One heavily debated topic that can be found anywhere in the news on any given day, both inside and outside of the United States is the topic of healthcare.  Healthcare is a service used every day by billions of people worldwide, whether it be offered in a universal form or by the government, or by private insurance firms, or both.  Specifically, in the United States, there is a gap in health insurance coverage between where the government offers assistance to those in need, and those earning enough money to be capable of buying health insurance from private firms.  This phenomenon is more commonly known as the coverage gap, and those found inside the gap are neither insured by Medicaid, government funded healthcare, nor make enough to purchase Obamacare, the subsidized health insurance market put in place by the Obama administration for those that do not make enough to purchase private insurance.  Over the past couple years, there has been a movement of states to expand Medicaid to offer insurance to residents that make up to 138% of the poverty level, which is an increase from the current cutoff at citizens who make up to 100% of the poverty level.  The catch, however, lies in the fact that each individual state, following a Supreme Court ruling, is allowed to decide whether or not they wish to expand coverage.  With the expansion of Medicaid, states not only have the option to minimize the coverage gap, but also reap the benefits that come with expansion while avoiding the hefty consequences that come otherwise.    

Being caught in the coverage gap is not uncommon for many Americans today.  With the idea of living without insurance looming overhead daily, thoughts persist about what happens when one gets sick again, or a family member needs to go to the doctor, or a child suffers from an accident.  These thoughts, while living uninsured are enough to drive people away from seeking seriously needed medical treatment and attention due to the fact that they cannot afford to pay the doctor or hospital bills.  Failing to narrow the coverage gap and leaving people uninsured when such an easy solution such as expanding Medicaid is on the table seems senseless.  Daniel Chang, a South Florida native and University of Southern California journalism grad reporting for the Miami Herald recently reported the interactions he had with citizens in South Florida during individual interviews.  After speaking to a few of the many hundreds of thousands of citizens living without insurance in the the South Florida area, Chang reported that "people in the gap [are] piecing together their own  --  largely inadequate  --  health care. They use free clinics, visit community health centers when they can afford the discounted prices and, if all else fails, wind up in a hospital emergency room that often leads to crushing debt.  They cut pills in half, borrow money or cash in retirement funds for co-payments, and wait months or even a year to see a doctor" (Chang).  This surely is no way to live on a day to day basis, especially in a country where we have a ready fix that is already being accepted by other states in the form of Medicaid expansion.  The horror stories do not stop here, all around the country it is possible to hear of the atrocities brought upon those found in the coverage gap.  Just ask Georgia resident, Dymond Jones.  Jones, continuously seeking full time employment, "has an eye disease that requires expensive contact lenses, but since his income is above Medicaid requirements and below Obamacare subsidy requirements, he cannot obtain coverage, forcing him to sacrifice the care for his eye condition" (Palmer, Pat).  This not only makes finding a job harder, but he suffers in his day to day life because he is caught in the unrelenting medical coverage gap.  Another, more extreme example can be found by looking at Cheryl Stumph who, for a while, was living without coverage.  After "a genetic issue that caused a stroke while he was driving, ultimately resulting in his death," her and her "family of six others lived in constant worry about their overall health and genetics" knowing that she would not be able to afford anymore accidents or illnesses without some sort of insurance help (Palmer, Pat).  The coverage gap is obviously an issue that affects the entire country, however there are pockets around the nation that have higher proportions of its citizens in the gap.  This is especially important to look at while analyzing the reasons why some states choose not to support the expansion.  

At first glance, the coverage gap is easily explained in terms of demographics, politics, and fiscal disagreements.  When looking at the reasons to expand Medicaid expansion, demographics plays an important role. For starters, southern states have the largest amount of people that could be reached if governments do expand coverage.  In research published by Rachel Garfield on The Kaiser Family Foundation website based on CPS survey data for 2015/2016, there were 2.9 million people living in the coverage gap.  Of those 2.9 million, 26% reside in Texas, 20% in Florida, 22% in Georgia, 8 % in North Carolina, and only 36% in all of the other 46 states.   Regionally, "nearly 90% of people in the coverage gap reside in the South" (Garfield, Rachel).  Looking at the nation as a whole, research indicates that "45% of uninsured adults in the coverage gap are White non-Hispanics, 23% are Hispanic, and 28% are Black" (Garfield, Rachel).  Further breaking down these findings, it appears that a larger proportion of females are caught in the coverage gap than males (52% versus 48% respectively).  These numbers are ridiculously large, especially considering that "about a quarter of a million uninsured children have a parent in the coverage gap," meaning that those children do not receive insurance either (Garfield, Rachel).  Numbers this high ought to be alarming to politicians and legislators in states that have not expanded.  The market for expansion would serve nearly 2.9 million people, furthering the amount of care hospitals and doctors are able to give, and decreasing the coverage gap immensely.  The fact that 2.9 million fellow citizens of this country are currently living in fear of the next time they get sick or have to go to the doctor, while there is already solution that is readily available, not to mention tested and proved to be successful in other states, is completely unnecessary and illogical.  While these numbers stay inflated and less and less people go to the hospital because of their lack of insurance, serious effects can be observed worldwide.   

