A new paper from the National Bureau of Economic Research examines the affects of Medicaid expansion, or more to the point, the probable outcome of states refusing to take that expansion. That political, anti-Obama, anti-Obamacare posture had a big cost, the authors Sarah Miller, Sean Altekruse, Norman Johnson, and Laura R. Wherry claim.

"Our estimates suggest that approximately 15,600 deaths would have been averted had the ACA expansions been adopted nationwide as originally intended by the ACA," they write. "This highlights an ongoing cost to non-adoption that should be relevant to both state policymakers and their constituents." It should, but many of those 14 states that still have refused expansion are also suing in federal court right now to have the entire law struck down, including Medicaid expansion.

The authors used data from the American Community Survey (ACS) from the years 2008 to 2013, a national survey which "contains approximately 4 million respondents in each year and allows us to observe information on specific characteristics that determine Medicaid eligibility including income, citizenship status, and the receipt of other social assistance." Using that data to identify the population that would likely be eligible for Medicaid, they focused on the 55-64 age group, because they are at greater risk of mortality. They could follow individuals in the sample and using a Census data set that contains records on the death date for everyone with a Social Security number, determine mortality rates in that group through 2017. Comparing the expansion states to the non-expansion states allowed them to arrive at their death toll.

Of course access to health care is going to prevent people from dying prematurely, not to mention improve quality of life. That's such an obvious observation that it remains hard to imagine anyone choosing to go into public service deciding that that's a bad or even an unnecessary thing. That includes Supreme Court Chief Justice John Roberts, who became single-handedly responsible for allowing the worst of Republican state lawmakers to deny this care when he made the political decision to make expansion optional.