I always try to remind myself not to criticize with stories like the one I’m about to describe, or perhaps better to say, not to forget the core reason for providing a comprehensive national plan to provide health insurance for everyone who needs it. But this story really puts that sentiment to the test, as well as exposing the perverse politics and perceptions on this issue in Republican-run states.

Luis Lang needs an expensive eye operation to save his eyesight. But he can’t afford it, can’t get covered for the procedure and he blames President Obama and his over-complicated ACA legislation.

As the Charlotte Observer explains, Lang is a self-employed handyman who works as a contractor with banks and the federal government to maintain foreclosed properties. He was making a decent living, enough to be the sole breadwinner in the family. As the Observer puts it, Lang “he has never bought insurance. Instead, he says, he prided himself on paying his own medical bills.”

All seemed good until this February when a series of headaches led him to the doctor. Tests revealed that Lang had suffered a series of mini-strokes tied to diabetes. (It’s not clear to me from the piece whether Lang knew he had diabetes earlier or whether that was the diabetes diagnosis as well.) He now also has a partially detached retina and eye bleeding tied to his diabetes. The initial medical care for the mini-strokes ran to almost $10,000 and burned through his savings. And now he can’t work because of his eye issue and can’t afford the surgery that would save his eyesight and also allowing him to continue working.

That’s where we pick up the narrative from the Observer …

That’s when he turned to the Affordable Care Act exchange. Lang learned two things: First, 2015 enrollment had closed earlier that month. And second, because his income has dried up, he earns too little to get a federal subsidy to buy a private policy.

Lang, a Republican, says he knew the act required him to get coverage but he chose not to do so. But he thought help would be available in an emergency. He and his wife blame President Obama and Congressional Democrats for passing a complex and flawed bill.

“(My husband) should be at the front of the line because he doesn’t work and because he has medical issues,” Mary Lang said last week. “We call it the Not Fair Health Care Act.”

Since Lang now has no income, he should be eligible for the ACA’s expanded Medicaid coverage, for which the federal government picks up tab. But Lang lives in Fort Mill, South Carolina. And South Carolina refused to accept Medicaid expansion. So he’s out of luck on that front too.

Just to recap: Lang broke the law by refusing to get health insurance coverage because he prided himself on being able to pay his bills out of pocket. But he got sick and actually had too little savings to cover even relatively small health care bills. By now open enrollment has closed. But he figured he’d be able to buy in if he got in a jam or wait till he got sick to buy coverage. Luckily the ACA’s Medicaid expansion covers him regardless. But the state of South Carolina refused to accept Medicaid expansion even though the federal government would pay for it. Lang is left in precisely the situation that would exist if the ACA had never been passed. So he blames Obama.

Now, however irresponsible Lang might have been in the past and whoever he blames, Lang is basically screwed. He’s trying to find some charity or government program he can shoehorn his care into. But so far he and his doctor – who’s already provided a lot of discounted care but can’t sign on for the whole thing – haven’t found anything.

Lang’s condition is declining rapidly. And if he goes blind, the costs for supporting his condition and him and his wife will only go up from there.