The Health Gap Between Conservative & Liberal America Is Written in the Mortality Data: CHART OF THE DAY
Medicaid expansion is the easiest albeit very, very partial fix on offer. And it is something that the people whom red states elect to rule them could implement immediately and very, very cheaply if America’s Republican politicians did not hate the people who vote for them so much…
This is just gonzo, on so many levels:
Perhaps an eighth of this gap is due to the lack of Medicaid expansion in the bottom-right corner of the graph. But that is an eighth of the gap. The Affordable Care Act plus a bare minimum of gubernatorial courage have already shown how many lives Medicaid can save.
The murderous consequences of a lawless judgment by corrupt Supreme Court Chief Justice John Roberts, the brave and tremendous public service for the country done by a handful of Red-State Democratic governors, and a simple policy choice that the vicious Red‑State Republican élites still refuse to make. When expanding health coverage is this much of a proven life‑extender, continued opposition to a Medicaid expansion which does not burden a state’s government budget stops being “philosophy” and starts looking like malpractice.
À propos of this, we have wise words from Matthew Yglesias. Progress—not a solution, not more than minor and incremental progress, but progess—can be made with respect to this awful problem of disgracefully poor health outcomes in Red America with this very easy, step:
Matthew Yglesias: Hard Work Is Good <https://www.slowboring.com/p/hard-work-is-good>: ‘Biden-era Democrats… were obsessed with trying to find solutions…. But the Obama administration already solved this problem with the text of the Affordable Care Act, and then the Supreme Court threw it out. Then Andy Beshear and John Bel Edwards and Laura Kelly solved the issue again. And nothing is stopping Republican governors in Florida and Alabama from solving it. They just don’t want to. The next [Democratic] administration’s message should be that:
there are a lot of problems…
one [huge] such problem is… [massively] subpar… health outcomes… in conservative states (accurate!)
and one easy… [fix] would be for Red America politicians to hate poor people less and expand Medicaid.
That’s it. No policy. Just tweets and press conferences and encouraging people to write articles…
If we could get Medicaid expansion in the deep red states, it would be likely to buy us something on the order of a few extra months (six[?]) of life expectancy for the average resident, and of course, a couple of years for the low-income adults who actually get better coverage.
Cf.:
Elder, Elizabeth & Neil A. O’Brian. 2026. “The political polarization of health outcomes in the USA.” Nature Human Behaviour. May 14. <https://www.nature.com/articles/s41562-026-02474-9>.
And, of course, there is lots lots more evidence on this by now.
If you start from today’s disgracefully poor health outcomes in much of Red America, you do not need a sophisticated twelve‑point policy plan to make at least some progress. The lowest of the lowest-hanging fruit is this: You need governors and legislators willing to do one boring thing: expand Medicaid. Continued resistance to Medicaid expansion by Red-State Republican political élites should be understood what it is: a conscious choice to let people who voted for you die, out of loathing for them.
References:
Broaddus, Matt & Aviva Aron-Dine. 2019. “Medicaid Expansion Has Saved at Least 19,000 Lives, New Research Finds”. CBPP. November 6. <https://www.cbpp.org/research/health/medicaid-expansion-has-saved-at-least-19000-lives-new-research-finds>.
Elder, Elizabeth & Neil A. O’Brian. 2026. “The Political Polarization of Health Outcomes in the USA.” Nature Human Behaviour. May 14. <https://www.nature.com/articles/s41562-026-02474-9>.
Feldscher, Karen. 2025. “Health Insurance Saves Lives, Studies Suggest”. Harvard T.H. Chan. November 12. <https://hsph.harvard.edu/news/health-insurance-saves-lives-studies-suggest/>.
Wyse, Angela & Bruce D. Meyer. 2025. “Saved by Medicaid: New Evidence on Health Insurance and Mortality from the Universe of Low-Income Adults”. May. <https://www.angelawyse.com/>.
Yglesias, Matthew. 2026. “Hard Work Is Good”. Slow Boring. June 12. <https://www.slowboring.com/p/hard-work-is-good>.