One topic that is sure to be heard blaringly over news channels, newspapers, daily reports, and daily journals across the nation, and even the world, is the topic of healthcare in the United States.  Specifically speaking, the coverage gap, or the proportion of individuals caught in between federally funded Medicaid and government subsidized healthcare policies (commonly known as Obamacare), is one of largest issues facing American healthcare today.  Narrowing it down, the decision for some states to decline the expansion of coverage is an even more interesting debate.  Of the distribution of those who are uninsured in the U.S. it comes of no surprise that the 14 states that have chosen not to expand Medicaid have some of the highest numbers of uninsured citizens.  Minorities make up a large part of the gap, however they often times do not make up the majority.  Closing the coverage gap, if even piece by piece over a number of years, is obviously beneficial in that more people will become insured and not have to live in constant fear of getting sick and needing medical coverage while not being able to afford it. However, the mystery lies within the research.  Studies conducted have shown that if the states who have not already changed their minds, do in fact change their mind and expand Medicaid coverage later on in time, it could lead to more people being insured, more funding from the federal government, and even a surplus of funds to be used to pay off future medical bills that people default on or cannot afford to pay.  It would appear to many that the decision to expand Medicaid would benefit everyone seeing as that the state is allotted more money, more citizens are insured, and the overall status of our country is slowly improving.  Unfortunately, monetary discrepancies and lack of funds make for difficult decisions for policy makers in regards to the expansion of Medicaid.  Ultimately, the question being asked is: "what are the effects of closing or minimizing the coverage gap, specifically in states that chose not to expand Medicaid?" 

This topic is of great interest to me because as my goal is to eventually become a practicing nurse, it is very important that I stay on top of these issues while I look for work, internships, and even places to get my own insurance policies.  Being a healthcare provider comes with a sense of compassion for all patients, and I feel like no one should have to be afraid to go to the doctor or neglect seeking medical treatment because they cannot afford it.  The value of life and good health, in my opinion, is worth more than some massive multibillion-dollar insurance firm worrying about citizens of the same country, defaulting on payments. This topic effects my values because I believe we need to cut down on government spending in order to reduce the national debt, but I believe some departments and branches should be reduced in order for more funds to be allotted to this area because of how big of a problem it is causing across the country.  I have found myself always reading the debates about this topic as well as newspapers and journal articles on the topic so I was fairly researched coming into this, due again in part to my desire to study to become a nurse.  

Palmer, Pat. "Medicaid Expansion: The Pros and Cons of Closing the Coverage Gap - MRS." MRS RSS. Medical Recovery Services, 09 Apr. 2014. Web. 28 Nov. 2016.

The first source speaks about the pros and cons of closing the coverage gap.  There are many personal anecdotes from people inside the coverage gap that help to strengthen the idea of what life is really like living without health insurance, having to avoid going to the doctors and forgoing medical treatment due to lack of insurance and unaffordability of the necessary treatments.  The major interests at stake are health and human lives for tens of millions of people.  This source will be very easy to include in my argument by evoking the readers sense of emotion and empathy.  The readers will feel a sense of sympathy for those going without treatment and will cause them to start to support the side of the patients while putting blame on the government for not making sure everyone has coverage.  The author is very credible as she has written case studies and other articles for individuals and businesses about medical finances.  Given that she has worked with many patients and people affected by this lack of coverage, she may be biased in the way that she supports the expansion of Medicaid in order to help the suffering people she writes of.  

Garfield, Rachel, and Anthony Damico. "The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid  --  An Update." The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid  --  An Update. Kaiser Family Foundation, 21 Jan. 2016. Web. 01 Feb. 2016.

The second source I have found speaks of the distribution of people living in the coverage gap.  Geographically, more states in the south have chosen not to expand, racially, there are more non-Hispanic whites than any other race that are caught in the gap, and sorted by gender, the study proved that there is a slightly larger number of females caught in the gap than males.  This is important and correlates directly with the states, and demographics of people living in those states, that have chosen not to expand Medicaid.  This article could be used to argue the success found in some of the North Eastern states that have expanded coverage.  Similarly, this could disprove any claims that immigrants are the cause of the gap as a majority of those included are non-Hispanic whites, even in some border states such as Texas.   The major values at stake pertain to researchers.  Data such as that found in this source will help researcher and policy makers identify the groups that they will be tailoring their ideas and reparative plans toward in an attempt to fix this issue of massive non-coverage.  Interests vary depending on who is analyzing the research whether it be policy makers, politicians, insurance companies, or other researchers. The author is very credible as she has numerous health-related degree from many well-accredited schools.  Furthermore, she has spent her entire career in directing positions on research and analysis teams regarding healthcare and Medicaid.  The author will hopefully be unbiased as she has seen thing from the patient's and doctor's perspectives (from working in hospitals) as well as insurance provider's perspectives as she was going through school.  However, given that the author works for an insurance provider, and insurance providers operate as businesses, it is hard to tell for sure if the author is actually biased of if she has some underlying ulterior motive.  

Price, C. C., and C. Eibner. "For States That Opt Out Of Medicaid Expansion: 3.6 Million Fewer Insured And $8.4 Billion Less In Federal Payments."Health Affairs 32.6 (2013): 1030-036. HealthAffairs. Web. 07 Feb. 2016.

Lastly, my third source provides valuable data and studies conducted that tests different methods of solving the coverage gap crisis between states that chose not to expand, as well as the benefits and disadvantages of each.  For example, one proposed solution was to only include people up to 100% of poverty rather than 138%, which would earn the states more federal funding and eventually create a surplus of funds from residents in the state paying into the program.  The downside is that it will cost the Federal Government a couple million dollars. Followoing European models would call for a steep increase in taxes, but in the United States of America, raising taxes does anything but convince voters to support that issue.   Obviously, solutions such as this positively support my argument in that the states as well as it's residents both benefit from the situation.   Included for each possible solution is analysis of data and findings from the studies.  The primary author of this journal is a mathematician with a doctorate in applied mathematics.  He has completed many healthcare related studies such as cost of coverage in the event of healthcare reform and use of new technology in the field.  He has worked in hospitals for much of his career performing research and conducting studies.  I think the author provides an unbiased opinion because he is a mathematician rather than a healthcare provider or insurance broker.  He simply runs the studies, crunches the numbers, and reports what he finds with little skin in the game in regards to his career path.  

My research question is arguable because it has much more behind it than simply keeping American citizens insured.  The debate between closing the gap is extremely political in nature because it involves funding from the states and the federal government. Agreements between the sources would include the fact that healthcare in the United States is a pressing issue and the coverage gap needs to be minimized in the coming years. Solutions to this problem, as well as the effects of the solutions vary quite significantly.  Other disagreements occur between significance of the problem and where the blame should fall and who should be receiving the pressure to fix it.  These sources have definitely shaped my perspective into one of disbelief, especially with the last source I read.  The fact that multiple proposed solutions to closing, or at least decreasing, the coverage gap have been studied and are projected to benefit not only the people (being that they gain insurance they did not have before) but the state as well in increased funding and surplus of funds seriously troubles me.  The downside to most of these problems, simply put, is that the federal government would have to spend more money.  As if they had any problem with the deficit spending of $18 trillion they've deemed 'necessary,' but all of a sudden $20 million to insure American citizens is too much.  My research question may need be revised by talking about specific states, however it is difficult to get even more specific with my topic than I have gotten thus far.  

