After a great deal of commentary on the presidential election, Paul Krugman takes it local in Monday's column; specifically, to Texas where a deeply upsetting trend is taking hold. The mortality rate for pregnant women in the Lone Star state has doubled in recent years, and is now comparable to places like Russian and the Ukraine, Krugman points out. By way of recent history, the upward trend in deaths happens to coincide with the state's decision to defund Planned Parenthood, and many if its clinics have been forced to close.

"All of this should be seen against the general background of Texas policy, which is extremely hostile toward anything that helps low-income residents," Krugman writes.

It's not just a potential sociopath in the White House; local politicians can also ruin an awful lot of people's lives. Krugman digs into the healthcare question:

This is especially true when it comes to health care. Even before the Affordable Care Act went into effect, there was wide variation in state policies, especially toward the poor and near-poor. Medicaid has always been a joint federal-state program, in which states have considerable leeway about whom to cover. States with consistently conservative governments generally offered benefits to as few people as the law allowed, sometimes only to adults with children in truly dire poverty. States with more liberal governments extended benefits much more widely. These policy differences were one main reason for a huge divergence in the percentage of the population without insurance, with Texas consistently coming in first in that dismal ranking. And the gaps have only grown wider since Obamacare went into effect, for two reasons. First, the Supreme Court made the federally-funded expansion of Medicaid, a crucial part of the reform, optional at the state level. This should be a no-brainer: If Washington is willing to provide health insurance to many of your state’s residents — and in so doing pump dollars into your state’s economy — why wouldn’t you say yes? But 19 states, Texas among them, are still refusing free money, denying health care to millions. Beyond this is the question of whether states are trying to make health reform succeed. California — where Democrats are firmly in control, thanks to the GOP’s alienation of minority voters — shows how it’s supposed to work: The state established its own health exchange, carefully promoting and regulating competition, and engaged in outreach to inform the public and encourage enrollment. The result has been dramatic success in holding down costs and reducing the number of uninsured.

No such luck if you happen to live in one of the red states, which have have refused to help their poor and uninsured even when the federal govenment is paying. What accounts for this cruelty? There's always that claim that free market economics is the only thing that helps create jobs, and Krugman does have to concede that Texas has been a leader in job growth. But are policies the reason, or energy and cheap housing, Krugman wonders.

The great red state of Kansas is having no such luck, whereas California is having an employment boom under left-leaning Jerry Brown. Long story short, there's no economic justification for being cruel to the less fortunate.

"A large part of the answer, surely, is the usual one: It’s about race," Krugman regrets to inform. "Medicaid expansion disproportionately benefits nonwhite Americans; so does spending on public health more generally. And opposition to these programs is concentrated in states where voters in local elections don’t like the idea of helping neighbors who don’t look like them."

Mix in a little misogyny, and you've got Planned Parenthood clinics closing down and pregnant women dying.

Krugman's larger point. Don't stop voting when all the presidential shouting is done, lest the cruelty continue to be carried out in your name.