Social and economic issues - healthcare in the USA

• The USA has no free national healthcare system; most people rely on private insurance.
• The US spends more on healthcare than any other country, although health outcomes are often poorer than in similar nations.
• Costs are driven up by inefficiency, high wages, bureaucracy, and expensive prescription drugs.
• Many Americans face medical debt, avoid treatment due to costs, or declare bankruptcy.
• Racial inequalities exist in access to healthcare, with Black and Hispanic Americans more likely to be uninsured.
• Health outcomes vary by race, with Black Americans experiencing lower life expectancy and higher mortality rates.
• Medicare, Medicaid, CHIP and the ACA provide coverage for some groups.

Keep going to learn:

• What problems are there with the US healthcare system?
• Inequality in access to healthcare
• Inequality in health outcomes
• Health programmes in the USA
• What is the Affordable Care Act (ACA)?

Then test how much you have learned.

There are different ways Americans access healthcare. The way in which healthcare is organised in the US has been divisive.

Unlike the NHS in the UK, there is no free at the point of use national healthcare provision in the US.

Most Americans are expected to provide for their own healthcare through private medical insurance. Many people receive their private health insurance through their employer.

One of the providers is the Blue Cross Blue Shield Association, which provided health insurance for 115 million members as of 2023.

The US healthcare system can work well for those with full coverage private medical insurance.

Facilities and treatments are world-class, public satisfaction rates are high and waiting times are low.

However:

• despite spending proportionally the most money on healthcare in the world, outcomes e.g. life expectancy and infant mortality, are poorer than many other developed countries.
• there is a great deal of inefficiency in the US healthcare system as companies compete for business and bureaucracy (paperwork) costs are high.
• salaries of doctors and registered nurses are higher than elsewhere in the world - this makes costs for patients higher.
• US prescription drugs cost 2.78 times more than in other developed countries. (Source: ASPE, 2022)
• According to a 2019 study, around 530,000 US citizens file for bankruptcy each year because of debt from medical costs. (Source: American Public Health Association, 2019)
• There are few incentives to promote health education.

Costs of medical treatment, especially for the uninsured or under-insured has an impact on people's finances and their health:

• Almost a third of working age U.S. adults are currently in debt because of medical or dental bills.
• Fear of incurring medical debt also deters many Americans from seeking medical care.
• Nearly 40% of adults who have incurred medical debt say they have had to cut back on basic necessities like food, heat, or rent.
• 41% have used up all or part of their savings to pay down their medical debt.

(Source: Commonwealth Fund, July 2025)

There are significant differences in access to healthcare for different racial groups in the US.

Black and Hispanic Americans have higher rates of being uninsured compared to white Americans. This could be due to many factors including lower income, higher unemployment, employment in jobs that do not include health cover.

As of 2024, Hispanic Americans have the highest rate of individuals with no personal healthcare provider.

Hispanic and Asian Americans have the lowest take up rate for routine cancer screening

(Source for all statistics: KFF, 2025)

Life expectancy and other health indicators show inequality between different racial groups in the US.

Life expectancy for black Americans is lower than for other groups and has reduced in recent years.

Pregnancy-related mortality rates are significantly higher for black Americans than other racial groups.

Infant mortality rates are twice as high for black Americans as for white and Hispanic Americans, and nearly three times higher than for Asian Americans.

Cancer rates are highest for white Americans, but death rates from cancer are highest for black Americans.

(Source for all statistics: KFF, 2025)

The US government has health programmes that cover those who cannot afford private medical insurance.

These include:

• Medicare – mostly for people over 65 years of age and administered by the federal government. In 2022, Medicare covered 65 million people and cost $905 billion.

• Medicaid – covers people on low incomes including children, pregnant women and people with disabilities. It is administered by individual states. In 2024, over 88 million individuals (26.2% of the population) were enrolled in Medicaid, costing the US government $832 billion.

