For many years, my home state of Indiana provided very limited access to Medicaid, a deadly state of affairs that still exists in the ten states that have stubbornly refused to accept Affordable Care Act funds to expand the program. For many Medicaid applicants in those settings, their only path to health care is meeting an onerous standard for proving they are disabled. When residents of our state still faced that hurdle, our law school clinic often represented clients in appeals of Medicaid denials. They had severe illnesses and limitations, but their applications for help paying for prescribed medicine and care had been rejected by the state agency.

Once one of my colleagues helped a woman pull together reams of evidence about her chronic pain and her struggles to afford medication and therapy. Together, they presented it to a judge who was hearing the appeal of the state agency’s decision denying her Medicaid. The judge somewhat impatiently listened to all of the testimony, then promptly denied her request. The woman rushed from the courtroom in tears.

Her lawyer started packing up his files. The judge lingered for a moment and broke from his stoic demeanor. “It really is too bad what she is going through,” he said to my colleague. “Isn’t there some kind of program out there to help people like her?” Since he had just blocked her access to the government program designed to help her, it was clear the judge was referring to a charity program.