At the time, Edwards noted that Louisiana “consistently ranked one of the poorest and unhealthiest states” and that improving Medicaid access would break the cycle of the state’s residents having to choose “between their health and their financial security.” Indeed, Louisiana is fourth from the bottom, among states, in life expectancy.

Last January, Louisiana voters elected John Bel Edwards governor (the only Democrat governor in the Deep South). On just his second day in office he signed an executive order that made Louisiana the 31st state to expand Medicaid, which is a crucial part of Obamacare. Edwards’s predecessor, Bobby Jindal, rejected the measure on the grounds – and I’m not making this up – that expanding access would “jeopardize the care of the most vulnerable in our society.”


Seven months later, the impact of Edwards’s executive order is being felt across the state. Though applications for the new Medicaid benefit did not begin until June, already 265,723 Louisianians have signed up.

The law is having a transformative effect, according to a recent article in the Los Angeles Times. “Patients burst into tears at this city’s glistening new charity hospital when they learned they could get Medicaid health insurance,” Noam Levey reported. One doctor said telling patients that they were eligible for health care coverage – something most of us take for granted — was like telling them, “I cured cancer.”

Residents who had held off getting prescriptions filled or postponed screenings or seeing a doctor are now able to do so with Medicaid coverage.

The same thing is being seen elsewhere. As Levey points out, since Pennsylvania passed its Medicaid expansion, nearly 10 percent of the more than 650,000 who enrolled in the program began drug and alcohol abuse treatment – that’s approximately 65,000 people with an opportunity they didn’t have before to end their addictions.


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According to one study that looked at the effect of the expansion in Arkansas and Kentucky (and non-expansion in Texas), “poor adults” had more access to care and “skipping medications because of cost and trouble paying medical bills declined significantly.” Moreover, the “share of individuals with chronic conditions who obtained regular care increased” and the percentage of residents who were able to simply have a medical checkup jumped by 7 points. In Texas, where expansion has not taken place, there’s been little success in reducing uninsured rates or improving health care outcomes.

This is a great public policy story — one that shows how a targeted effort using government resources for the most vulnerable can produce positive, even life-changing results. But the political part of the story is less great in the 19 states that have continued to reject calls for expansion.

Not coincidentally, all 19 have either a Republican governor or a Republican state legislature. While many of these states have argued that the costs will be prohibitive, it’s long past time to discard this dishonest talking point.

As part of the newly expanded Medicaid program, the federal government has agreed to initially pick up the tab and then pay for 90 percent of coverage beginning in 2020. Republicans argue that the federal government will at some indeterminate point in the future stop footing the bill, even though there is no reason — and no evidence — to believe this will occur.


In Virginia, the GOP-controlled legislature has long resisted a push from the state’s governor, Terry McAuliffe, to expand Medicaid for more than 400,000 Virginians, with bogus claims that it would cost the state $1 billion. The actual cost as estimated by the fact-checking site, PolitiFact, is around $3 million.

“Concern trolling” about the costs of Medicaid expansion masks the real reason for continued GOP opposition — a refusal to support anything that has the name Obama on it. Expanding Medicaid would mean that Republicans implicitly acknowledge that Obamacare has some positive elements to it — and risk the political fallout from Republican voters. For the modern GOP, that’s a bridge too far. But the impact of GOP recalcitrance is significant.

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According to the Kaiser Family Foundation, approximately 3 million more Americans would receive access to care if Medicaid expansion occurred in every state.

That’s 3 million Americans who can’t see a doctor or a dentist, can’t fill prescriptions, and can’t get the drug or alcohol treatment that could turn their lives around. They are put in the impossible position of having to choose between their health — and the health of their family — and putting food on the table. Ultimately, Obamacare at its core is about not forcing ordinary Americans to have to make these choices. It was intended to reduce the very real anxiety that comes with not having access to health care. As Edwards said in January about the impact of broadening access to care for his state’s residents, “This will not only afford them peace of mind, but also to help prevent them from slipping further into poverty and give them a fighting chance for a better life.”


But in the 19 GOP-controlled states that continue to refuse Medicaid expansion, a different choice is being made: to put political preservation and hatred of President Obama above the needs of their citizens. Not surprisingly, these states are among the unhealthiest in the nation, with some of the highest rates of illnesses and deaths from diseases that are often easily preventable.

There might not be a bigger and more shameful political story in America today than this one. And there also might not be a better example of the fundamental divide that separates America’s two political parties.

That’s something worth keeping in mind when you cast your vote next November.

Related:

• Renée Loth: Prepare for voter whiplash

• Pay me to vote

• How American voters fell out of love with their own parties

• Q&A: Vote all you want. The secret government won’t change.

Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.