“Right now, 37 percent of the revenue from the Affordable Care Act goes to Americans in four states,” Louisiana Republican Senator Bill Cassidy, coauthor of the Republicans' last-gasp effort to repeal the Affordable Care Act, said on Monday. Cassidy’s culprits—the four states at the center of this cosmic injustice—are California, New York, Massachusetts, and Maryland.

“That is frankly not fair,” Cassidy complained.

Well—whose fault is that? California, New York, Massachusetts, and Maryland are among the 31 states (32, if we count the District of Columbia) that agreed to accept federal funds made available by the ACA’s expansion of Medicaid; California and New York are by far the most populous of those 31 states, with nearly 60 million residents combined. Nineteen states, however, chose not to accept the federal funds that would expand their Medicaid rolls. In each of the 19, the decision not to accept the funds was made by the state’s Republican governor. This Republican impulse to discipline the poor, lest they loll around in the comfort of hospital emergency wards, is also reflected in the lower levels of Medicaid benefits that Republican-controlled states generally set.

Cassidy's chutzpah isn't confined to hailing as victims the actual perpetrators of the imbalance he describes. His bill to repeal the ACA contains provisions similar to ones in the previous Republican ACA repeal efforts, which the Congressional Budget Office concluded would deny Medicaid benefits to 15 million recipients. His plan is not to erase the gap between blue states and red by expanding Medicaid to eligible recipients in all states, but by throwing millions off the rolls and reducing expenditures to the levels in the neo-Confederacy (nine of the eleven Southern states that formed the Confederacy are among the 19 that refused to accept the Medicaid expansion funds), where the impulse to discipline the poor is made steelier yet by the impulse to discipline blacks and other people of color.

Cassidy's vision of fairness, finally, is to have no Medicaid at all. That way, the sick and the poor in blue states won't be able to lord it over the sick and the poor in the red ones. What could be fairer than that?