It is stunning—and revolting–the depths to which ultra-conservative Republicans will go to harm their fellow Americans.  Particularly fellow Americans of color.

Living in Massachusetts, a state with an especiallly progressive health care safety net (thanks in part to the efforts of then-Governor Mitt Romney, a then-moderate Republican), I hadn’t been paying that much attention to what was happening with health care reform out in the rest of the country.

This morning’s headliner in The New York Times—“Millions of Poor Are Left Uncovered by Health Law”—was a real wake-up call.

How could it be that “two-thirds of poor blacks and single mothers and more than half of low-wage workers without insurance” will be left stranded by Obamacare?

Simple.  The Supreme Court, although it upheld the health care exchange idea, also allowed states to choose to opt out of the expansion of federally funded Medicaid benefits.  Even though the federal government would cover the cost of the expansion through 2016, and at least 90% of Medicaid expenses thereafter, Republican-controlled state legislatures have balked at the prospect of picking up the tab for even 10% of an expanded Medicaid program that would provide health care for millions of people in their states.

It seems they’d rather let those people suffer and die.

According to The Times, “The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.”

What would happen if those working poor, the minimum wage earners who clean those Republican legislators’ houses, take care of their children, cook their meals, and tend to their aging parents in nursing homes—what would happen if they just up and left?

I have a vision of a vast migration of health care refugees, fleeing the red states just like they did after it became clear that the end of chattel slavery did not mean the end of bondage—it just morphed into debt bondage and serfdom.

If states can say “No thanks” to Federal Medicaid coverage, citizens should be able to say “No thanks” to states.  Let’s see how they like it down in Mississippi and Alabama when there’s no one left to flip their burgers and shine their shoes.