Why would any state make that choice? After all, the federal government will pay 90 percent of the cost, and experience shows that expanding Medicaid produces indirect cost savings — for example, by letting states reduce aid to hospitals for uncompensated costs.

Furthermore, the federal funds brought in by Medicaid expansion boost a state’s economy, which raises tax revenues. So expansion is, from a state fiscal point of view, neutral or even net positive. Why would any state turn it down?

Yet 14 Republican-controlled states, many among the nation’s poorest, are still refusing to expand Medicaid.

At the same time, a number of states are trying to limit access to Medicaid by imposing stringent work requirements. This may sound like a cost-saving measure, but it isn’t — trying to enforce work requirements, it turns out, costs a lot of money.

The point is that these state governments are only pretending to be penny pinchers. In reality, they’re actively trying to make peoples’ lives worse, and they’re willing to lose money to accomplish that goal. But why?

In 2018, The Atlantic published a memorable essay by Adam Serwer titled “The Cruelty Is the Point,” about the political importance of shared pleasure from other people’s suffering. Serwer was inspired to write that essay by photos of lynchings, which show groups of white men obviously enjoying the show. Indeed, in America, gratuitous cruelty has often been directed at people of color.

But as Serwer also noted, it’s not just about race. There are more people than we like to imagine who rejoice in the suffering of anyone they see as unlike themselves, especially anyone they perceive as weak.