. >> reporter: harold pollack is a public health researcher, also at the university of chicago. he's an expert on the national health care reform law and a supporter of it. he says gail's difficulties show how important it is to help vulnerable people navigate the system. >> because it's not enough to just insure people. you actually have to have systems in place that are effective and economical and credible. >> reporter: is medicaid and the private health insurance expansion enough to get people in chicago who have persistent mental illness the care that they need? >> medicaid and private insurance, they're... that's just what it is. it's insurance. it doesn't mean that it's care and it doesn't mean that it's access to care. but it's a necessary precondition to what we're able to do. >> reporter: not everyone agrees though that medicaid expansion is the necessary first step. twenty states have decided not to expand their medicaid programs mostly out of cost concerns. the federal government has agreed to pay 100% of expansion costs, but that figure steadily declines to 90% by 2