There is no cogent economic, political, practical or moral justification for the state of Georgia to continue to reject expansion of Medicaid.

There are no more lame excuses, no more what-ifs or just-supposes. There is only cruel obstinance.

Forty states have implemented the program, bringing health-care to hundreds of thousands of their citizens and billions of federal dollars to their communities; only 10, including Georgia, continue to balk.

We’ve been told for a decade or more that Georgia couldn’t afford it, yet much poorer states such as Arkansas and West Virginia have managed to swing the expense, and our state’s coffers are now brimming with a $6 billion surplus. We can afford it.

Last year alone, we could afford to give tax subsidies to the film industry worth $1.3 billion, which according to a state audit generates less than 20 cents on the dollar in additional state revenue. We could afford to give Rivian $1.5 billion in state and local tax subsidies for its electric-vehicle plant. But we supposedly cannot afford $350 million to cover the state’s share of Medicaid expansion, even though it will bring back literally ten times that much in federal money and provide health insurance for almost half a million Georgians who today have no coverage.

That’s $3.6 billion in federal money left on the table by Georgia each and every year, money that among other things would help save struggling rural hospitals that are the economic and medical lifelines of their communities. Think of the lives that could have been saved and improved, the pain and illness eased over that time, but were not.

Over the years, we’ve also been warned that Obamacare would turn out to be a disaster, that it would be repealed and leave the state holding the bag. Well, that didn’t happen and isn’t going to happen. Some 40 million Americans now use Obamacare to provide health insurance, and for the most part they’re happy with it. In a poll last year for the Kaiser Family Foundation, 59% of American adults reported having a favorable opinion of Obamacare. These days, getting 59% of Americans to agree in support of anything is a minor miracle. And when Donald Trump recently issued a call for repeal of Obamacare should he win election, the response from his usually cult-like fellow Republicans was silence. They wanted no part of that argument.

In other words, like Medicare and Social Security, Obamacare is here to stay.

We also know that none of the 40 states that have expanded Medicaid has become the boiling cesspool of socialism predicted by Obamacare’s opponents. There are no “death panels,” no “death spiral” of costs, and most participating states have cut their uninsured population by at least half.

And what about Georgia and the other nine states that still refuse to participate?

Eight of those 10 states, including Georgia, have life expectancies below the national average.

Nine of the 10 have maternal mortality rates well above the national average, which is tragic because experts say 80% of such deaths are preventable. (Georgia has the nation’s seventh highest rate of maternal death.)

Nine of the 10 states that haven’t expanded Medicaid, including Georgia, have higher-than-average rates of premature death, meaning people who die before reaching age 75.

Most states that have rejected expansion, including Georgia, have higher-than-average rates of infant mortality. (According to the Centers for Disease Control and Prevention, Georgia was one of just five states in which infant mortality rose significantly from 2021 to 2022.)

Of the 10 states with the highest rates of uninsured, eight have rejected Medicaid expansion. (Georgia has the nation’s third-highest rate of uninsured.)

Confronted with such overwhelming evidence, Georgia Republicans offer no real explanation or justification for their stubborn refusal to help their own constituents.

They offer none because none exists. As in most other states that have refused expansion, they are captives to an archaic mindset that still sees working people not as human beings with human needs but as units of production that must be kept lean and uncertain to guarantee maximum economic efficiency.