Last winter, Virginias Republican legislative majority blocked Democratic Gov. Terry McAuliffes plan to extend Medicaid to 400,000 Virginians without medical insurance.

Afterwards, McAuliffe vowed to take executive action but discovered legal restrictions limited him to adding 25,000 people to the rolls, mostly those with mental illnesses, though he included funds to encourage 160,000 more to enroll in private insurance.

As a result, he was denounced for failing to live up to his vow by the same Virginia GOP whose legislators blocked Medicaid expansion in the first place.

To make sure he failed, the Legislatures Republican majority last week again blocked what The Washington Post termed McAuliffes top legislative priority.

Once again, Terry McAuliffe has far over-promised, and mightily under-delivered, said state GOP communications director Garren Shipley, echoing the way Republican officials regularly portray actions limiting the Affordable Care Act as defeats for Democrats like McAuliffe and President Barack Obama.

In truth, preventing Medicaid expansion or other aspects of Obamacare in Virginia and other states, including Texas, is less a defeat for its political champions than a defeat for millions of Americans. After all, their participation in the landmark universal health care program is at stake when states consider the expanded Medicaid program, at mostly federal cost, or courts decide if its legal for them to receive a federal subsidy.

As a result, 375,000 poor and often elderly Virginians will still be denied health insurance. Over the next 10 years, the Urban Institute and the Robert Wood Johnson Foundation estimated, the state will lose $1.5 billion in additional Medicaid funds and its hospitals will lose more than $6 billion in reimbursements.

That pattern has been repeated on an even larger scale in Texas. The Urban Institute-Johnson Foundation analysis estimated more than 1.5 million people would be denied Medicaid coverage because Gov. Rick Perry rejected federal funds to underwrite 90 percent of the cost. The state will lose a potential $65.6 billion in federal funding.

By 2016, the Urban Institute says, those Texas numbers would deny 176,000 cholesterol screens, 44,100 Mammograms, 75,200 Pap smears and 3.2 million additional physicians visits for Medicaid-eligible Texans.

That pattern has been repeated in other states where Republican governors or legislatures have sought to undermine or halt the Affordable Care Act, preventing more than 5 million Americans in 20 states from participating in Medicaid.

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Carl Leubsdorf: Health care battles continue to roil