Remember the Simon and Garfunkel oldie, “The Sound of Silence”? Very existential, as I remember. Here in Missouri the sound of silence isn’t, however, a symptom of urban twenty-something angst. It’s simply what we’re hearing as the October 1 deadline for implementing the Affordable Health Care Act (a.k.a. Obamacare) health care exchange nears.

Actually, included in this sound of silence is the sound of the proverbial Zen one hand clapping. That single hand would be the non-profits that are stepping up to help get the word out about the Obamacare health care exchange that is due to open on October 1, going it alone while state and local governments are M.I.A. The Missouri Hospital Association has set up a great Website with information about the exchanges: http: //www.enrollmissouri.org/. Other private groups have also stepped up. Missouri Health Care for All has been working to help educate people in the state about the provisions of the law, and the Missouri Foundation for Health will dedicate $8 million dollars to assist uninsured Missourians. These agencies are on the side of the angels, but the fact remains that, as the New York Times observes about Missouri that “looking for the new health insurance marketplace, set to open in this state in two months, is like searching for a unicorn.”

If Obamacare is going to work, the exchanges are vital. They’ll provide online shopping for offerings from participating insurers, and, if properly implemented, they’ll offer a good deal for everybody who isn’t already insured through their employer, Medicare or Medicaid. Subsidies will be available for those who meet the income requirements. Many of the 850,000 uninsured Missourians will qualify for coverage through the state’s exchange, but it might not happen if Missourians don’t get reliable information about what is on offer and what they need to do to get it.

Since the exchanges are so important, everybody must want them to be implemented in the best way possible, right? Wrong. Let me count for you the ways our state Republican pols are trying to sabotage the Obamacare health care exchange in Missouri:

1.Refusing to create a state exchange and hindering formation of the federal exchange for Missouri: The legislature passed a law forbidding the state to build it’s own exchange, leaving the job to the federal government. The law, however, goes an extra step, revealing the extent of GOP anti-Obamacare spite. It stipulates that “state and local officials cannot provide ‘assistance or resources of any kind’ to a federal exchange.” A final measure of GOP virulence is the provision that would make any government officials liable to wingnut lawsuits should they attempt to cooperate with the exchanges.

2. Refusing federal funds to extend Medicaid coverage in Missouri: Not only will this mean-minded action deny health care coverage to many poor Missourians, it will affect perceptions of the exchanges among members of a population that has already been lied to again and again about what the law will do. While the exchanges will offer subsidies based on income to insure that eligible individuals can afford coverage, it will not subsidize coverage for those below a certain income point since the intent of the law was to provide health care to those individuals through the Medicaid expansion that the GOP jackasses in Jefferson City have so far squelched.

3. Controlling and limiting information about the Missouri exchange: GOP lawmakers have learned a thing or two from their “War on Women” strategy of regulating reproductive choice almost out of existence, and seem to be using the same regulatory approach to sabotage the Obamacare exchange. Otherwise religiously anti-regulation GOPers have decided that they must rigorously regulate individuals, known as navigators, hired to help Missourians use the exchanges lest they engage in “fraud.” And if they manage in the process to slow the information stream to a trickle, well, what can you do? Requiring unnecessary “on-going” training – all navigators are already required to take extensive federally provided training and pass a test – charging wannabe navigators a fee, and requiring a bond ought to do the trick nicely. Add into the mix a prohibition on actually helping citizens decide which choice works best for their needs and you’ve got a real killer. An added bonus – there’s currently no regulatory framework to define the extra training content, administer it, or handle the licensing process, and, if I were you, I wouldn’t hold my breath expecting it to be in place really soon – certainly not before the October 1 deadline for the exchanges.

What all this obstruction aims to do is retain the unacceptable status quo where far too many Missourians lack access to good health care. No matter how loud folks scream about extreme rhetoric, no or poor health care can be a death sentence. And, no, emergency rooms don’t cut it. Think about dealing with cancer through emergency room services, early detection is unlikely in that scenario and coordinating the often messy and complicated cancer treatment regimes in such ad hoc settings is almost unthinkable.

Why are Republicans trying their best to do the worst thing for their constituents? A partial answer lies in the traditional deference they show corporate allies – the law to “regulate” exchange navigators was based on model legislation drafted and distributed to several states by the National Conference of Insurance Legislators, which opposes federal involvement in the insurance industry. Insurance agents and brokers are “worried about losing market share” so compliant GOPers have come to their aid.

A more potent reason, though, may be the cruel, brain-dead, conservative ideology that animates today’s radicalized Republican party. For example:

State Senator Rob Schaaf, the Republican author of a 2012 ballot measure that prevented the state from setting up its own insurance exchange, said: “We can’t afford everything we do now, let alone provide free medical care to able-bodied adults. I have a philosophical problem with doing that, and I’m also worried about our country’s financial situation.

This is wrong on so many levels that it makes one’s head hurt to contemplate the many layers of stupidity. First, to restate the obvious, our country’s financial situation is far from dire, and its structural problems will not be improved by killing Obamacare – actually the opposite is probably true as long as the implementation goes well. As Jonathan Cohn observes:

Obamacare can help a great many people, while improving the short- and long-term budget oulook. But its success will depend, at least partly, on the willingness of states to go along. And although they should, if only for pure self-interest, that doesn’t mean that they will.

The more important point, though, has to do with Mr. Schaaf’s philosophical inclinations which reflect those of many in his party. Right now we’re all subsidizing, through our health care premiums, very expensive, but very bad care for low-income adults. I have a serious philosophical problem with that. I have an even greater philosophical problem with doing nothing at all and letting poor folks die while those who got rich off of government subsidized corporate welfare live high on the hog and enjoy the best health care on offer. Americans are better than that – or at least we should be.