Saying “it is unconscionable” that 400,000 low-income Virginians who could be getting free Medicaid coverage are going without it, Governor Terry McAuliffe today told the state that he is going to find some way to get them covered, even if Republicans who control the legislature don’t want to accept the Affordable Care Act’s Medicaid expansion.

“I am moving forward to get health care for our Virginia citizens,” he said, though he did not say exactly how he would do it, other than having his Secretary of Health and Human Services come up with a plan by September 1st. This has been the cause of an intense political struggle in Virginia for months, with McAuliffe pushing to accept the Medicaid expansion, which was one of the central platforms of his campaign last November.

In today’s Post, there’s a terrific article by Jenna Portnoy that makes clear just how diabolical Republicans are being here. It’s a story about politics, about human suffering, and about the power of propaganda to convince people whom you’re screwing over that you’re actually doing them a favor.

Two weeks ago, Democratic state senator Phillip Puckett resigned his seat, giving control of the state senate to Republicans. They may have promised Puckett a job and his daughter a judicial appointment if he resigned; the matter is currently the subject of a federal investigation. So Portnoy went to Puckett’s district in southwest Virginia to see what his constituents thought about the controversy. What she found was a lot of extremely poor people who would get free health insurance if Medicaid were expanded, but wanted nothing to do with it. Her story begins with a woman whose father was a coal miner:

In old age, he suffered from black lung disease and wore an oxygen supply constantly. But unlike his daughter, he never worried about how he would pay his medical bills. The union took care of it.
That doesn’t make Carolyn Underwood, 63, a supporter of expanded government health coverage, even though she would benefit from it. In a region where the decline of the coal industry has sent poverty and health-care needs soaring, another force has grown at least by equal measures: antipathy to President Obama and the Affordable Care Act (ACA).
“I am scared of Obamacare,” Underwood said. “We’ve been hearing too many tales about it. We heard there’s doctors who get to decide . . . ” Before she could put her finger on the term “death panels,” her sister Nancy Taylor, 62, made a gun gesture with her hand and said, “Pow!”

I genuinely wonder what conservatives think when they hear stories like that, and like those of the other people with similar circumstances and similar sentiments Portnoy meets. Maybe they think, “Something should really be done to allow the magic of the free market to help those people.” Or maybe they think, “Heh — suckers.”

Remember that what we’re talking about here is health coverage paid for almost entirely by the federal government, with a maximum of 10 percent paid by the state in coming years. Every analysis that has been done shows that accepting the expansion will produce all kinds of benefits that come from having a healthier and more economically secure population, and it will save the state money.

It’s also important to understand how stingy Medicaid in Virginia already is. First, you can’t get covered if you have no children under 18, no matter how poor you are. Now let’s say you’re a parent, in a family of four. Your children will be eligible for Medicaid/CHIP if the family’s total income is under $34,104. That may not be great, but it could be a lot worse. But it’s a different story for the parents: they’ll be ineligible for coverage if the family’s total income exceeds $11,688 a year. Ask yourself: if you and your spouse were together making twelve grand a year, do you think you could afford health coverage?

Of course not. But Republicans would literally rather see poor people have no health insurance than allow them to get insurance from the government. And they’ve pulled off a neat trick: screw people over, and convince them that you’re doing them a favor. It’s positively villainous.

There’s no telling yet what sort of program McAuliffe could come up with that would allow Virginia to accept the federal money without the permission of a GOP majority in the legislature that is dead-set against it. It will probably take some creativity. But that’s what government is supposed to do: find ways to help citizens who need help. There’s a moral imperative that has to be served.