'Tennessee is one of the 14 states that still refuse s to expand Medicaid under the ACA. Here is the reality: America’s rural health care crisis is largelya direct result of political decisions which has denied health insurance to millions who could have had it with a stroke of the pen. Rural hospitals are closing, rural doctors leaving, in large part because people can’t afford to pay for care. The simple fact is that the Republicans who run Tennessee and other “non-expansion” states have chosen to inflict misery on many of their constituents, rural residents in particular. And it’s not even about money. Just compare Tennessee with Kentucky which expanded Medicaid, and did its best to make Obamacare work. The result was a two-thirds drop in the uninsurance rate. This isn’t a problem of policy, it’s a problem of politics — and most of the blame lies with Republican state governments.