Social  determinants of health are defined as indicators unrelated to medical  care that play an important role in the physical and emotional state of  individuals. These indicators include economic stability, education,  accessibility to medical care, and the environment, among others. These  determinants contribute significantly to health disparities because they  accentuate inequalities between population groups in access to basic  well-being resources.

One of the most important policies to reduce disparities in public health is Medicaid Expansion.

Medicaid  Expansion under the Affordable Care Act represents an important health  policy that considers social determinants in the U.S. by expanding the  reach of medical care for low-income adult populations. This policy  directly boosts indicators such as accessibility to health services,  economic well-being, and health indicators, especially among populations  living in marginalized areas.

Impact on Social Determinants of Health

Medicaid  expansion has a significant impact on various social determinants of  health, such as income: When self-paid medical expenses are reduced or  eliminated, the economic security of low-income families is  strengthened. Another example is accessibility to health services: There  is increased access to primary and preventive care, as well as  monitoring chronic conditions. States that implemented Medicaid  expansion saw a substantial decrease in the number of uninsured  patients. Kaiser Family Foundation (2023). Child and maternal health  were also positively impacted by expanded coverage during pregnancy and  the postpartum period, contributing to the decrease in maternal death  rates, especially among Indigenous and African American women (KFF,  2023).

Limitations and Strengths

Among  the positive outcomes achieved by the implementation of Medicaid  Expansion are increased accessibility to medical services, decreased  mortality rates, and a reduction in racial disparities in health care.  Recent research has concluded that states that implemented Medicaid  Expansion reported significant decreases in hospitalization rates and  improvements in mental health services (Bailey et al., 2022). Despite  the advantages, there are limitations due to the lack of implementation  by some states, such as those in the south of the country, as well as  structural factors such as racism or a shortage of providers in rural  areas that continue to limit the capabilities and benefits of this  policy.

Role of Advanced Practice Nurses

Professional  nursing personnel play a vital role in the development and promotion of  policies that implement the Social Determinants of Health. Advanced  practice nurses have the privilege of maintaining direct contact, in  their daily practice, with vulnerable population groups, allowing them  to identify and document the unmet social needs of these populations.  They also stand out as leaders in the implementation of health  initiatives that benefit the community through active participation in  the implementation of health policies, providing reliable data based on  clinical evidence, and thus influencing legislative decision-making. In  conclusion, the implementation of Medicaid Expansion is an indispensable  tool for reducing inequalities in health care by improving  accessibility for disadvantaged population groups. However, it is  important to emphasize that, to achieve maximum effectiveness, it must  be adopted nationwide.