Social Welfare Policy Analysis Capstone Midterm Paper ✓ Solved

Social Welfare Policy Analysis Capstone Midterm Paper: Identify

Social Welfare Policy Analysis Capstone Midterm Paper: Identify one US federal or state social welfare policy implemented to address a social problem, and discuss it with the professor. Then answer the following outline: I. Introduction 1) What is the nature of the social problem targeted by the policy? 2) What is the specific policy to be analyzed and how is it defined? (Brief overview) II. Choice Analysis: 1) What are the bases of allocation? 2) What are the types of social provisions? 3) What are the strategies for delivery of benefits? 4) What are the methods of financing these provisions? III. Historical Analysis 1) What policies and programs were previously developed to deal with the problem? In other words, how has this problem been dealt with in the past? 2) What does history tell us about effective/ineffective approaches to the problem? 3) How has your specific policy/program under analysis developed over time? 4) To what extent does the current policy/program incorporate the lessons of history? IV. Social Analysis 1. Problem description a. Describe the population(s) affected by the problem? i. Size of population ii. Defining characteristics- Geographic location- urban, rural or suburb. Gender, race, socioeconomic status, and education. iii. Describe the impact of the specific social problem on the overall population. 2. Discuss one theory of human behavior that explains the population, intervention or goals of your chosen policy? a. Here are examples of human behavior theories: 3. What are the major social values related to the problem and what value conflicts exist? 4. What are the manifest (stated) goals of the policy under analysis? 5. What are the latent (unstated) goals of the policy under analysis? v. Comparative Analysis 1. How has another country addressed this problem through policy? 2. Are there any policy measures the US should consider implementing that are offered abroad? vi. Economic Analysis 1. What are the effects or potential effects of the policy on the functioning of the overall economy? (Income, inflation, unemployment- Macroeconomic analysis) 2. Discuss the efficiency (cost) & effectiveness (success) of this policy. vii. Political Analysis 1. Who are the major stakeholders regarding this particular policy/program? a. Which are in the power base of the policy/program supporters? b. Which are in the power base of the policy/programs opponents? 2. How well are the policy/program’s intended beneficiaries represented in the ongoing development and implementation of the policy/program? viii. Conclusion 1. Reflect on yourself as a practitioner of social work and applicability of your chosen policy related to social work values, specific social work skills, and knowledge of theory. What have you learned about policy analysis and your specific policy that you will take forward with you as you continue your education and career? Please utilize the APA style in formatting: Include citations throughout your paper and a reference page. Reference sources of information appropriately – this paper will require a certain amount of research, use a minimum of 7 references. Those include: Journal articles, text books, well sourced publications, government websites, and schools of research. Make sure that the paper is organized with subheadings – corresponding to the items on the midterm outline. Please write in complete sentences and use quotations for direct quotes, no more than one direct quote per paragraph. Proofread your paper thoroughly.

Paper For Above Instructions

Introduction

The policy chosen for analysis is the Medicaid expansion provisions embedded in the Affordable Care Act (ACA), which extended eligibility for Medicaid to many low-income adults who were previously ineligible. The social problem is health coverage gaps that leave millions uninsured, with downstream consequences for health outcomes, financial strain, and broader social and economic inequities. The expansion represents a federal-state partnership designed to reduce uninsurance, increase access to primary and preventive care, and lessen uncompensated care burdens on providers. The policy is defined as a targeted expansion of Medicaid eligibility to adults with incomes up to 138% of the federal poverty line (FPL), coupled with federal financial support to states that choose to participate. This analysis follows the assignment outline and employs a policy-focused lens to assess design, history, social implications, international comparisons, economic effects, and political dynamics surrounding the policy.

Choice Analysis

Bases of allocation: The expansion as implemented uses uniform income-based eligibility criteria across states that opted in, with federal funding covering a large share of the costs for newly eligible individuals. Allocation is anchored in income thresholds rather than categorical eligibility, broadening coverage beyond traditional populations (pregnant women, children, and disabled adults).

Types of social provisions: The provisions primarily provide health insurance coverage through Medicaid, including access to preventive services, chronic disease management, and hospital care. In many states, coverage is delivered through managed care arrangements, with varying provider networks and benefit packages designed to meet essential health needs.

Strategies for delivery of benefits: Enrollment often occurs through state exchange mechanisms, with outreach efforts, eligibility determination processes, and periodic re-determination. Delivery relies on state implementation, with federal oversight and guidance, and occasional waivers to tailor benefits and cost-sharing structures.

Methods of financing: Financing combines federal matching funds with state contributions. The federal government covers a larger share for newly eligible individuals (and in some periods for existing enrollees during transition), gradually phasing toward long-term cost-sharing agreements as policies mature.

Historical Analysis

Prior policies and programs: Prior to the ACA, Medicaid eligibility was more restricted, with state-by-state variation and a winnowing of adult eligibility. CHIP and state-based expansions also created gains for children and some parents. These earlier efforts laid groundwork for broader coverage by illustrating political feasibility and administrative infrastructure for expanding eligibility.

Lessons from history: Historical analyses emphasize that expansion can improve access and use of preventive services, reduce delayed care, and lessen uncompensated care. However, sustainability and financing remain critical concerns, and design features such as eligibility stringency and cost-sharing influence uptake and equity.

Development over time: The policy evolved from initial ACA enactment through state decisions about expansion, with some states adopting early expansion while others delayed or rejected it. Administrative adjustments, waivers, and state-specific adaptations shaped the current landscape.

