Incorporate challenges you would anticipate for the proposals in the write up below, as well as arguments to overcome those challenges. Should be 200 to 400 words:There are many Americans who are unable to afford quality healthcare in the U.S. health system. This is due for many reasons. There are about two million Americans who fall into the insurance coverage gap. These individuals make slightly above the annual income requirement for Medicaid but are still living in poverty and are not covered by the ACA (Garfield, Orgera and Damico, 2020). The original intent of the ACA was to expand Medicaid and the Children’s Health Insurance Program to provide coverage to millions of uninsured, low-income Americans (Understanding the ACA, 2019). However, a supreme court ruling in 2012 allowed states to opt out of the expansion of Medicaid. 18 states, primarily southern states did not adopt Medicaid expansion, leaving many Americans remaining uninsured.Medicaid expansion or adjustments of Medicaid qualifications is a public policy that needs to be changed to improve quality of healthcare. Uninsured rates rose in the 18 states who did not expand Medicaid and individuals of low-income uninsured rate rose from 21-25% (Mills, 2018). Hospitals have a choice whether to treat uninsured individuals. Many times they do treat them but the hospitals do not always get reimbursed for those healthcare costs (Mills, 2018). Most individuals who lack insurance get most of their healthcare in emergency rooms. That not only increases healthcare costs, but also increases waiting times, resulting in compromised quality of care for everyone. With the expansion of Medicaid in those states who opted out of it, this would not only reduce healthcare costs, but would reduce waiting times in the emergency room as people would have the option to see their primary care rather than take up a bed in the emergency room.Another public policy that could be used to reduce healthcare costs and improve quality is a single-payer or Medicare for all healthcare system. A single-payer system would grant everyone access to healthcare. Cai et al. (2020) conducted an analysis that shows savings from a single-payer system would outweigh the costs. This would grant all U.S. citizens the right to obtain healthcare. Individuals would be able to receive the preventative care, annual physicals and screenings and treatments without taking an emergency room bed from someone who really needs it. Granting the uninsured access to these services could also improve public health, resulting in less hospitalizations and healthcare costs annually.The ACA had intended to improve quality of healthcare for everyone without significantly increasing expenses. Unfortunately, that could not happen nationwide due to a supreme court ruling that granted the states the opportunity to opt out of Medicaid expansion. If that court ruling had not happened, it is likely that millions of Americans would have been granted insurance or access to quality healthcare. If the republicans chose to replace the ACA without a similar or better healthcare plan, this could also result in more uninsured individuals receiving either no healthcare or poor-quality healthcare. There needs to be a public policy change for the U.S. healthcare system. Individuals should have a right to receive healthcare. Without insurance or any type of coverage, individuals cannot afford to be sick.

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