At Wonkblog today, Ezra Klein cites a Rand Corporation study analyzing 14 states that have firmly rejected the Affordable Care Act’s Medicaid expansion option, and toting up the damage:

[T]hey get $8.4 billion less in federal funding, have to spend an extra $1 billion in uncompensated care, and end up with about 3.6 million fewer insured residents.
So then, the math works out like this: States rejecting the expansion will spend much more, get much, much less, and leave millions of their residents uninsured. That’s a lot of self-inflicted pain to make a political point.

Sure is. But how about those 3.6 million people who fall into the “wingnut hole?” (my suggested term for the coverage gap afflicting those living below the federal poverty level who are denied Medicaid in the rejectionist states but also don’t qualify for purchasing subsidies). Could there possibly be some blowback for the politicians denying them access to affordable health care even as people higher on the income ladder get subsidies? Ezra considers that possibility:

Obamacare creates an extraordinarily unusual situation. The Affordable Care Act will implemented in states that reject Medicaid. There will be huge mobilization efforts in those states, too, as well as lots of press coverage of the new law. The campaign to tell people making between 133 and 400 percent of poverty that they can get some help buying insurance will catch quite a few people making less than that in its net. And then those people will be told that they would get health insurance entirely for free but for an act of their governor and/or state legislature.

And all that growing awareness of being betrayed by one’s own elected officials for no apparent reason other than hatred of the president will be sinking in just as the 2014 elections are held.

No wonder Republicans remain determined to build potholes in the road to the ballot box. There could be some unusually motivated low-income voters heading to the polls seventeen months from now who normally would never vote in a midterm election. It’s worth watching.

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Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.