Vulnerable Populations - Adrianne Tozer Ferris State University

Vulnerable Populations: The Underinsured and Uninsured
Adrianne Tozer and Brianna Hall
Ferris State University
This paper investigates the vulnerable population in our country who lack the privilege of health
insurance. We examine the characteristics which are commonly found in the under or uninsured
population. Those without coverage suffer health disparities and consequences, but the negative
impact does not stop there, it extends into our communities and nation. Americans have based
their beliefs on misconceptions surrounding the uninsured. Many of these individuals have been
stereotyped incorrectly. Through promotion of equal health opportunities nursing can increase
the number of people who have access to health care. As the number of insured Americans
increase, so will the quality of available health care options (Pauly & Pagan, 2007).
Vulnerable Populations: The Underinsured and Uninsured
Scattered throughout the nation are vulnerable populations such as the mentally ill,
disabled, minorities, immigrants and the homeless, just to name a few, all of which make these
individuals at an increased risk for poor physical, psychological or social health outcomes
(Pender, Murdaugh, & Parsons, 2011). Many vulnerable populations are linked by one common
factor, the inability to access healthcare due to inadequate health insurance, or no insurance at
all. Should the health of our nation be based on those who have and those who have not?
In 2011, 47.9 million Americana’s under the age of 65 were without medical insurance
(The Kaiser Commission, 2012). What characteristic make up this vulnerable population?
According to the report by The Kaiser Commission (2012), most of these individuals are low
income or below poverty workers. The report goes on to state adults are more likely to be
uninsured then children because they usually do not qualify for Medicaid. Lastly, The Kaiser
Commission states that Hispanics, African Americans, native or naturalized United States
citizens make up the greatest population of the uninsured. From this vulnerable population, one
of four scenarios can occur. First, workers may not be adequately covered by their insurance.
Secondly, they are not offered insurance through their employer. Thirdly, individuals cannot
afford the insurance that is offered and lastly, the individual does not have a job.
Point of View
Being uninsured or underinsured in America not only affects the individual and their
family but their communities and the nation as a whole. “Lack of health insurance has important
implications for health promotion and prevention efforts, such as screening and access to
wellness programs” (Pender et al., 2011, p. 288). Pender et al. (2011) also states that this
vulnerable population experiences greater health problems, an increased risk for negative
outcomes, a higher mortality rate, and has fewer resources to maintain or improve their health.
Due to the absence of medical insurance and its damaging effects, these individuals miss more
work and are less likely to obtain higher education (Pender et al., 2011). All these factors
combined, have a negative bearing on earning potential (Hadley, 2002).
Uninsured individuals also pose a risk to the insured population. When an abundance of
uninsured families reside in one community, those with coverage often find it difficult to locate
the needed care and tend to be unsatisfied with the care they do receive. This is because health
care providers and hospitals usually set up practice or make investments in communities with
high rates of insurance (America's Uninsured, 2009).
Many Americans, whom are gainfully employed, with good health insurance coverage,
feel the uninsured or underinsured are not motivated. We often hear negative statements like,
“They need to attend college!” “Stop living off the system!” “They need to get a job.” This is
myth number one. The article, Dispelling Myths About Health Insurance, states eight out of ten
families without insurance are employed (Shomon, n.d.). The article by Shomon goes on to
debunk myths Americans believe to be true. Another common misconception is thinking the
uninsured are not at an increased risk for health problems. Women with breast cancer and men
with colon cancer are twice as likely to die from the disease as compared to their counterparts
who have insurance (Shomon, n.d.). Plenty of Americans feel the uninsured can always get care
if they need it. The fact is, those without coverage prolong getting proper medical care, suffer
with illness longer and die younger (Shomon, n.d.). Lastly, according to Shomon, Americans
believe not having insurance does not pose any financial risks. However, unpaid medical bills
are the number one reason bankruptcy is declared (Shomon, n.d.).
