Earlier this month, President Trump proclaimed that it’s not fair 30 million Americans are uninsured, acknowledging this puts them at a disadvantage, especially as COVID-19 spreads. He suggested we should expand health coverage to the uninsured. The majority of Americans agree with the president on this topic.

Due to a lack of leadership and action at the state and federal level, the problem is only going to get worse. 

Last week, the “Annals of Internal Medicine” published a study that estimated 1.5 million American workers would lose coverage after becoming unemployed and projects that 5.7 million more will lose coverage by the end June. The study highlighted states that haven’t expanded Medicaid or fully implemented the Affordable Care Act (ACA) would be most impacted.

Addressing this challenge is going to require leadership at the state and federal level. The first focus should be to encourage states to expand Medicaid coverage for millions of hard working Americans.

The obstacle to thousands gaining coverage through expanding Medicaid could instantly vanish if President Trump would use his Twitter account to make this point, and my guess is that within weeks or months many of the 14 holdout states would expand Medicaid. 

Rather than broaden coverage or urging states to expand Medicaid, the federal government will directly pay hospitals for the care they provide to uninsured COVID-19 patients. This approach, while a good start, does not give uninsured Americans the comprehensive coverage they need to stay healthy. It puts them at risk of surprise bills for unrelated care and fails to address mental health and primary care needs.     

We can do better. The president’s instinct to support expanded coverage last week was right because it would help uninsured Americans access health services and because it is broadly supported by the citizens of holdout states, like Kansas.

In 2016, I met with Kansans about the need to expand Medicaid. In over 65 town hall meetings throughout Kansas — rural, urban and everywhere in-between — thousands of citizens raised their hands to join our effort to expand Medicaid. Why? It meant their kid’s child care teacher could have health insurance, their local hospital could keep its doors open and it would result in good-paying health care jobs in their community.  

That same year, voters in Kansas elected a legislature that overwhelmingly supported expanding Medicaid. In the months after, when repeal of the ACA was at the top of the national agenda, our legislature overwhelmingly supported expanding Medicaid, coming up just short of overriding a veto from former Gov. Sam Brownback. The failure to reverse the veto, followed by expanding Medicaid in ensuing sessions, runs contrary to poll after poll showing over 65 percent of Kansans and a majority of legislators support expanding Medicaid.

It’s not just in Kansas that expanding Medicaid has the full support of voters. Idaho, Maine, Nebraska and Utah have demonstrated their support for it by overwhelmingly passing ballot initiatives in recent years.

Still, 14 states have resisted the will of their citizens and haven’t expanded Medicaid. If each of these states acted, 4.4 million more Americans could access health coverage through Medicaid as they face the threat of COVID-19. The impact of expanding Medicaid would provide health and economic security to hardworking Americans who are doing essential jobs or have been laid off. Many child care workers, home health aides, grocery store workers and others would benefit by having Medicaid coverage as they risk their lives to serve their neighbors.

Expanding Medicaid would also provide financial relief to hospitals, particularly rural hospitals that were already struggling before the challenges created by the spread of COVID-19. Most rural hospitals in Kansas and across the country are operating at a loss, and those in non-expansion states are six times more likely to close than those in states that have expanded Medicaid.

As hospitals struggle to deal with COVID-19 and a loss of revenue from sharp reductions in elective care, they need all the help they can get. 

In the coming weeks, President Trump can provide important leadership by encouraging states to expand Medicaid. A Saturday morning Tweet storm could provide a new lease on life to a rural hospital and new hope for uninsured Americans. 

We should also be exploring other strategies to expand coverage like re-opening the ACA marketplace, improving subsidies and other coverage expansions. Now, is the time for the president, federal government and states to all work to expand coverage.    

David Jordan is the president & CEO of the United Methodist Health Ministry Fund. Prior to joining the foundation, David led campaigns to expand access to health care in Kansas and nationally.