After the US Supreme Court ruled that the federal government could not penalize states for choosing to opt out of the Medicaid expansion provisions of the Affordable Care Act, several Republican governors announced that they would do exactly that. It's an act of defiance that, according to a new study published in the New England Journal of Medicine, will end up killing thousands of their citizens:

State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health. ... Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties.

Oh. Well. As long as they're just killing poorer nonwhites, I guess that's okay.

The researchers compared mortality rates for 20 to 64 year olds in three states that substantially expanded Medicaid since 2000 to rates from neighboring states that did not. Researchers found that Medicaid expansion reduced the death rate by 19.1 per 100,000, or 6.1 percent. Rates of access to care, delayed care, uninsurance, and self-reported health status all significantly improved with Medicaid expansion.

While not announcing plans to opt out of Medicaid expansion if elected governor, attorney general Rob McKenna expressed pride in his role in the health care law suit, while stating concerns about the cost of Medicaid expansion in Washington state. He even claimed a victory of sorts following the court's ruling, kvelling "we achieved our goal of defeating the mandate on commerce clause grounds," as if what was truly at stake was some vague constitutional tangent rather than the lives of millions of un- and underinsured Americans.

Compassionate conservatism, and all that.