The purpose of discussing the uninsured as a vulnerable population is to draw attention to
the inequalities, such as access to health care. Pender et al. (2011) discuss that higher
socioeconomic status directly correlates with more access to health care because having a higher
socioeconomic status relates to increased health care coverage (p.288). Similarly, low
socioeconomic status accounts for inequalities in access to health care related to lack of health
insurance (Pender et al., 2011, p.288). This is relevant to the field of nursing because the first
step to minimizing these disparities is acknowledging that they exist.
Pauly and Pagan (2007) discuss in their article that one benefit to increasing the number
of people insured will be the improvement in the quality of services provided when more people
in the community are insured. This is related to the fact that more practitioners will be drawn to
the area providing a wider range of health care options (Pauly & Pagan, 2007). Lack of health
care leads to an increase in cost to providers and an increase in public as well as private
spending; to compensate for the cost of the uninsured (Pauly & Pagan, 2007).
Lack of heath care to vulnerable populations has always been a topic of concern for
nursing. Nurses struggle in hospitals and clinics to get their patients access to the proper medical
treatment they desperately need. By understanding that a health disparity exists we, as
Americans, can work to change this inequality. Promoting universal access to quality health care
will have positive repercussions on all health care recipients, not just those that do not have
insurance (Pauly & Pagan, 2007).
“Approximately one of every six Americans are uninsured” (Pauly & Pagan, 2007, p.
1305). With the number of the uninsured so high, one wonders why more is not being done to
achieve better health care coverage for the underserved. Pauly and Pagan (2007) suggests that
the number of uninsured remains high because there are misconceptions about what insuring
these people will cost as well as the effect it will have on availability of services to people who
are already insured. The article continues to discuss that these misconceptions lack validity
(Pauly & Pagan, 2007).
“Health disparities can be eliminated through the promotion of heath equality” (Pender
et al., 2011, p.289). By educating people on health disparities, we can work to eliminate the
inconsistencies. Community health centers are one way to improve access to care for patients
who do not have insurance (Baldwin, 2003). By establishing a relationship with a primary care
provider, patients are more likely to receive the care they need (Baldwin, 2003). Another
important aspect to negotiating health inequalities is promoting wellness and health lifestyles
through education with disadvantaged populations (Baldwin, 2003). Promotion of healthy life
style will help to eliminate the uneven morbidity and mortality rates facing vulnerable
populations (Baldwin, 2003).
Acknowledging that health care disparities exist is the first step to finding a solution.
Vulnerable populations can be found in many different forms including minorities, homeless,
and socioeconomically disadvantaged (Pender et al., 2011). One thing these vulnerable
populations have in common is their limited access to healthcare. Lack of healthcare has been
shown to increase the risk for negative health events including a higher mortality rate (Pender et
al., 2011). By improving access to the uninsured or underinsured, the quality of community
health services will go up due to the increase in available health care options (Pauly and Pagan,
2007). Nursing has long been concerned with minimizing the difference in health inequalities
though promotion of equal opportunity to health care (Pender et al., 2011, p.289).
America's uninsured crisis: Consequences for health and health care. (2009). Retrieved from
Institute of Medicine of the National Academies Web site:
Baldwin, D. (2003). Disparities in health and health care: Focusing efforts to eliminate unequal
burdens. Online Journal of Issues in Nursing, 8(1). Retrieved from
Hadley, J. (2002). Sicker and poorer: The consequences of being uninsured. Retrieved from The
Kaiser Commission:
Pauly, M.V., & Pagan, J.A. (2007). Spillovers and vulnerability: The case of community
uninsurance. Health Affairs, 26(5), 1304-1314. doi:10.1377/hlthaff.26.5.1304
Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion in nursing practice
(6th ed.). Upper Saddle River, NJ: Pearson.
Shomon, M. (n.d.). Dispelling myths about health insurance. Retrieved from Web
The Kaiser Commission. (2012). The uninsured: A primer key facts about Americans without
health insurance. Retrieved from