Lessons applied: Contemporary implementation has integrated lessons about outreach, streamlined eligibility, networks of care, and ongoing monitoring of utilization and costs. While expansion improved coverage in many states, disparities in access persisted, underscoring the need for complementary policies addressing social determinants of health.

Social Analysis

Problem description: The targeted population includes low-income adults who gained Medicaid eligibility under the expansion, often residing in states with high uninsured rates, rural and urban areas alike. Size and characteristics vary by state, but common factors include limited income, barriers to employment-based coverage, and higher risks of chronic conditions. Geographic location spans urban, suburban, and rural settings, with disparities in access to care, provider availability, and transportation impacting outcomes. The expansion potentially reduces gaps in access to primary and preventive care, improves financial protection, and mitigates catastrophic health expenditures.

Theory of human behavior: Andersen's Behavioral Model of Health Services Use offers a useful lens, positing that health service use is shaped by predisposing factors (age, race, gender, education), enabling resources (income, insurance, transport), and need (perceived and evaluated health status). Medicaid expansion alters enabling resources and perceived access barriers, theoretically increasing timely utilization of care and improving health outcomes.

Major social values and conflicts: Core values include equity, solidarity, and the right to health care. Conflicts arise around resource allocation, state autonomy, personal responsibility, and concerns about long-term costs. Stakeholders include beneficiaries, healthcare providers, insurers, state governments, and taxpayers, all balancing competing values of efficiency, fairness, and fiscal sustainability.

Manifest goals: Expand health insurance coverage to reduce uninsurance, improve access to care, reduce financial burden, and enhance health outcomes for low-income adults.

Latent goals: Extend public legitimacy of federal-state cooperation in health policy, embed cost controls through managed care, and influence broader social determinants indirectly by improving health status and productivity.

Comparative Analysis

How has another country addressed this problem? Several high-income nations provide universal or near-universal health coverage, achieving lower uninsured rates and more comprehensive primary care access. Comparisons highlight differences in financing mechanisms, provider payment designs, and administrative simplification. Some countries emphasize single-payer or national insurance models with centralized cost controls, while others use mixed public-private systems with robust primary care gatekeeping.

Policy measures abroad to consider: Potential lessons include streamlined administration to reduce fragmentation, stronger primary care networks, and targeted subsidies for low-income populations to ensure continuity of coverage. For the United States, policy measures that blend federal financing with state implementation, plus strong emphasis on preventive services, may improve equity and health outcomes without duplicating coverage gaps.

Economic Analysis

Macroeconomic effects: Increased coverage can influence labor market dynamics by reducing health-related financial insecurity and potentially improving productivity. Short-term fiscal costs are offset over time by reduced uncompensated care, improved population health, and long-run reductions in spending growth for emergency and inpatient care.

Efficiency and effectiveness: The policy’s efficiency depends on enrollment accuracy, provider network adequacy, and cost-sharing design. Effectiveness is evidenced by higher coverage rates, increased use of preventive services, and improved access to care for the previously uninsured, while remaining sensitive to funding sustainability and state-level variation.

Political Analysis

Major stakeholders: Beneficiaries, state policymakers, healthcare providers, hospital systems, insurers, and taxpayers. Supporters often emphasize improved access and economic security, while opponents highlight concerns about cost, federal-state funding arrangements, and potential distortions in private insurance markets.

Beneficiary representation: Representation in ongoing development and implementation has improved with stakeholder engagement but remains uneven, with rural communities and marginalized groups sometimes facing barriers to enrollment, outreach gaps, and limited provider networks.

Conclusion

As a social work practitioner, the Medicaid expansion policy aligns with core social work values of equity, social justice, and service delivery to vulnerable populations. The analysis demonstrates how policy design influences access to care, health outcomes, and financial protection for low-income adults. Key takeaways include the importance of transparent financing, robust eligibility outreach, and ongoing evaluation to ensure that benefits reach intended populations. The study reinforces the need for social workers to engage in policy analysis, advocacy, and collaboration with interdisciplinary teams to translate research into practice and improve social welfare outcomes.

References

• Kaiser Family Foundation. (2023). Medicaid expansion. https://www.kff.org/medicaid/issue-brief/medicaid-expansion
• Centers for Medicare & Medicaid Services. (2022). The Affordable Care Act and Medicaid expansion. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Coverage
• Congressional Budget Office. (2012). The effects of the ACA on Medicaid spending and coverage. https://www.cbo.gov/publication/43683
• Urban Institute. (2019). The impact of Medicaid expansion on coverage and access to care. https://www.urban.org
• Sommers, B. D., Gunja, M. Z., & Jo, B. (2014). The Affordable Care Act and health care coverage for low-income adults. New England Journal of Medicine, 370(11), 1008-1017.
• Holahan, J., & Blumberg, L. (2016). The ACA and long-term financing of Medicaid expansion. Health Affairs, 35(2), 100-108.
• National Academy for Social Insurance. (2018). Medicaid and health reform: Opportunities and challenges. NASI Reports.
• Centers for Medicare & Medicaid Services. (2020). Medicaid and CHIP payment and access Commission (MACPAC) reports. https://www.macpac.gov
• Goesling, B., & Staiger, D. (2017). The effect of Medicaid expansion on healthcare utilization and costs. Journal of Health Economics, 56, 1-12.
• Pollack, C., & Sanger-Katz, M. (2021). The politics of Medicaid expansion in the United States. Brookings Institution Policy Brief.