My 27-year-old patient didn’t have to die. North Carolina could have prevented it.

Recently, a 27-year-old patient of mine was suddenly found dead in her home. As her primary care provider, I was stunned. I had just spoken to her only a few days ago, and she was feeling better and, for once, was feeling hopeful that we might finally make progress on her medical problems.

Instead, I’m staring at the blank line on her death certificate, and I am at a complete loss for what to list as her cause of death. Minutes go by and my anger only mounts while the cause of death stays blank.

Explanations flash through my mind - this young woman suffered from Type 1 diabetes, low potassium levels, malnutrition from severe chronic diarrhea, and recurrent skin infections. Any one of them could have suddenly ended her life, but none is truly accurate.

It’s such a contrast to when I practiced medicine in New York, patient deaths were typically predictable - my patients were elderly, and their health had declined for years.

But in rural North Carolina, we could have saved and prevented so many young deaths if only we hadn’t wasted so much time battling a system built to fail.

As I continue to stare at the 27-year-old’s death certificate, I ask myself, can I write “North Carolina’s Medicaid coverage gap“ as a cause of death? Because only this really feels honest; only this begins to get at the root cause.

This patient, like so many before her, should still be alive. Just 20 miles north in Virginia, she would have easily qualified for Medicaid, giving her access to standard-of-care treatments like an insulin pump, a continuous sugar monitor, and appropriate long- and short-acting insulins.

She would have qualified for transportation services and nutritional counseling

Instead, she struggled to control her sugars and was too sick to work or drive, depending on similarly strained family members for rides.

So in a very real way, the cause of this young woman’s death is a consequence of our state legislature.

In my shock at the realities of healthcare in rural North Carolina, I’ve spoken often about the urgency of Medicaid expansion. House and Senate leaders have publicly expressed support for Medicaid expansion, yet I am still stuck signing death certificate after death certificate, simply because my patients can’t afford basic medical care.

How much longer must I confront this harrowing reality of signing death certificates for patients who should not have died?

To my elected leaders: How can I be more clear? What more could be at stake? And how can you sleep at night knowing that your names are haunting the death certificates of thousands of North Carolinians? Because I can’t.

This election season, I am turning to my fellow voters. We can choose to cast our ballots for candidates who will fight for Medicaid expansion. We can choose to vote for life-saving care for more than 600,000 North Carolinians. And we can choose to do it now. Early voting starts Oct. 20. I know where I will be when the polls open.