I live in a state whose Republican-controlled legislature decided to opt-out of Medicaid expansion. As you probably remember, expanding Medicaid was a key provision of the Affordable Care Act—a way to enable more uninsured people to gain access to healthcare services. Unfortunately, the U.S. Supreme Court made it possible for backward-thinking, Obama-hating state legislators to exclude the lowest-income people from getting health insurance, by allowing states to opt out of Medicaid expansion.

Remember: States like mine are doing this even though 90 percent of monetary costs associated with Medicaid expansion under the Affordable Care Act would be paid for by the federal government. Why would they do that? You can’t argue that it costs too much, when the federal government is offering to pay for it. According to a new study by the Commonwealth Fund, foregoing Medicaid expansion will cost Missouri $2.2 billion per year in federal funds by 2022. There’s only one explanation for leaving that much money on the table: Protesting “Obamacare” and punishing poor people is a higher priority than trying to make things better for people in the state.

A new study [January 2014] shows the price that will be paid for this irrational and mean-spirited move by state legislatures. The study relates the human toll that will be taken by untreated diabetes, skipped mammograms and pap smears, and lack of medical treatment in those states opting out of Medicaid expansion. You can read the report in detail at Health Affairs, where you’ll find statistics for every state. Here is a summary of some of the findings that pertain to mine.

In Missouri:

238,427 Missourians, who could have been insured under expanded Medicaid, will remain uninsured.

Between 218 and 700 Missourians will die each year for lack of proper medical care

4,086 women will not get a mammogram this year

14,134 women will not get an annual pap smear

12,947 people with diabetes won’t get their medications

21,816 people will not get their depression recognized and treated

7,770 people will have catastrophic medical expenses

I have health insurance. So do most of my friends. So does every Missouri state legislator. What kind of world are we living in, when lawmakers can so callously and spitefully inflict this pain on the citizens they supposedly represent?