From the very beginning, one massive irony has loomed over the Obamacare debate. The elephant in the room? Health care is worst where Republicans poll best. From access to care and insurance coverage to the health of their residents, red states generally produce the most dismal rankings. And while Democratic-led states are now embracing the Affordable Care Act to bring new insurance options, lower premiums and improved customer service to blue state denizens, many GOP states are doing almost nothing at all.

The New York Times provided the just latest red-state horror story. It's not just that 24 mostly GOP controlled states have chosen to turn their backs both on billions in expanded federal Medicaid funding and millions of their own residents. As it turns out, while 16 mostly Democratic states are investing heavily to make near-universal health care a reality, the 34 states refusing to run their own insurance exchanges are expending almost no money--and even less effort--in helping their residents learn about and navigate through all of their new options under the Affordable Care Act:

Maryland is spending $24 million on a program that will soon dispatch 325 navigators and assisters around the state. Colorado is investing $17 million on 400 "coverage guides," and New York is spending $27 million on a similar effort.
But in states like Virginia, which declined to build their own insurance markets under the law and ceded the task to the federal government, navigators will not have much money to get the word out. The Obama administration has promised up to $54 million for navigators in the 34 states where the federal government is setting up all or part of the markets. The grants are to be awarded Thursday.

As the Bush administration learned the hard way with its bungled launch of the Medicare Part D prescription drug benefit in 2006, those customer service "navigators" are absolutely essential. (When the program first went into effect, there were only 300 customer service representatives standing by for the 43 million Medicare recipients.) And as the chart above shows, the gap is staggering. Texas, with six million uninsured--24 percent of its entire population--is spending less ($11 million) on outreach and customer service than Minnesota, where only about half a million currently lack coverage. And as the New York Times revealed two weeks ago in its profiles of Missouri and Colorado, the red-blue difference in Americans' experiences will be like night and day.
While Colorado is "a hive of preparation, with a homegrown insurance market working closely with state agencies and lawmakers to help ensure the law's success," in Missouri by contrast "looking for the new health insurance marketplace, set to open in this state in two months, is like searching for a unicorn."

While states like Colorado, Connecticut and California race to offer subsidized insurance to their citizens, Missouri stands out among the states that have put up significant obstacles. It has refused to create an insurance exchange, leaving the job to the federal government. It has forbidden state and local government officials to cooperate with the federal exchange.
It has required insurance counselors to get state licenses before they can help consumers navigate the new insurance market. And, like many states, it has refused to expand Medicaid.

That's why an estimated 723,000 of the 877,000 people now without insurance in the Show Me State will still be on their own after the ACA kicks in in full on January 1, 2014. Nationwide, an estimated 11.5 million Americans will unnecessarily be denied health insurance. In Texas, that number could reach a mind-boggling 1.9 million.
But then again, almost everything about the Republicans' all-out opposition to Obamacare is mind-boggling. After all, while health care in Blue State America will be improving, the reddest of red states will continue to suffer most.