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The push to shutter the government instead of implementing Obamacare is a macrocosm of a fight Republicans have already won: condemning millions of extremely poor residents of their states to the uncertainty that comes from no health care coverage.

A stunning report from The New York Times indicates that, even after the Affordable Care Act goes into full effect on January 1, millions of Americans will still lack health coverage because they are too poor to qualify for subsidized plans and live in states that refuse to expand Medicaid coverage. It's another dimension to the political struggle over Obamacare that's crippled the government — but one with an immediately harmful effect on actual Americans.

The roll-out of President Obama's health care program was meant to accomplish several things. Those with existing employer coverage wouldn't be affected. Those without employer coverage could sign up for an insurance plan under one of the state-based insurance exchanges that pooled various options, and at certain income levels, those plans would be subsidized. For those whose incomes were below a certain level, the federal Medicaid program would be expanded to cover them. Each of these plans has seen hiccups, of course. A few employers have rolled back coverage for their employees, offering ammunition to the president's opponents. The website offering enrollment in the exchanges has been hammered with traffic.