The first numbers on the body count from the Republican sabotage of the Affordable Care Act are just now coming in. Last week, an analysis from Harvard's Theda Skocpol revealed that states that both set up their own health care exchanges and embraced the ACA's expansion of Medicaid are racing toward their enrollment goals, while the reddest of red states which refused to do either are barely moving the needle for their uninsured populations. Now, a George Washington University study shows that states that also passed laws limiting the ability of health care "navigators" to advise customers have severely compromised their residents' ability to gain access to health care.

As the case of Missouri shows, that subterfuge of the work of the community groups, health care organizations and other non-profits isn't just tragic, it's ironic. After all, the entire Obamacare navigator program is based on the exact same approach Medicare has used since 1990 to assist, inform and enroll millions of American seniors. (The Bush administration spent millions on navigators as part of its launch of the Medicare Part D prescription drug program.) And as it turns out, the very groups Show Me State Republicans are trying to stop from helping residents get health insurance under the Affordable Care Act are the same ones receiving federal funding as Medicare navigators.

In August, the Department of Health and Human Services (HHS) announced $67 million in grants to Obamacare navigators nationwide. In Missouri, the two major recipients were Missouri Alliance of Area Agencies on Aging ($750,000) and Primaris Business Health Care Solutions ($1,045,624). These funds were then subcontracted to a host of regional groups and non-profits whose staff and volunteers provide outreach, customer service and enrollment assistance to Missourians seeking health insurance.

Both the Missouri Alliance of Area Agencies on Aging and Primaris are well known to Missouri residents and politicians alike. As the Primaris website explains:



For 30 years, Primaris has played an integral role in improving healthcare for Missouri's one million Medicare beneficiaries and beyond. Founded in 1983 by the Missouri State Medical Association and the Missouri Association of Osteopathic Physicians and Surgeons, Primaris' team of experts assists Missouri's healthcare providers with quality improvement, medical case review, electronic data reporting and health information technology. Located in Columbia, MO, Primaris is the official Medicare Quality Improvement Organization (QIO) for Missouri. Primaris has held this contract since its founding - the latest three-year contract was awarded to the firm in 2011... Primaris also provides insurance counseling services for Missourians on Medicare as well as for Missourians wishing to enroll in the Health Insurance Marketplace. Both programs help people understand their benefits and options so they can make informed decisions about their healthcare.

You read that right. The same organizations getting federal dollars to help roll-out the Affordable Care Act in Missouri are the same ones that have been getting millions for years from the