It’s looking less and less like Virginia will expand Medicaid any time soon. A long-standing political stalemate over the expansion was broken earlier this month when a Democratic state senator abruptly resigned his seat, throwing control of the chamber to the Republicans, who now control the entire Legislature. The Republicans passed a budget that does not expand Medicaid, and McAuliffe, his political options limited, said on Friday that he’d explore other avenues for expanding coverage in the state.

McAuliffe indicated previously that bypassing the Legislature and expanding Medicaid through executive authority was an avenue he was considering, but the legality of such a move is questionable, and would likely touch off a constitutional crisis. Whatever route he takes, he’s sure to meet as much Republican opposition as can be mustered (they’re already moving to challenge his line-item veto of the budget amendment that would prohibit him from expanding Medicaid).

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That’s bad news for Virginia’s 400,000 or so residents who would be eligible for coverage under the expansion. And it’s an obvious setback for McAuliffe, who campaigned and won on expanding Medicaid. The Democratic senator who stepped down, Philip Puckett, is now under investigation by federal authorities after allegations surfaced that he resigned in exchange for job offers for himself and his daughter. The only winners in this sordid, corrupt, anti-democratic mess are the Republicans, whose morally dubious obstructionism successfully denied their state federal money to give people health coverage.

The whole Virginia affair is instructive in that it lays bare the degree to which Affordable Care Act opponents have successfully capitalized on fear and misinformation to fuel opposition to the law.

Washington Post reporter Jenna Portnoy went down to Puckett’s Senate district in southwest Virginia and found a family that could really benefit from the Medicaid expansion, but they oppose it because they are afraid that if they enroll for coverage under the Affordable Care Act, then the government will literally murder them:

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“I am scared of Obamacare,” Underwood said. “We’ve been hearing too many tales about it. We heard there’s doctors who get to decide . . . ” Before she could put her finger on the term “death panels,” her sister Nancy Taylor, 62, made a gun gesture with her hand and said, “Pow!”

“Death panel,” of course, was the charmingly insane term coined by Sarah Palin to describe what she imagined would be Obamacare’s process for selecting elderly and disabled Americans for passive euthanasia by denying them coverage. It was, and remains, a malicious untruth.

But the problem with “death panels” is not just that it was wildly untrue and needlessly provocative – the problem is that Affordable Care Act opponents seized on it as an effective P.R. weapon against the law. Its promoters included media personalities like Glenn Beck and Rush Limbaugh, as well as some of Congress’ more eccentric conservative thinkers, like Rep. Paul Broun (“This panel is not going to put them to death, but it's going to deny treatment”) and Rep. Steve King (“It funds abortion and it has death panels and it regulates everything that has to do with our health care”).

And as a P.R. weapon it was really effective. Political scientists Brendan Nyhan put together a study tracking the spread of healthcare misinformation, and he found that within weeks of Palin inventing the term, it had permeated the American consciousness:

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By mid-August, Pew reported that 86% of Americans reported having heard of the claim that the health care reform legislation “includes the creation of so called ‘death panels’ or government organizations that will make decisions about who will and will not receive health services when they are critically ill” (Pew Research Center for the People and the Press 2009). Among those who had heard of the claim, fully half either believed it was true (30%) or did not know (20%), including 70% of Republicans (47% true, 23% don’t know).

As the reporting from southwest Virginia makes clear, it’s still having an impact. People are scared of the Affordable Care Act because someone with authority whom they trust – a radio host, their congressman – told them it was a threat to their well-being. And as a consequence, they’re denying themselves access to healthcare. Paul Waldman summed it up perfectly: “They’ve pulled off a neat trick: screw people over, and convince them that you’re doing them a favor. It’s positively villainous.”

And it’s not just death panels: there’s a whole menagerie of bullshit aimed at stoking irrational fears about a law that expands access to healthcare: it will give the IRS access to your “personal intimate” secrets (said Rep. Michele Bachmann); it will force you to divulge details about your sex life (said Betsy McCaughey); government agents will invade your home (said derpy conservative bloggers).

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The willingness to concoct, promulgate and defend lies like these is amoral enough. That they’re intended to restrict healthcare access to people who really need it is just monstrous. And you get very little sense that conservatives care or even recognize this for the problem that it is.