The effects of high rates of uninsured citizens can be see across the nation, and it comes of no surprise that "40 percent of rural hospitals nationwide are operating in the red," and "since 2013, 24 rural hospitals have shut down across the nation" (Ma, Amber).  For states that choose to expand Medicaid coverage for their citizens, the amount of benefits and rewards exhibited are innumerable.  There has been a large amount of research done as to the benefits of expansion, of which the studies regarding the benefits to hospitals have been seen to be especially notable.  Hospitals have a large amount at stake when it comes to expansion.  The results found in one study published on Community Catalyst by Amber Ma, a long time healthcare and Medicaid researcher, found that "the uninsured rate dropped by 38 percent" in states that have have chosen to expand Medicaid coverage.  Unfortunately, "By contrast, states that did not close the coverage gap saw only a 9 percent decline in uninsured" since the start of the Medicaid program in the first place (Ma, Amber).  This is an important factor for hospitals because when patients come in without insurance, there is a much higher probability that doctors and hospitals alike will not be paid back, whether the patient assumes massive amounts of debt that they will never be able to pay back, or are forced to declare bankruptcy immediately.  In fact, these deficits, called uncompensated care costs (UCC), add up extremely fast. In 2014, "hospitals in expansion states reaped the greatest share of UCC savings, at $5 billion" (Ma, Amber).   These savings fund various causes such as providing cleaner more sanitary facilities in hospitals, paying doctor's salaries, and funding the purchase of the most up to date technology and equipment to further enhance the capabilities of doctors in the hospitals.  

One of the more important findings regards patients on an individual and daily basis.  While it is important to back research with statistical and numerical data and federal implications that come along with expansion, there are also other effects of closing the coverage gap by expanding Medicaid coverage that cannot be computed through large formulas.  Ryan Crowley and William Golden, two published professionals found plenty of this sort of information in their extensive, compelling research on the effects of Medicaid expansion on individuals from a day to day basis.  In their peer-review article published in the Annals of Internal Medicine, they claim that "Evidence shows that expanding Medicaid eligibility to previously uninsured adults leads to better self-reported health; substantially less health care -- related financial stress; and elevated use of preventive services, such as mammography" (Crowley, Ryan A., and William Golden).  These traits appear marginal at first, however it is hard to put a price on the effect of "substantially less health care -- related financial stress," especially considering that those who would benefit from this expansion undoubtedly already face other financial stresses in their lives.  Relieving even one burden from the backs of over 2.9 million people, as well as solidifying healthier practices in the future is undoubtedly worth the any of the unimportantly small downsides that expansion might bring about.  

In order to further prove the positive effects and benefits of the minimizing of the coverage gap and the expansion of Medicaid, it is important to look at some of the less solid arguments against that are found in opposition to the program.  First and foremost, it is hard to stop or slow the movement of increasing the reaches of Medicaid coverage when some of the most conservative states in the nation have already made the decision to support and enact the change and expansion.  When deciding whether or not to expand, there is a lot that goes into a state's decision.  As illustrated by the facts previously listed about the region of states that have not expanded, it is important to realize that the south is composed of primarily conservative states, especially those that would mark a piece of legislature such as the expansion of Medicaid as "socialized healthcare."  These conservative states have a variety of reasons for choosing not to expand, however some of the most conservatively lead states in the nation have realized the benefits and made the theoretical expansion a reality.  These states have come to their senses and realized, through the influence of "public opinion, interest group pressure, budgetary considerations, and need," that the expansion of Medicaid not only reaps positive benefits daily, but also helps to close the national coverage gap (Rose, Shanna).  All of these reasons further drive the support behind expansion and leave those in charge of the state's decision to expand with very little wiggle room in terms of making a decision.    

