Voters in three conservative Western states overruled their elected officials in the midterm elections and expanded Medicaid to hundreds of thousands of low-income people via ballot initiatives.

“The GOP has been bashing the [Affordable Care Act] for nearly a decade, and voters in the reddest states in the country just rejected that message,” Jonathan Schleifer, executive director of The Fairness Project, told ABC News. “It’s a repudiation and a tectonic shift in health care in this country.”

It’s a fair assessment of what happened, but Schleifer got one key point wrong. Nebraska, Utah and Idaho are all quite red, but they’re not “the reddest.” That would be Wyoming, where our entire congressional delegation, all five statewide elected officials and dominance of the state Legislature are all safely Republican. And Wyoming still stubbornly refuses to accept, despite mountains of evidence to the contrary, that Medicaid expansion would bring positive health care and fiscal results.

Not one of the horrors Wyoming’s lawmakers argue would befall the state by expanding Medicaid has happened anywhere else. Meanwhile, a litany of opportunities that would benefit the state have been missed. It’s been a lesson in abject stupidity by our legislative leaders, and only voters can change the situation.

But voters themselves must shoulder much of the blame. After 2013-14, the first years the Legislature considered Medicaid expansion, voters put the lawmakers who led the fight against Medicaid expansion back in power.

Republican Gov. Matt Mead, who initially opposed expanding the program, changed his mind and begged the Legislature to pass it. But lawmakers in his own party thumbed their nose at the chief executive for three more sessions. Now no one except the few Democratic legislators will even mention the issue.

Wyoming will have a new governor in January, but Mark Gordon is just as vocally against expansion as Mead once was. “I just don’t think it’s necessarily the right solution for Wyoming at this time,” Gordon, the current state treasurer, said at a post-election conference call with reporters. He also vigorously campaigned against it.

Voters in Nebraska, Utah and Idaho didn’t agree, and passed initiatives that will bring health insurance coverage to a total of 360,000 low-income adults. Expanding the program in Wyoming would add an estimated 20,000 to the Medicaid rolls, but most of the states that have already expanded the program have found that the actual number of beneficiaries is higher than predicted.

Meanwhile, Democratic governors who support Medicaid expansion were elected in Maine and Kansas, where lawmakers have seen previous expansion approvals nixed by Republican governors. That will add to the 12 million people who now have access to health care thanks to the ACA.

Let’s review what Wyoming has lost by rejecting Medicaid expansion:

About $120 million annually from the federal government. Over six years that’s $720 million… and counting.

The solvency of our health care providers. Hospitals have seen their uncompensated care costs skyrocket, because the poor have no other health care option than to visit emergency rooms for expensive treatment they can’t pay for. The Wyoming Hospital Association has pleaded with lawmakers to pass expansion to no avail.

Affordable insurance premiums. Those millions of dollars in uncompensated care must be paid by someone, and they are — through higher health insurance premiums.

And, most importantly, our neighbors. There are 20,000 low-income adults who have no health coverage. The Wyoming Department of Health estimates lack of care will result in 111 premature deaths of residents annually.

Legislators direly warned that the state budget would collapse under the burden of Medicaid expansion. It’s 2018 and the feds are still footing 94 percent of expansion costs. There’s no sign that figure will fall below the 90 percent level it will reach in 2020.

Here’s the verdict from the Kaiser Family Foundation, which analyzed 202 studies about what’s happened in states that have expanded Medicaid since 2014: “States have realized budget savings, revenue gains, and overall economic growth.”

What Wyoming Medicaid opponents — especially Sen. Charles Scott (R-Casper), the leading doomsayer — have warned us about since 2013 has been disproven.

One study, Kaiser said, found Medicaid expansion lowered ACA Marketplace premiums by 7 percent in expansion states. “The effects of Medicaid expansion under the ACA suggests that expansion has had largely positive impacts on coverage; access to care, utilization and affordability; and economic outcomes, including impacts on state budgets, uncompensated care for hospitals and clinics, and employment and the labor market,” the foundation concluded.

Other states that put undue restrictions on expansion, including work requirements and premiums, are now considering removing them. Scott and his cronies have brayed for years that low-income people need such “skin the game.” Kaiser found such punitive measures “could compromise coverage and access gains achieved under expansion or slow future progress.”

I know what Medicaid expansion foes will say: If it’s so great, why did Montana voters reject it 55-45 percent?

Here’s the reason: Montana already expanded Medicaid in 2015. Its Legislature chose to let the expansion expire later this year, but even legislators who opposed expansion have said it will be renewed. What Montana voters did was say no to a proposal to pay for it through a tobacco tax increase.

The Fairness Project, funded by a California health workers union, paid for the four state ballot initiatives this year. The project will consider expanding the effort in 2020 to some of the 18 states that still haven’t bought in.

Here’s an open invitation to The Fairness Project to come to Wyoming and help us let voters decide the issue. It’s clearly the only way Medicaid expansion will reach this reddest of states.

Kaiser’s research shows that Medicaid expansion helps the poor who have no insurance, decreases premiums for others, helps states save money by reducing funds spent on other safety net programs, improves hospitals’ bottom lines and results in employment increases.

What on earth on that list is there not to like, and why should Wyomingites continue to suffer without it?