"Because of this document--and the long years of struggle which so many have put into creating it--in this town, and a thousand other towns like it, there are men and women in pain who will now find ease. There are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help. There are those fearing the terrible darkness of despairing poverty--despite their long years of labor and expectation--who will now look up to see the light of hope and realization.

There just can be no satisfaction, nor any act of leadership, that gives greater satisfaction than this.”

Those are the words of Lyndon B. Johnson speaking in Independence, Missouri at the signing of the Social Security Amendments of 1965 that created Medicare and Medicaid.

More than 50 years later, the state of Missouri, home to more than 253,000 uninsured Americans who could gain access to care, is one of the twenty four states that refuse to expand Medicaid. Over 5.4 million Americans could gain access to care in 2014, but won’t because of choices made by their elected state officials. There are few clearer examples of how political gamesmanship has real life consequences for people.

The administration is ramping up efforts to raise awareness about the how people can gain access to affordable health care if their leaders act. Earlier this week, President Obama visited three states where over 1.5 million Americans could be helped but have been left behind by their governors. At an event in Texas, President Obama expressed concern for those Americans:

“Across this state, you've got a million people -- because this is a big state -- a million people, citizens, who don’t have health insurance that could get health insurance right away if the state of Texas decided to take advantage of it.

So one of the things that sometimes gets me a little frustrated, although I understand it because I’m in politics, is folks who are complaining about how the website is not working, and why isn’t Obama fixing this, and all these people are uninsured, and yet they're leaving a million people right now without health insurance that they could immediately fix. There’s not a lot of logic to that.”

Yesterday, the President called on Louisiana’s leaders to work together to expand Medicaid – a move that would provide health insurance coverage to 265,000 uninsured residents in Louisiana by 2016:

“Republican governors in states like Ohio and Nevada, Arizona, they're doing it, too. Oregon has already reduced the number of uninsured by about 10 percent. And some of these folks opposed Obamacare, but they did support helping their citizens who can’t get coverage.

“So we want to work with everybody -- mayor, governor, insurance -- whoever it is that wants to work with us here in Louisiana to make sure that even if you don't support the overall plan, let’s at least go ahead and make sure that the folks who don't have health insurance right now can get it through an expanded Medicaid. Let’s make sure we do that. It’s the right thing to do.

This decision not only adversely impacts the lives of those who are denied access and health security: it is having grave consequences for hospitals and communities. Some rural hospitals may be forced to close without the expansion. In today’s New York Times, one Georgia hospital administrator explains her concerns:

“We were so thrilled when the law passed, but it has backfired,” said Lindsay Caulfield, senior vice president for planning and marketing at Grady Health in Atlanta, the largest safety-net hospital in Georgia.

If Georgia expanded Medicaid, about 500,000 residents could have access – and Medicaid payments to hospitals in Georgia could increase by nearly 30 percent over the next decade.

To provide state with the financial support for extending Medicaid, the Affordable Care Act directs the federal government to fully fund coverage in the first three years, and pay no less than 90 percent for coverage newly eligible individuals over time. This significant increase in federal funds is partly offset by lowering the special payments to hospitals for the uninsured, called disproportionate share hospital (DSH) payments. While there is a scheduled $500 million cut to Medicaid DSH for 2014, we proposed to delay these cuts in light of some states’ refusal to expand Medicaid – only to have Republicans in Congress refuse to pass legislation to delay these cuts. Hospitals that serve the most vulnerable are between a rock and a hard place – but only until their governors and state legislatures act in their best interest, along with the best of their residents, businesses, and economy.

After President Johnson went to Independence, MO to sign into law Medicare and Medicaid, 26 states signed up in the first year – same as now – with all but two states signing up within the next four years.

Since then, American families have counted on Medicaid in moments of need. For families who have a child born with Downs syndrome or working Americans who are waiting tables or bringing in crops but don’t have jobs that provide health insurance – this program has had a huge impact on their lives and the health of our communities and country.

Yet, Medicaid has gaps that the Affordable Care Act can fill. There are still millions of Americans who are working day and night who lose sleep worrying what might happen if they get sick or hurt. They can’t wait years for care.

That is why we are making our case across the country.

Administration officials will continue to team up with local officials to press for those Americans living in states that are neglecting to provide health coverage to their low-income citizens. On Friday, HUD Secretary Shaun Donovan raised the issue at a health insurance outreach and enrollment event in Tampa, Florida where he urged the state to pass an expansion of Medicaid that would cover 848,000 Floridians by 2016. The Administration will continue to visit cities with high rates of uninsured Americans and push to make sure no American is left behind by their state.

Find out more about your state here.

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