why hospital visitation was meaningless

Contracts don't mean a thing

At least when the state can just decide to ignore them rather than respect and enforce them.

"wills, powers of attorney, and medical directives, all naming each other" - None of these are things that require you to name someone who you are legally married to or even related to. You can name whoever you want, with some limitations mostly relating to your own mental status. So instead of abiding by these contractual arrangements made in good faith, the state decides to ignore them, because...why? That isn't even necessarily a problem merely limited to homosexual couples at the point where governments decide to do as they please and bypass our private arrangements without due process.