* Kaiser Health News…

Patricia Powers went a few years without health insurance and was unable to afford regular doctor visits. So the Missouri resident, who lives near St. Louis, had no idea that cancerous tumors were silently growing in both of her breasts.

If Powers lived just across the Mississippi River in neighboring Illinois, she would have qualified for Medicaid, the federal-state health insurance program for low-income residents that 36 states and the District of Columbia decided to expand under the Affordable Care Act. But Missouri politicians chose not to expand it — a decision some groups are trying to reverse by getting signatures to put the option on the 2020 ballot.

Powers’ predicament reflects an odd twist in the way the health care law has played out: State borders have become arbitrary dividing lines between Medicaid’s haves and have-nots, with Americans in similar financial straits facing vastly different health care fortunes. This affects everything from whether diseases are caught early to whether people can stay well enough to work. […]

A recent University of Michigan study found Medicaid expansion substantially reduced mortality rates from 2014 to 2017. The researchers said Illinois averted 345 deaths annually while Missouri had 194 additional deaths each year. The same trends held for other side-by-side states such as Kentucky (did expand) and Tennessee (did not), New Mexico (did) and Texas (did not).

And it’s not just the averted deaths. It’s also the averted debilitating impacts of untreated or partially treated illnesses and injuries and the crushing debts which often lead to bankruptcies and the inability to work or be productive citizens…

In neighboring Illinois, getting Medicaid through the expansion helped Matt Bednarowicz avoid debilitating medical debt after a motorcycle crash.

The wreck crushed his left foot, requiring doctors to insert pins. Without Medicaid, he would have faced thousands of dollars in medical bills.

“The debt would have been greater than I could comprehend overcoming,” says Bednarowicz, who is now 29.

His Medicaid kicked in “just in the nick of time” to cover the surgery, Bednarowicz says. It also allowed him to get psychiatric help for depression. More than a year later, he’s able to get around well — even jog — and works as a caregiver for an elderly man.

Having insurance helps people like Bednarowicz stay productive, says Riopedre.