- Race, inequality, and health
- LGBTQ+ health policy
- United States public health
- International comparisons of health systems
- The U.S. government and global health
- The role of public opinion polls in health policy
- Congress, the executive branch, and health policy
- The politics of health care and the 2024 election
public health framing tip
Ask, “How does this policy affect populations, not just individual patients?”
Financing care: Who pays? Who profits? Who’s left out?
Health financing in the United States is a patchwork. Most people are covered through employer-sponsored insurance, but others rely on Medicare, Medicaid, the ACA marketplaces, or are uninsured.
Key public health concern
Coverage alone doesn’t guarantee access. Insurance networks, cost-sharing, and underinsurance all shape whether care is actually affordable or accessible.
Use KFF’s resources to learn
The flow of dollars in public vs. private systems.
The implications of high-deductible plans.
How cost-sharing disproportionately burdens low-income patients.
Health Insurance Coverage in the United States
think about this
How does financing affect population-level outcomes, such as preventive care uptake or chronic disease control?
Access to care: More than insurance
Let’s unpack what “access” really means. Even when people have coverage, they may face:
- Provider shortages, especially in rural and low-income urban areas.
- Transportation barriers.
- Language and cultural gaps.
- Drug affordability issues.
policy question
What health system design would reduce these barriers at scale?
public health asks
Who is consistently being left behind, and what systemic barriers are at play?
Examine disparities in access for
• People on Medicaid vs. private plans.
• Non-English speakers.
• Older adults with multiple chronic conditions.
Prescription drug costs: A lens into systemic gaps
Now let’s take a real-world issue—prescription drug affordability—and analyze it through both patient and provider eyes.
Nearly 4 in 10 Medicare beneficiaries reported skipping or delaying medications due to cost.
Even with insurance, drug prices create financial toxicity, leading to:
- Poor adherence.
- Disease progression.
- Provider frustration with care limitations.
public health framing tip
Focus on population-level consequences: Rising hospitalizations, health disparities, and inefficiency.
Discuss in Slack: Should the United States allow Medicare to negotiate drug prices? What are the ethical and economic tradeoffs?
Bring it all together: Policy in practice
At this point, you’ve explored the fragmented nature of United States health financing, the gaps in access, the burden of drug costs, and the inequities baked into the system.
Now we shift from analysis to applied public health thinking:
- How do these issues intersect in the real world?
- How can policy be used as a lever for population-level change?
Understanding health policy as a tool for structural change
From a public health standpoint, policy is prevention. It can:
- Create environments that promote health (e.g., Medicaid expansion reducing mortality).
- Remove structural barriers (e.g., transportation vouchers for rural patients).
- Regulate affordability (e.g., insulin cost caps).
But policy can also entrench inequities if not designed with equity and access in mind. For example:
- Coverage expansions may exclude undocumented immigrants.
- Value-based payment models can penalize safety-net hospitals with sicker patients.
- Narrow insurance networks may prevent access to essential specialists.
Policy isn’t just about coverage—it's about who gets care, who gets left out, and what outcomes result.
Current policy debates through a public health lens
Let’s walk through some real-time policy issues with a public health mindset.
- As of 2025, 10 states have not expanded Medicaid under the ACA.
- Non-expansion is strongly correlated with:
- Higher rates of uninsurance.
- Higher preventable mortality (especially among Black adults).
- Widening rural hospital closures.
Public health lens: Medicaid expansion isn’t just financial—it’s an equity intervention.
- The Inflation Reduction Act allows limited price negotiation for high-cost Medicare drugs starting in 2026.
- Anticipated outcomes include:
- Lower out-of-pocket costs for beneficiaries.
- Budget savings for Medicare.
- Potential industry backlash or changes in R&D behavior.
Public health lens: Affordable medications lead to better adherence, fewer complications, and reduced strain on emergency services and hospitals.
- The No Surprises Act (effective 2022) prevents out-of-network charges in emergency situations.
- Reduces financial shocks but does not address the underlying cost of care.
Public health lens: One-time protections are a start, but systemic price transparency and equity in billing are needed.
- Several states (e.g., Washington, Colorado) have piloted “public option” plans to reduce premiums and expand access.
- National proposals vary, from strengthening the ACA to creating Medicare-for-All.
Public health lens: The key question isn’t just whether more people are covered—it’s how comprehensively, affordably, and equitably they receive care.
Apply systems thinking
Think across domains:
| Policy issue | Population impact | System-level consequences |
|---|---|---|
|
High drug costs |
Medication nonadherence → poorer outcomes, more ER visits
|
|
|
Coverage gaps |
Delayed or foregone care |
|
|
Cost sharing |
Financial strain on low-income patients |
|
|
Surprise bills |
Patient financial trauma |
Erosion of trust in the system |
Discuss in Slack (optional): If we designed a health system from scratch using a public health framework, what would it look like, and how would it differ from the one we currently have?