The Hole in Healthcare Coverage: States’ Rejection of Medicaid Expansion

Almost a year ago, I was working as a research intern at the National Institute of Health. It was during my lunch break when my friend and coworker peered over her smartphone to announce to the table that the Supreme Court had upheld the Affordable Care Act. Many of us had followed the debates and controversy surrounding the Affordable Care Act since President Obama signed it into law in 2010. And for the rest of the day, the excitement in the building was palpable as news of the ruling spread.

Ideally, the Affordable Care Act was indeed something to be excited about. It eliminates many gaps in healthcare, particularly amongst the uninsured. Notable changes to insurance coverage includes young adults’ eligibility to join their parents health plans, an end to exclusion of children and adults with pre-existing conditions, and a prohibition of lifetime or annual limits on benefits.

However, the Supreme Court ruling also struck down the law’s mandated expansion of Medicaid, a loophole that some states are now exploiting. With Wisconsin as the latest state legislature to reject the proposed Medicaid expansion, many of the country’s citizens with the lowest incomes would be among those left uninsured.

A handy illustration of how the hole created by rejection of Medicaid expansion would lie directly under the poorest.

Wisconsin Governor Scott Walker cited “fiscal uncertainty coming out of Washington, D.C.” among the reasons for his opposition to the Medicaid expansion, but Democrats view the act as another ploy in the GOP’s continued resistance of “Obamacare.” You can check where your state currently stands using this interactive map.

Regardless of the reasons, states like Texas, Georgia, Alabama, and Missouri, along with their rejection of Medicaid expansion limit the effectiveness of the Affordable Care Act. Their resistance also burdens those who are the poorest. And such effects illustrate a dire failure in our basic responsibility to care for those most in need.


Serena Yin graduated with a degree in English from Johns Hopkins University in 2013. She is joining the Washington Reading Corps to promote literacy in local schools. A New England native, she loves ballet, beaches, and hamburgers. When she’s not on the hunt for the nearest Starbucks, she’s working on realizing her lifelong dream of meeting J.K. Rowling.

Revolving Door Admissions and the Future of Healthcare

Treating symptoms without addressing the root causes seems to be an affliction of modern society. Here, take another aspirin if you still have a headache. But why do we have a headache in the first place? Not enough caffeine in my case probably, but that’s not necessarily a universal issue.

One area where this avoidance of the real issue really stands out is healthcare for the homeless. Or indeed in America, healthcare for any uninsured. It’s been referred to as “revolving door admissions.” Patients coming into the hospital, often the ER if they’re unable to afford primary care, having their symptoms treated, and then being discharged, only to return to the same dire situation they were in before. With nothing resolved, eventually they end up right back in the hospital.


What is needed is a support network to actually address their problems. If poor health is a result of homelessness and malnutrition, then those are the issues that should be addressed. There should be a way to transfer the bill footed by the public for emergency room visits by the uninsured, and instead transfer it to preventative care, keeping people out of the hospital in the first place.

In the United Kingdom, the government is giving £10 million, about $15 million, to charities that work with the homeless after their discharge from the hospital. The idea being to address their health and housing needs outside of the hospital, and so break them from the cycle of endless re-admission for the same maladies. In a way it’s empowerment: giving a person the means to take care of themselves, rather than simply patching them up and shuffling them along.

It will be interesting to see how much can be accomplished with the funding. But it is at least a positive to see the foresight, and to see organizations focused on solving the root causes of homelessness, rather than just temporarily alleviating the strain.


David Wilson graduated from the University of Texas in 2006. Since then he has gone wherever the wind blows him, living in Europe, China, and the States, and traveling extensively throughout the rest of the world. When he’s not on the move, you can find him obsessing over latte art, playing piano, or trying to bleach his hair in the sunshine. Follow him on Twitter.