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. 

  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 :

Access to healthcare is more than just the ability for one to receive care but also the way that they receive it (Shi & Singh, 2018). It is important as future providers to improve the quality of care we give to our patients without increasing cost. One public policy that could be implemented in order to improve the quality of care without increasing the cost is through programs established via the Affordable Care Act. This act was established in order to provide healthcare coverage to all including those who may not be able to afford it. However, this has come with many challenges when it comes to quality care as well as cost. Changes to the ACA are being looked at frequently especially within the Trump administration. One of the changes was recently brought to light through a new program that would allow states to offer patients more benefits while controlling costs and government spending (Galewitz & Pradhan, 2020). This would be an option for states and not required however it would allow them better control over spending and cost. This could also improve the quality of care that patients receive because it would be geared towards patients who have great medical needs rather than focusing on the poverty class that is frequently looked at within the ACA (Galewitz & Pradhan, 2020).

Another policy that could improve quality without increasing expense is through the plans established in the KFF comparison models. These are public plans in comparison to Medicare to offer the public options in additional to current sources of coverage private or public (Shi & Singh, 2019). A good example to help keep cost down but improve quality would be through the KFF comparison model, Single payer plan (Medicare for all) federal program. This plan provides comprehensive benefits for all US residents, tax financed with no premiums, replaces all private insurances, and eligibility is based on US residency (KFF, 2019). This plan could aide in the quality of care because it provides comprehensive benefits that could cover preventive medical visits and screenings. That is an important step to improving quality healthcare and life as well as decreasing cost (Shi & Singh, 2018). As we have looked at in previous discussions and lectures those who are uninsured and struggle are those that fall within the poverty class because of their risk for financial insecurity. By implementing these new changes to the ACA we could see more people getting quality care which could improve outcomes. However, there are still many changes that need to occur within the healthcare system and the ACA in order to insure that all Americans are receiving healthcare even if they cannot afford it. Research showed that many who are uninsured end up going into financial debt related to medical bills and those who specially may not be able to afford care just don’t seek it therefore end up in the hospital for illness that could have been prevented (Majerol, Newkirk, & Garfield, 2015). Although our hands are tied to an extent as healthcare providers we can do our best to treat our patients to the highest standard of quality care while the politic side of healthcare continues to change.