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Leaving the uninsured behind

Associated Press

In early August, reflecting on Republican tactics, President Obama told reporters, "Their number one priority, the one unifying principle in the Republican Party at this moment, is making sure that 30 million people don't have health care." It was an argument that had the benefit of being true.

But Karl Rove's attack operation, American Crossroads, pushed a different message. Shortly after the White House press conference, Crossroads sent a message to reporters, claiming, "CBO states that under Obamacare, we'll still have 30 million uninsured in 10 years." The Republican group added that the White House's policy "isn't even solving the problem of uninsured."

It was one of those arguments predicated on the assumption that political reporters are fools. What Crossroads failed to mention is that the CBO report said we'll still have tens of millions of uninsured in 10 years, even after "Obamacare" is fully implemented, because several Republican governors refuse to expand Medicaid. (The Republican operatives at American Crossroads, in other words, were indirectly attacking Republicans for denying Americans health care benefits.)

Whether Rove's attack operation understands this or not, the policy is a tragedy -- which the White House is powerless to fix.

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.

The Affordable Care Act originally made Medicaid expansion mandatory for states, guaranteeing coverage for millions, but a narrow Supreme Court majority ruled that it must be optional -- if states want to take advantage of an amazing deal they could, but if they choose to turn down the federal money, Washington can't force them to accept it.

In fairness, it's not completely a partisan issue, and several Republican governors have both a moral compass and a healthy enough understanding of arithmetic that they welcomed Medicaid expansion in their states.

But with most of the South rejecting the policy -- most notably Texas, the state with the highest percentage of uninsured Americans in the nation -- the result is millions of struggling families who'll go without access to basic, affordable care, which they would otherwise get if they didn't live in a "red" state.