As a medical scribe at an urgent care center in rural Alabama, I witnessed firsthand how the current healthcare system and the insurance industry fails people. Many patients traveled over 45 minutes because their towns lacked primary care services, while others had no insurance or relied on urgent care as their primary provider. Some avoided the ER altogether, fearing unaffordable hospital bills. Patients with serious conditions were often referred for imaging, specialists, or the ER, only for us to later learn they had passed away or required long-term treatment— outcomes that could have been prevented with more accessible primary care and affordable insurance options. Grace Williams Now as a graduate student in Connecticut, I am surrounded by immense wealth and poverty, which is highlighted by a 12 year life expectancy difference for people living in Northeast Hartford compared to the state average. Factors such as socioeconomic status, insurance coverage, access to primary care, and housing affordability drive these disparities and perpetuate inequities in health outcomes. As a public health student, I am deeply focused on the issue of universal healthcare access. Why does the U.S., despite being one of the world’s wealthiest nations, continue to lag so far behind other high-income countries in achieving universal healthcare? While our country is far from providing healthcare for all, the creation of Medicaid and Medicare, especially the former, were steps forward in providing care for vulnerable populations. Even better, as of this month, 41 states (including DC) adopted Medicaid expansion under the Affordable Care Act (ACA) which would cover almost all adults with incomes up to 138% of the Federal Poverty Level. Were this to stand, access to healthcare, health outcomes, and state financial benefits would all improve. To be sure,  there are obstacles to universal healthcare and Medicaid expansion. Critics often argue that expanding these programs places a financial burden on federal and state budgets, especially in times of economic downturn. Additionally, the complexity of restructuring the healthcare system raises valid questions about how to balance quality of care, provider reimbursement, and fiscal sustainability. Long-term benefits, however, greatly exceed short term financial barriers according to states that have already adopted Medicaid expansion. However, this past November, the American people reelected Donald Trump as President, and he has already indicated policy changes aimed at restructuring Medicaid. Among the proposals recommended by Republicans is a reduction in the federal match rate for Medicaid expansion groups. This shift would transfer a significant portion of Medicaid spending from the federal government to the states. As states deal with the financial shortfall, many would likely scale back their Medicaid programs, reversing the gains in access to care and health outcomes achieved under expansion. If these policies to reduce federal funding are enacted, approximately 4.3 million Americans currently covered under Medicaid expansion could lose their insurance. This would lead to higher uninsurance rates, delayed care, worsening health disparities in marginalized communities, and an increase in mortality rates. Additionally, hospitals—especially in rural and underserved areas—would face rising uncompensated care costs, leading to closures and further straining the healthcare system. To offset financial losses, costs may be shifted to private insurers, ultimately raising premiums for individuals and employers. With this reversal, a significant portion of low-income individuals would lose access to affordable coverage, creating a substantial coverage gap. These individuals would earn too much to qualify for Medicaid but not enough to afford subsidized private insurance in most states. As a result, private insurance would become increasingly out of reach for lower-income populations, leaving it as a feasible option primarily for the upper class. This disparity in insurance access will directly affect health outcomes, perpetuating a system that prioritizes higher-income individuals, allowing them to maintain better health and enjoy greater benefits. The challenges of our healthcare system are epitomized by the dominance of private insurance companies like UnitedHealthcare, which covers 50 million people and earned an astounding $281.4 billion in revenue in 2023. Despite these massive profits, UnitedHealthcare has faced many allegations of denying coverage for critical treatments, leaving patients to undertake excessively high medical bills or choose to forgo treatment altogether. These examples show the realities of a system that prioritizes profit over patient care. Adding fuel to the fire, the public is continuing to grow more frustrated with the insurance industry, which has been shown through recent events such as the shooting of UnitedHealthcare CEO, Brian Thompson. While the shooting itself is a tragedy that should never be condoned, the unsympathetic reaction that the public has given to this event shows a broader disenchantment with the insurance industry. Many view this as the first domino to fall in a reckoning for an industry that has long benefited from the suffering of everyday Americans. If the United States ever aspires to achieve real healthcare reform, we must challenge the disproportionate power of these corporations and insist on a system that prioritizes people and equity over profit. Achieving these systemic changes to address health inequities requires strong social reform and strategic advocacy efforts. Grace Williams is a Master of Public Health Student in New Haven.