While high-profile fights over the Affordable Care Act’s Medicaid expansion in states like Florida, Texas and most recently Michigan have gotten national attention, small disasters that loom large for the uninsured are brewing elsewhere.

Accidental Gov. Paul LePage of Maine proved low-interest midterm elections matter by successfully vetoing Medicaid expansion, as majority legislative support for the expansion fell short of the super-majority needed to override him.

In Indiana, Medicaid expansion (or something like it) will depend on whether the Obama administration accepts a waiver request from Republican Gov. Mike Spence that would move Medicaid beneficiaries into a state program that requires the use of the conservative pet rock of Medical Savings Accounts, in effect imposing high copays.

And in Mississippi, the refusal of Republican legislators to allow a vote on the Medicaid expansion has imperiled the existence of Medicaid itself, which will cease to exist on July 1 unless that fine progressive thinker Gov. Phil Bryant calls a special legislative session, and also abandons his dubiously legal claim that he can continue Medicaid by executive order.

With most state legislatures ending sessions this time of year, the longstanding hope of health care advocates that state-level Republicans would “see reason” on Medicaid expansion and/or would be pressured by hospitals and other health care providers to accept the astonishingly good fiscal terms of the expansion is beginning to look naive. Yes, it’s happened in some Republican-governed states. But when it’s all said and done, the human toll of the U.S. Supreme Court’s decision to make the expansion a state option is going to be depressingly high.

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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.