Rebecca London, Ph.D., is Director of Research at Stanford University’s John W. Gardner Center for Youth and Their Communities. Rebecca lives on California’s central coast with her husband and two school-age daughters. She’s frequently quoted in the press as an expert on poverty, youth, and working motherhood. Here she is! -GWP

The New York Times reported last Monday that people who lack health insurance tend to receive cancer diagnoses later in the stages of their illness, making treatment more costly and survival less likely (“Study Finds Cancer Diagnosis Linked to Insurance”). This finding, though horrific, is fairly predictable given previous research on health insurance coverage. Numerous studies have shown that lack of health insurance can be detrimental because uninsured patients tend to not receive regular or preventive care, their undiagnosed or under-medicated conditions thrive in the absence of such care, and when medical crisis escalates, they find their way into the emergency room and subject to exorbitant medical bills.

What is unusual – indeed frightening – about the study reported in the Times is that the findings apply not only to those with no insurance, but also to those who are insured by Medicaid, the health insurance program for poor adults and children. Medicaid should work like private health insurance, offering its subscribers access to preventive and acute-need health care on a timely and low-cost basis. However, it is well known that Medicaid reimbursement rates to doctors are lower than reimbursements from private insurers, and come with a tremendous amount of bureaucratic paperwork. Many medical professionals opt to not provide treatment to those covered by the program simply because it is not cost effective to do so.

The result: expanding inequality in access to health care with truly dire health consequences.

In this election year, any politician who tells us that universal health care is not needed to fix the U.S. health care crisis is avoiding a painful truth. Expanding Medicaid is not an option if we want to ensure health care access to everyone. We need to look back to the dark days of Hillary’s universal health care plan failure and critically analyze what happened with it in order to create a fresh version that will be palatable to policymakers and the public. Maybe a decade later, we’re ready to make a critical move.