During a September 2011 debate, the assembled Republican White House hopefuls provided one of the most disturbing moments of the last presidential campaign. When CNN's Wolf Blitzer asked Ron Paul what should happen to a healthy 30 year-old that refused to pay for an insurance policy and then suddenly has a major medical emergency, the GOP audience provided the answer: "Let him die."
With the polls closed on the first open enrollment period for the Affordable Care Act, a clear frontrunner has already emerged in the Republicans' "Let 'Em Die" primary for 2016. Thanks to his refusal to expand Medicaid coverage in the Lone Star State, Texas Governor Rick Perry has left two million of his constituents needlessly uninsured and sentenced up to 3,000 annually to needlessly die.
That's the conclusion a team of researchers from Harvard Medical School recently published in Health Affairs. The authors of "Opting Out Of Medicaid Expansion: The Health And Financial Impacts" tallied up the coming body count in the Republican states that rejected the ACA's extension of Medicaid to millions of their residents:

Nationwide, 47,950,687 people were uninsured in 2012; the number of uninsured is expected to decrease by about 16 million after implementation of the ACA, leaving 32,202,633 uninsured. Nearly 8 million of these remaining uninsured would have gotten coverage had their state opted in. States opting in to Medicaid expansion will experience a decrease of 48.9 percent in their uninsured population versus an 18.1 percent decrease in opt-out states...
We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104. Medicaid expansion in opt-out states would have resulted in 712,037 fewer persons screening positive for depression and 240,700 fewer individuals suffering catastrophic medical expenditures. Medicaid expansion in these states would have resulted in 422,553 more diabetics receiving medication for their illness, 195,492 more mammograms among women age 50-64 years and 443,677 more pap smears among women age 21-64. Expansion would have resulted in an additional 658,888 women in need of mammograms gaining insurance, as well as 3.1 million women who should receive regular pap smears.

Republican primary voters will have plenty of choices among the long list of GOP governors vying for their support in opposing Obamacare. With the 46th ranked health care system in the country and 24 percent of his residents uninsured before the ACA (30 percent under age 65), Perry is the obvious body count leader. But Louisiana's Bobby Jindal, who rolled out his own health care proposals this week despite leaving 272,000 uninsured--and up to 540 dead each year, isn't far off the pace. Jindal narrowly trails Indiana's Mike Pence (262,000 uninsured, up to 760 dead annually) and Wisconsin Governor Scott Walker (152,000 uninsured, 670 dead). Sam Brownback from Kansas (124,000 uninsured, 330 dead) brings up the rear.
Other likely Republican contenders in 2016 have hurt their chances among the GOP's hard-right base by endorsing Obamacare's Medicaid expansion for their states. New Jersey's Chris Christie and Ohio's John Kasich will have no "coverage gap" in their states. Governor Kasich looked at the math and looked in the mirror before concluding that accepting federal dollars for Medicaid expansion would not just save lives but actually save the Buckeye State money. In June 2013, he explained his decision to extend Medicaid coverage to 300,000 Ohioans to his fellow Republicans:

"When you die and get to the meeting with St. Peter, he's probably not going to ask you much about what you did about keeping government small, but he's going to ask you what you did for the poor. You'd better have a good answer."

Kasich's answer may help him with the Lord, but GOP voters in Iowa and South Carolina are another matter. Governor Rick Perry, in contrast, knows his audience. During another September 2011 Republican debate, NBC moderator Brian Williams asked Perry about the record-setting 234 executions during his tenure as Texas Governor and whether "you struggled to sleep at night with the idea that any one of those might have been innocent?" David Edwards recalled the scene:

The conservative audience broke into cheers and applause...
"No, sir, I've never struggled with that at all," Perry flatly stated. "In the state of Texas, if you come into our state and you kill one of our children, you kill a police officer, you're involved with another crime and you kill one of our citizens, you will face the ultimate justice in the state of Texas, and that is you will be executed."
The audience again cheered at Perry's mention of "the ultimate justice."

Just imagine the cheers when candidate Perry touts his new Lone Star death toll and declares, "Texas will not be held hostage to the Obama administration's attempt to force us into this fool's errand."