WASHINGTON — Health care policy remains a potentially divisive subject not only in Congress but in the heartland of America, as hospitals across the country continue to be affected by states' decisions regarding Medicaid expansion.

Although Medicaid has provided affordable health insurance to low-income individuals for decades, provisions in the 2010 Affordable Care Act now allow states to extend health care coverage to millions of additional uninsured Americans who had previously not qualified for the program.

Prior to 2010, the median eligibility level for working parents to qualify for Medicaid was 61 percent of the federal poverty level, and non-disabled adults without dependent children were ineligible to receive health insurance through the program. Today, states that decide to expand Medicaid benefits extend health care coverage to all non-elderly individuals in families with incomes below 133 percent of the federal poverty level, which is $27,310 for a family of three in 2014.

While many legislators were concerned that extending coverage would be a costly process, the federal government has agreed to cover the majority of costs associated with expansion, paying 100 percent of the cost of covering newly eligible individuals through 2016 and paying 90 percent subsequently.

In addition, researchers at the Urban Institute have estimated that, if every state elected to expand Medicaid, reductions in uncompensated care currently financed by state governments would more than offset any additional Medicaid costs, generating $10 billion over 10 years for all states.

So far, 5.2 million Americans have gained Medicaid or Children's Health Insurance Program coverage in hospitals within 26 states and the District of Columbia. One of those hospitals, Mercy Medical Center in Canton, Ohio, uses Medicaid and other community health programs to provide quality health care for all individuals.

Thomas F. Turner, vice president of development, physician services and government relations at Mercy Medical Center, described how employees at the Catholic hospital "continue Christ's healing ministry."

"Our role in this community is to provide affordable, accessible care for individuals in a Christ-like fashion, and we continue to do that by providing the dignity of coverage to people who are working and trying to contribute to society," Turner said. "People come to the cross no matter what your current status in life may be. We in Catholic health care grant charity to patients on their balance on a bill after insurance payments or will provide charity care based on need if there is no ability to pay. We have become a more trusted point of care because of the work that we do as the faith-based hospital in the region."

As of June 30, 285,000 newly enrolled individuals have benefited from Medicaid expansion in Ohio, and hospitals like Mercy Medical Center have increased revenues as they continue serving new patients daily.

"We have seen a lot of people who are eligible now that never had been before and have expanded our primary care network in order to meet the demand," Turner told Catholic News Service. "In women's health more people are getting their well-checks and examinations because they know that there is a methodology to pay for it.

"Young families are becoming more apt to visit the pediatrician or go to their primary care doctor instead of avoiding medical care and then ending up in the emergency room," he added. "People feel that they have found greater access to care, and we attribute this to the expansion of Medicaid."

Although many individuals have benefited from newfound coverage in expansion states, many hospitals in the 24 states that have not opted to expand Medicaid are facing increased economic hardship because they are serving more poor and uninsured patients and are not receiving federal money they expected to cover uncompensated care. Some hospitals have had to shut down.

During a recent news conference, the Rev. Susan McCann of Grace Episcopal Church in Kansas City, Missouri, described how the people in her state have been affected by the decision not to expand coverage.

"Life expectancy in one-fourth of our counties is going down," McCann said. "This is the first time that this has happened in recent recorded history. People in Missouri are living sicker and dying younger, and we believe the decision not the expand Medicaid has produced this moral crisis."

Gabriela Saenz, vice president of advocacy and public policy for CHRISTUS Health in Texas and Louisiana, explained how hospitals in non-expansion states are being affected by decisions regarding Medicaid.

"For CHRISTUS, more than 60 percent of reimbursement comes from government-sponsored care, like Medicare and Medicaid," Saenz said. "Medicaid expansion or alternatives to Medicaid provide financial relief for hospitals, physicians, employers, counties and property owners. Ultimately, it is about creating a stronger state economy.

"Without it, uninsured, low-wage working individuals will rely on  hospital ERs as their primary source of health care, causing major financial repercussions to the entire state's economy."

According to a July 3 report released by the presidential Council of Economic Advisers, the 24 states that have not yet expanded Medicaid "would have created an additional $66 billion in total economic activity through 2017" and helped produce 184,000 new jobs in 2015 alone if they had made the decision to expand Medicaid benefits according to the provisions in the Affordable Care Act.

Although expansion would produce numerous benefits, many legislators have not elected to expand Medicaid coverage because they believe the federal government cannot afford to keep its promises to pay for expensive statewide expansion initiatives and would leave state governments with even larger health care bills than those they say they are currently facing.

In addition, many legislators believe the entire U.S. health care system is deeply flawed and are convinced Medicaid cannot be expanded until health care undergoes major systemic changes.

"Along with the governors of both Louisiana and Texas, many of our state lawmakers believe that the current Medicaid system is broken and that infusing money into a 'broken' system is not the answer," Saenz said. "There are many alternatives that states may seek that could offer a private market-based coverage plan that will improve the health of low-wage working citizens and strengthen the state's economy."

While Saenz does not believe that legislators in Louisiana or Texas will choose to expand Medicaid coverage, she remains hopeful that individuals still living without health insurance will be offered the care that they need.

"For non-expansion states, doing nothing is not the answer," Saenz said. "There are too many lives at risk and too much money already invested by providers and taxpayers. We are hopeful that legislators will consider alternative options to Medicaid expansion and provide necessary care to the American people."