Medicaid Coverage in the Context of an Ecological Framework of Health in the United States-A Present-Day Power Dynamic with Negative Implications.

Abstract

Power dynamics may be defined as "a way different people or different groups of people interact with each other and where one of these sides is more powerful than the other one." Pronk et al. recently proposed an ecological framework for United States (U.S.) population health, identifying culture, politics, policy, and socioeconomics as forcing factors that drive variations in health behaviors, health conditions and ultimately health outcomes. The current analysis examines the percentage of individuals currently covered by Medicaid alone in the context of the forcing factors and health outcomes of the ecologic framework. Counties identified as aggressively individualistic had a significantly higher percentage of the population covered by Medicaid alone compared to all other groups. The percentage of the population covered by Medicaid alone was significantly correlated with all measures and outcomes within the ecological framework. Apart from the prevalence of binge drinking and cancer, all other measures and outcomes trended toward a less favorable pattern as the percentage of the county-level population covered by Medicaid alone increased. The potential for reductions in Medicaid funding represents a current political power dynamic. The current study indicates this power dynamic may have significant adverse consequences to the proposed ecological framework for health-the percentage of the population covered by Medicaid alone is related to an unfavorable phenotype across all forcing factors of the framework as well as health outcomes. Loss of Medicaid coverage has significant implications for further worsening population health.