After seeing that most states are expanding and that the pressure is on for state officials to make a decision, there is one argument circulating in the media quite often.  It is not uncommon for those who oppose Medicaid expansion to claim that "Medicaid expansion would end up displacing higher-quality, employer-sponsored health coverage for millions of Americans. While these individuals will still have "coverage," and therefore will not increase the ranks of the uninsured, the quality of their coverage will meaningfully decrease" according to one not-for-profit health and tax policy research organization (Turner, Grace-Marie and Avik Roy).  Any logically mind citizen of the United States understands that this argument does not make sense on a practical level.  This statement can be taken one of two ways, the first way being that the private insurers are losing out on potential clients, which means losing out on paychecks, and "foregoing research opportunities."  This does not make any sense, because obviously those caught in the coverage gap cannot afford private insurance in the first place, otherwise this would not be an issue today.  Not to mention the fact that private insurance companies make such ridiculously large salaries due to the minimal return rates dished out each year over the long run that it is hard to feel sorry about an insurance broker now only making $500k a year rather than $600k.  The second way this argument can be interpreted is that those newly enrolled in Medicaid after the expansion will receive less quality coverage.  This also does not make sense in practical application.  Those living without coverage are not concerned with sleeping in the nicest mattresses overnight, and receiving the best medication that also doubles as an anti-aging medication.  These people are struggling, living day to day in fear that they will be crushed with irreversible debt due to just one doctors visit.  Common sense should explain how zero care is a whole lot better than "low quality care" in terms of medical care and the insurance markets.  

Stilly yet, there is one last argument that is commonly deployed in opposition to the expansion of Medicaid has to do with the amount that the government pays in regards to the expansion of the program.  Under current terms, the national government has agreed to cover 100% of the costs of Medicaid expansion until year 2017, where it will incrementally decrease its funding until it is split 50/50 with states.  This does not appear to be a problem at first glance, however, the government does not have a set budget for Medicaid funds, let alone for the expansion in even more states.  Author and director of the Center for Health Policy Studies Nina Owcharenko explains this in depth in an article she wrote for The Heritage Foundation.  In regards to this claim, it is important to understand that "The federal share of Medicaid is based on a formula calculation and actual expenditures. Rejected funds do not go into a general fund for redistribution to other states. The fewer states that expand, the less the federal government spends. States that draw down on these new federal funds fuel the fiscal crisis in our country" (Owcharenko, Nina).  However, even the drawback from this perspective is not as bad as it really seems.  This increase in expenditures will not come from an increase in taxes.  In some cases, the opposite will happen.  According to research collected by S. S. Flint in Consumer Health Complete in regards to the assertions that tax payers will incur a heavier rate due to expansion, "for the first 10 years of the expansions, eight states will actually make money.  The rest will incur new net costs no greater than 11 percent, with most adding less than 5 percent to their 10-year Medicaid bill" (Flint, S. S.).  On top of that, this added revenue adds to the employment opportunities of nurses, janitors, food services, and lab technicians (to name a few), that will generate more tax revenue through the new pay checks they earn, and ultimately bringing the state more money (Flint, S. S.).  This number is so relatively small due to the fact that it is on a state to state basis, that the new incurrences are practically negligible in terms of state funding.  When it comes down to it, the reason behind this argument appears valid in that the government does cut more money out of the budget each time a state expands, however given that the Fed has accumulated over $18 trillion worth of debt through expenses in less important sectors than insuring and protecting human lives, it is not hard to look past this small figure estimated at only $400 billion.  

Arguing over whether not to expand is effective and all, however aimlessly arguing without offering better alternatives serves no purpose.  Much research is applied to finding solutions and real life fixes to the problem at hand.  Of the research out there, there is one model that is particularly appealing due to its ability to not only insure more citizens than before, but also increase state savings. In the scenario weighed out by two analysts for the medical journal Health Affairs, they tested 'complete expansion' of Medicaid from all states.  In this simulation, the results stated that "If health reform were fully implemented and no states opted out of Medicaid expansion, then this coverage would cost states about $1.0 billion" (Price, C. C., and C. Eibner).  The beauty of this plan lies in the fact that "If states reduced their spending on uncompensated care in proportion to the cost of people who were newly insured, reform would result in savings of roughly $18.1 billion for states" (Price, C. C., and C. Eibner).  This plan is ideal because it accumulates all the pros while minimizing the cons, even erasing one of the biggest problems Medicaid expansion faces today.  Through full expansion of all states, the state governments would shell out more money, however that would be made back, and in fact would result in a net surplus leading to savings for all participating states.  

Through extensive research and investigation of sources, it is easy to understand why the expansion of Medicaid minimizes the coverage gap while benefiting virtually everyone that resides in the state, and avoiding horrible consequences that come along with choosing not to expand.  Not expanding out of spite of wanting to avoid liberal legislature or staying true to personal beliefs proves to be detrimental to those caught in the coverage gap, as well as the states in the amount of savings they are missing out on due to increased revenue.  "By not expanding, states are forgoing an opportunity for their poor citizens to achieve financial peace of mind, obtain a regular source of medical care, and receive preventive services to help stave off serious complications" (Crowley, Ryan A., and William Golden).   In the growing world, where human lives become exponentially more valuable by the day, protection and preservation is of the essence. In years to come, it is hopeful that Medicaid expansion is no longer a pressing issue for this nation, and that it is merely an afterthought due to states coming to realize the benefits of minimizing the coverage gap through expanding Medicaid coverage.  

