Add into that combustible mix a coming wave of coronavirus cases, and you have what health economist Austin Frakt described to me as a “looming catastrophe.”

This may be felt with great intensity in the south. That’s because in that region, there is a developing situation that could prove very distressing in coming weeks. On one hand, there hasn’t been enough social distancing in these places. On the other, many of those states have not opted into the Medicaid expansion, which could make the health care crisis far more acute.

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Here is where our two maps come in.

The first one is from a New York Times analysis of cellphone data, which showed that in places like Florida and the southeast, folks “have continued to travel widely, potentially exposing more people as the coronavirus outbreak accelerates":

As Indiana University health policy analyst Aaron Carroll pointed out, this visual “bodes really poorly for the south.”

The second map is from the Kaiser Family Foundation. It shows that many of these same states have not expanded Medicaid, represented here in dark blue:

The new jobs numbers are probably just a preliminary glimpse of how brutal the recession will be. A new Congressional Budget Office analysis projects that the unemployment rate will exceed 10 percent in the second quarter, and that in some scenarios it could remain nearly as high throughout 2021.

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The sum total of all these factors is unpleasant to contemplate. Soaring unemployment is likely to exacerbate the health-care crisis: The Economic Policy Institute estimates that at least 3.5 million people lost employment-related health insurance in the last week; obviously that could get substantially worse.

For that reason, experts believe skyrocketing unemployment could mean an explosion in people seeking Medicaid. That’s supposed to happen, since Medicaid is part of the welfare state. But those experts also worry that this big wave will massively strain the program, along with state budgets, since Medicaid is funded by both states and the federal government.

So what will happen in states that haven’t opted into the Medicaid expansion, and have thus refused to avail themselves of the huge infusion of federal money it offers to expand health coverage to poor adults?

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And what will happen if we get a massive new wave of covid-19 cases in those states?

‘A perfect storm’

“It’s a perfect storm,” Judy Solomon, a senior fellow at the Center on Budget and Policy Priorities, told me. “Those are the areas where the next spikes will likely occur, like what we’re seeing in New York.”

But, Solomon continued, in New York, people have much more access to health coverage than people in these parts of the South. “This will multiply the harms we’ve already seen in those states,” Solomon said.

“What it means is a lot more hardship, health problems and death,” Frakt, the health economist, told me. Frakt noted that the virus is now likely to spread in those regions, which will dovetail in a terrible way with the failure to expand Medicaid.

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“People who have lost their jobs and have nowhere else to turn,” if they can’t get on Medicaid, “they’ll have great difficulty affording the care they’ll need,” Frakt said.

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Or, as Larry Levitt of the Kaiser Family Foundation bluntly put it, “poor people in states that haven’t expanded Medicaid” will have “no help.” And those ranks will swell.

The Trump administration has hinted it might somehow use Medicaid to expand access to health coverage for the uninsured during the crisis. But these feints have been extremely vague, and President Trump — along with many Republicans — continues to support a lawsuit that could wipe out the ACA entirely.

Meanwhile, some Southern states, like Tennessee, are seeking federal approval to create contingency funds that would bring in additional federal Medicaid dollars. But if anything, this underscores the folly of continuing to refuse the Medicaid expansion.

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“Rather than seeking pots of money to cover hospital care for uninsured people, states should be expanding Medicaid, taking the federal dollars already available, and providing them with comprehensive coverage, Solomon told me.

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Ominously, in some of these states, cases are mounting. As of now, Florida has over 9,000 confirmed cases; Georgia has nearly 5,500; Texas has nearly 5,000; Tennessee has nearly 3,000; and North Carolina has nearly 2,000.

The twin crises we’re facing — an all-consuming pandemic emergency combined with a slide into a horrific economic downturn — are revealing with unique force just how exposed and vulnerable individuals have been left by our failure to invest sufficiently in public health and a robust welfare state.

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As political theorist Jedediah Britton-Purdy recently put it, we’re now learning to our great horror that our system is “totally lacking in resilience to shifts in human need.” Britton-Purdy added: “We can afford truly public health, but if everyone is driven to try to stay healthy alone, it won’t work, and trying will kill a lot of us.”

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A lot more than any of us can bear.