When you’re sick, nothing – not money, politics or even religion – matters more than getting well.

And, yet, when you’re healthy, those items matter more in any health care policy debate than the goal of the policy being debated: healing you when you’re sick. This disconnect isn’t just personal, it’s national, regional and local and it continues to drive almost every aspect of today’s fight over the best way to deliver the best health care to every American, rural and urban alike.

How this plays out carries bigger consequences for rural Americans because “out here” we’re older, poorer and more dependent on government-supported health care than urban counterparts.

We’re also understaffed. While nearly 25 percent of all Americans live in census-defined “rural” areas, only 10 percent of the nation’s physicians are our neighbors. The fight over the Patient Protection and Affordable Care Act, or ACA, after its Supreme Court tune-up last year, now travels from Capitol Hill to state capitals because, by Jan. 1, 2014, every state must begin to implement two ACA-directed programs.

First, each must establish and manage a “health care exchange,” a marketplace where people can purchase health insurance that is eligible for federal subsidies. Second, states must choose to participate in a federally funded expansion of Medicaid to cover more of their low-income, uninsured citizens.

Early on, both choices became overtly political. Republican-led red states lined up against building “bureaucratic” insurance exchanges and fought any expansion of Medicaid in their home pasture.

Later, however, when state legislatures and governors began to examine the programs, a less political picture began to come into focus.

For example, the mandated Medicaid expansion carries a fat federal carrot: the federal government – in essence, taxpayers in the other 49 states – will pick up 93 percent of its cost in your state from 2014 through 2022.

The expansion still won’t be cheap. The federal cost through 2022, estimates the Congressional Budget Office, will be $931 billion. The states’ combined cost, if all 50 join in, will be an estimated $73 billion.

That money, however, will insure 17 million more low-income Americans who will use local health care facilities in the coming decade whether your state or mine joins the ACA-offered deal.

In fact, according to an Urban Institute analysis, if all 50 states adopt the expanded Medicaid program, their collective, 10-year cost would be $26 billion to $52 billion less than if all remained in today’s Medicaid program for just the next five years.

Medicare spending also carries economic benefits for states. Two years ago, Oklahoma State University’s National Center for Rural Health Works estimated that Oklahoma spent $785 million to provide Medicaid statewide in 2010.

That spending, combined with the federal share, however, funded 113,000 in-state jobs and generated $10.5 billion in economic activity.

Even better, all that spending produced $351 million in taxes in the state. (For links to all research, go to www.farmandfood file.com)

The benefit is even bigger should you get sick, wrote Dr. Wayne Myers, a retired pediatrician and former director of the federal Office of Rural Health Policy, in a December post on the Daily Yonder (www.dailyyonder.com, where, full disclosure, I write a twice-monthly column, also).

A recent, five-year Harvard School of Public Health study, noted Myers, showed that “one life was saved each year for every 176 adults enrolled in Medicaid expansion.”

As such, he figured, an ACA expansion of Medicaid, if adopted by all states, would “save 80,000 lives per year for a state outlay of about $10,000 per life saved.”

Ten grand is chicken feed if you or a family member becomes sick. And, yet, the political leaders in 30 mostly rural states either stand undecided or decidedly against expanding Medicaid to their citizens.

Why? It can’t be money because the ACA is the law and Medicaid is almost certain to be expanded with or without these states taking the – duh – 93-percent-federal cost-sharing offer on the table.

That leaves either politics or religion as the reason, so ask your local politicians which it is. And while you’re at it, ask these political leaders what kind of taxpayer-supported health care insurance they have.