One of the reasons it took the US nearly 100 years to have something like a nationwide health insurance program is pretty stark and ugly: racism. The idea was initially raised in Theodore Roosevelt's 1912 run for the presidency on the Bull Moose or Progressive Republican ticket. His distant cousin Franklin talked about it but couldn't quite get there.
Neither could his successor Harry Truman, thanks largely to the opposition of southern senators who feared that health care reform would benefit African Americans and undermine the segregated hospital system.
It took the election of Barack Obama in 2008, a House Democratic majority, and a (brief) Democratic supermajority in the Senate to make the Affordable Care Act possible, as limited as it is.
While the ACA survived a challenge in the US Supreme Court, the majority of justices dealt it a major blow by making Medicaid expansion a state option rather than a mandate. And, surprise, many of the states that have so far not chosen to expand Medicaid under the ACA are former Confederate slave states.
Ironically, many if not most of southerners who would benefit from the expansion are white. That's just another example of how racism hurts everyone, not just the obvious targets.
You can read more about the politics of ACA in Mississippi here and look at how many Americans are or could have been covered by Medicaid expansion here.
Once again, I'm grateful that WV's Gov. Earl Ray Tomblin did the right thing in 2013. Since his decision to expand Medicaid, around 155,000 working West Virginians have gained coverage.
Oh, yeah, and I'm glad WV left the southern Confederacy 151 years ago. Otherwise, and among other things, that expansion of health care might never have happened.