It's actually quite easy to explain. The reason why 19 states have refused to expand Medicaid has nothing to do with the cost -- the federal government would cover the full cost of the expansion for the next two years, then 95 percent of the cost thereafter. It definitely doesn't have anything to do with a lack of need for such a solution. This, as with the refusal to establish health care marketplaces (exchanges), has everything to do with Obama Derangement Syndrome -- Republican governors who refuse for a variety of cheap political excuses to attach their names to Obamacare. By doing so, they're hurting their own people, including Republican voters by numbers into the hundreds of thousands per state.

The Affordable Care Act originally mandated that all states expand Medicaid eligibility from 100 percent of the Federal Poverty Level (FPL) to 138 percent of FPL. In other words, the government had previously established an income threshold for what constituted poverty: below the line and you're considered poor and therefore eligible for certain safety-net benefits; above the line and you're more or less on your own. But Obamacare raised the poverty threshold to qualify for Medicaid coverage, thus expanding Medicaid nationwide -- until the Supreme Court ruled against that part of the law in 2012, allowing states to opt out of the expansion.

That's a massive problem.

4.8 million Americans have incomes higher than the 100 percent threshold, so they don't qualify for Medicaid without the expansion, but they don't earn enough to qualify for health insurance premium subsidies through the marketplaces. The ACA was written with a nationwide Medicaid expansion in mind so the law's premium subsidies only kick in where Medicaid coverage was supposed to leave off, after 138 percent of FPL. Hence the coverage gap.

In Kansas alone, home of climate and science denier Gov. Sam Brownback, there are 77,000 residents trapped in the coverage gap. 77,000 people who have no choice but to go without insurance and medical care, all because Brownback refuses to touch Obamacare with a 10-foot pole, either because of his raging ODS or because he and his fellow red state governors prefer to sabotage the law or both.

By the way, Medicaid expansion in Kansas is supported by 59 percent... of Republicans. Republicans! It's supported by 72 percent of all voters.

In Georgia, there are around 400,000 residents in the gap, and no sign that Gov. Nathan Deal will participate in the expansion in spite of the fact that 54 percent of Georgians support it. 400,000 is a lot of people, and they're being denied insurance in order for Deal to prove his quality to the extreme flank of his party.

In fact, Brownback and Deal are so maniacal about blocking the very popular expansion of Medicaid, they're each lining up to sign recently passed legislation that would block future Democratic governors from expanding Medicaid without the approval of the solidly GOP state legislatures in each state.

In other words, GOP lawmakers have taken steps to guarantee that many of their poorest residents will remain uninsured under the health care reform law, no matter what happens in the gubernatorial election. Georgia Gov. Nathan Deal (R) and Kansas Gov. Sam Brownback (R) both oppose Medicaid expansion. They both look likely -- if not quite certain -- to win re-election in November. That should make the bills passed by their respective state lawmakers unnecessary, but they seem intent on guarding against even the remote possibility of a Democratic governor.

Actually, the possibility of Democratic victories aren't as remote as Talking Points Memo reported. Polls in both races are neck-and-neck, with PPP showing a slight advantage for the Democratic challengers to Brownback and Deal, Paul Davis in Kansas and state senator Jason Carter (grandson of former President Carter) in Georgia. And there it is: a possible explanation for the laws.

This is how far they're reaching to stymie evil, evil Obamacare. Not only are they refusing to create state-run exchanges, oddly ceding state power to the federal government, but they're refusing to allow the expansion of Medicaid, even though they don't have to spend a penny to do it -- worse, they're passing laws that will prevent others from doing it, too. It's yet another way to sabotage the law in a long list of plots to undermine it.

So, what are the consequences?

On Wednesday, the Orlando Weekly published the explosive and infuriating story of Charlene Dill, a struggling, 32-year-old mother of three who collapsed and died on a stranger's floor late last month. According to Weekly reporter Billy Manes, Dill suffered from a treatable heart condition. She also fell into what policy experts call the Medicaid coverage gap--a hole the Supreme Court punctured in the health safety net when seven of its justices rendered the Affordable Care Act's Medicaid expansion entirely voluntary.

We have no choice but to call this what it is: death by Obama Derangement Syndrome.