To a state legislator: support Medicaid expansion

Use this template only if you live in a non-expansion state: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, or Wyoming. Personalize with specific local effects: a rural hospital that has closed or is at risk, a family member or neighbor in the coverage gap, your local uninsured rate.

Dear [Senator/Representative] [Last Name],

I’m writing as a resident of [city/town] to ask you to support Medicaid expansion in [state name].

[State name] is one of ten states that has not adopted Medicaid expansion under the Affordable Care Act. The result is the coverage gap: roughly [thousands or tens of thousands] of [state] residents earn too much to qualify for traditional Medicaid here but too little to qualify for ACA marketplace subsidies. They are workers — many in retail, food service, agriculture, construction, and home care. They have no realistic pathway to coverage at any price they can afford.

The substantive case for expansion is well-established:

1. Coverage. Expansion would cover [number] uninsured residents who currently fall in the coverage gap.
2. Rural hospitals. [State] has lost [number] rural hospitals in recent years; many more are at financial risk. The empirical evidence is consistent: Medicaid expansion reduces rural-hospital closure risk by 60-70%, primarily by absorbing uncompensated care costs that currently fall on hospitals as bad debt.
3. Federal dollars. Expansion is funded primarily by federal dollars, with the federal share well above the standard Medicaid match. [State] residents’ federal tax dollars currently fund expansion in 40 other states without our state benefiting.
4. Economic impact. Medicaid expansion produces measurable employment and economic-output gains in healthcare, retail, and ancillary sectors.

[If applicable: insert a paragraph about a specific rural hospital, a family member or community member in the coverage gap, or a local healthcare worker who could speak to the consequences. Specific local examples make this letter substantially more effective.]

I understand expansion has been politically contested in [state]. I’m asking you to consider the substantive case on its merits. Several non-expansion states have eventually adopted expansion through ballot measure — Maine, Idaho, Missouri, Oklahoma, South Dakota, Utah, Nebraska — generally after the legislative path stalled. The political pressure on this issue continues to build because the underlying coverage and rural-hospital problems continue to worsen.

I’d appreciate knowing your position on Medicaid expansion and whether you anticipate supporting it in the current session.

Thank you for your service.

Sincerely,

[Your name] [Your address]