For some, of course, that remains an impossible contradiction. They don’t believe that a government-financed health insurance program can be reconciled with conservative ideology no matter what benefits it might bring.
It doesn’t matter to them that 31 other states, under both Republican and Democratic leadership, have accepted expansion. It doesn’t matter that under Gov. Mike Pence, Donald Trump’s running mate, Indiana has expanded Medicaid coverage and provided health insurance to an additional 345,000 people. It doesn’t matter that a relatively poor red state such as Arkansas has cut its uninsured rate from 22.5 percent, one of the highest in the nation, to less than 10 percent, one of the lowest. Nor does it matter that Arkansas, for example, reports $131 million in annual budget savings and additional revenue thanks to its Medicaid expansion, more than offsetting its additional cost.
So if the humanitarian impact doesn’t convince you, and if the economic and budget impacts don’t convince you, then congratulations, your ideological purity is impressive. But to those in need of medical help that they can’t afford, to those living in communities where the local hospital teeters on bankruptcy, to those who are dying years too early, your ideology is probably pretty poor comfort.