A state line divides Fulton, Kentucky, and South Fulton, Tennessee. Most people going to work or running errands could lose track of which state they’re in – until they need to see a doctor. Working families on the Kentucky side of town have access to health care. Families in South Fulton face the financial and emotional stresses – and poor health – that are part of life without health insurance in America. The same thing is happening further east in a town called Bluefield, which straddles the Virginia and West Virginia border. West Virginia and Kentucky are among 27 states that have expanded Medicaid programs. Tennessee and Virginia are among 23 states controlled by Republican state legislatures or governors that have blocked expanded Medicaid coverage under the Affordable Care Act.

Pam Rockwell, 58, of Murray, Kentucky, knows the difference firsthand. “It is a huge relief to have some coverage after nearly a decade,” Rockwell told investigators for Sen. Bernie Sanders’ primary health care subcommittee. Initially, she recalled, she had trouble signing up. “Then, bam! I had health insurance. I can’t tell you what a huge relief it was. When you’re in that situation, you try to do a lot of ignoring things and trusting that they will go away. Now I no longer have to worry if I become sick or injured. I can’t tell you how worried I was without it.”

The new federal health care law was designed to provide Medicaid coverage for more than 10 million of the poorest uninsured Americans. Under the law, the federal government covers 100 percent of the cost of expansion through 2016. States pay nothing. The federal government will continue to pay for almost all of the cost of expansion, covering 90 percent in 2020 and beyond. After the Supreme Court ruled in 2012 that the expansion could only be implemented voluntarily, Tennessee and Virginia were among states that resisted giving more people access to health care. Meanwhile, states that embraced the expansion have seen remarkable results. According to Gallup surveys, Kentucky cut its uninsured population almost in half from 20 percent to 12 percent.

Read more about Fulton, Kentucky, and South Fulton, Tennessee

Read more about Bluefield, West Virginia, and Bluefield, Virginia