• Children’s Health Insurance Program – covers those children who do not qualify for Medicaid. CHIP is administered by states. In 2024, over 7.25 million children were enrolled in CHIP.

Black and Hispanic Americans are more likely to have lower incomes or to be unemployed. This means that they are less likely to have private medical insurance and are more likely to depend on Medicare or Medicaid, or to be uninsured (not covered by government health programmes and without private medical insurance). In 2023, 26 million people or 7.9 percent of the population were uninsured.

In 2024, 27.2 million Americans (8.2% of the population) of all ages did not have health insurance.

This compares to 9.7%, or 31.6 million Americans who did not have health insurance in 2020.

Often referred to as Obamacare’, the act was passed in 2010 to give Americans better access to healthcare by putting in place comprehensive health insurance reforms which:

• expanded healthcare coverage
• held insurance companies accountable
• delivered lower health care costs
• guaranteed more choice
• enhanced the quality of care for all Americans
• required all Americans to have health coverage

The Affordable Care Act has been divisive. In general, Republicans are against it and believe it is unaffordable, that it has led to hundreds of thousands of jobs losses and represents excessive government interference in private lives.

Many Democrats have embraced the ACA. It has led to higher insurance premiums for some, but it has widened access to health insurance. The number of Americans who are uninsured has fallen since the ACA was passed from about 15.5% of the population in 2010 to 8.2% of the population in 2024.

There were attempts to repeal and replace ACA during the first Trump Presidency, but these failed. In 2017, despite the Republicans holding a majority in Senate, they were unable to repeal ACA or bring in an alternative.

Covid-19 led to many Americans losing their jobs and the health insurance that came with them. In response, some Republican politicians have openly suggested they look to ACA providers to find replacement insurance.

In January 2026, 17 Republican members of the House of Representatives voted with Democrats to re-establish tax credits that reduced costs for Affordable Care Act (ACA) health plans.

During his first Presidency, Donald Trump attempted to replace ACA with a new American Health Care Act, which he said would be cheaper, better and provide “insurance for everybody". However the plan failed to find support and was dropped when it seemed that it would be voted against in the House of Representatives.

A major issue in opposing ACA is that it is approved of by a majority of voters and has grown in popularity across all voter groups, as shown in the table below:

(Source: KFF Health Tracking Poll)

In January 2026, President Trump announced “The Great Healthcare Plan". This aims to limit health costs, including lowering the price of prescription drugs, increasing price transparency from health care and insurance companies, and making public data about insurance company finances and how they deal with insurance claims. Many of these aims are similar to parts of ACA.

The plan is different as it aims to redirecting government subsidies from insurers so that it goes directly to individuals who would then shop around for health care. Initial reaction to the plan has focused on a lack of detail on how this would work, and concerns about how well the plan would work for people with existing health conditions.

• The USA does not have a free, national healthcare system; most people must arrange and pay for their own healthcare through private medical insurance, often provided by employers.

• The US healthcare system can deliver advanced treatments, high patient satisfaction and short waiting times, but mainly for those with full private insurance coverage.

• Despite spending more per person on healthcare than any other country, US health outcomes are worse than in many comparable developed nations.

• Healthcare costs are high due to inefficiency and bureaucracy, competition between providers, high salaries, and prescription drugs costing nearly three times more than in other developed countries.

• Many Americans are in medical debt, some avoid treatment due to cost fears, and hundreds of thousands file for bankruptcy each year.

• There are significant racial inequalities in access to healthcare: Black and Hispanic Americans are more likely to be uninsured, lack a regular healthcare provider, and are less likely to receive routine cancer screenings.

• Health outcomes also vary sharply by race, with Black Americans experiencing lower life expectancy, higher pregnancy‑related mortality, higher infant mortality, and higher cancer death rates.

• Government programmes such as Medicare, Medicaid and CHIP provide coverage for older adults, low‑income individuals and children, while the Affordable Care Act (Obamacare) has expanded coverage but remains politically controversial.