It's frustrating to a lot of us. We are a big country made of states that have a degree of autonomy often surprising to outside observers. The result is surges

It's frustrating to a lot of us. We are a big country made of states that have a degree of autonomy often surprising to outside observers. The result is surges of progress, and pockets of injustice, all over. And even in other states that didn’t adopt the expansion, like North Carolina and Missouri, patients like Oregón still have hope of a transplant in a life-or-death situation. That’s because these states allow for a “medically needy” pathway, or a “spend-down” program, whereby patients can meet the Medicaid limit by deducting certain items, including unpaid medical bills, from their income. In NC at least, these mostly happen not because of the spend-down rule. They happen because we have a public university, with a public hospital, that is supported through the state by the public to provide care for the poor.