From the beginning, the defining irony of the never-ending debate over Obamacare has been this: health care is worst in those states where Republicans poll best. That is, the map of the states with the worst health care systems largely mirrors GOP strongholds in the Electoral College. Red state residents are generally the unhealthiest and more likely than their blue state cousins to be uninsured. The sad corollary is that the red states rejecting the Affordable Care Act's expansion of Medicaid are the ones that need it most. Now, a new analysis has a state-by-state body count of the millions of Americans Republican governors and state legislatures will leave without health insurance.
As the Washington Post reminded readers Friday, even with its combination of an insurance mandate, subsidies for employers and individuals and the expansion of Medicaid currently providing coverage for millions of poor, elderly and disabled Americans, the Affordable Care Act was predicted to leave roughly 26 million people uninsured. But as the authors of a new study published ("The Uninsured After Implementation Of The Affordable Care Act: A Demographic And Geographic Analysis") at Health Affairs found, the refusal by some state to accept the expansion of Medicaid means millions more will remain without health insurance.

The table above, which looks at just the states with the 10 best and 10 worst health care systems according to the Commonwealth Fund's 2009 State Health Care Scorecard, shows the painful impact of Republican rejectionism. In Texas, Governor Rick Perry denounced Obamacare Medicaid expansion as a "fool's errand." But his foolishness in opting out means an extra 1.9 million Texans will needlessly go without health insurance in state where 24 percent of all residents--and 30 percent between the ages of 18 and 64--lack coverage. In Florida, where the GOP legislature is rebuffing Republican Governor Rick Scott's choice to accept the windfall from Washington, another million residents will be left uncovered. (In contrast, over 300,000 more Arizonans will gain insurance, thanks to a rare showing of common sense by Governor Jan Brewer.) Next door neighbors Minnesota and Wisconsin provide another useful case study. While Democrat Mark Dayton will be cutting the ranks of the uninsured by almost half in his state, in Madison Republican Scott Walker is leaving an estimated 182,000 folks out in the cold.
(For more background, see "Health Care is Worst Where Republicans Poll Best.")