to all the Americans on the board, please remember to vote today as long as the republicans have not disenfranchised you

WASHINGTON -- The last few years of Tarika Collins’ life have been a series of horrendous medical complications. Four separate car accidents in 2012 left her with nerve damage in her back. That same year, she was diagnosed with an aortic valve leak, which, over time, led to heart disease. In 2013, she had a heart attack, which resulted in the installation of a stent in her coronary artery. Months later, she had to have neck surgery. She was told that without it, she may end up paralyzed.

Collins is just 45. But the parade of horribles leaves her with intense anxiety. She has been unable to work since leaving her job as a corporate travel agent following her heart attack. Today, she says, “It is very rare that I leave the house.”

Collins is among the nearly 5 million Americans estimated to be too poor for Obamacare, because of actions by the Supreme Court and Republican politicians in 23 states.

Collins estimates she has made a dozen trips to the hospital emergency room in the past few years. Having sold all her assets to pay for her care, she's now about $500,000 in debt and is hosting Internet fundraising drives to help with the bills. Absent a breakthrough with disability insurance (she has a court date in December), Collins has one last hope: That on Tuesday, voters in her state of Florida send a message through the ballot box that they want an expansion of Medicaid.

“It would get me in the system,” Collins, of Clearwater, said. “I would be able to get some health care. For me, it would mean a longer lifespan.”

“Mostly, the emotions I feel are scared,” she said of her wait for the outcome of the race between Gov. Rick Scott, a Republican, and former Gov. Charlie Crist, a Democrat. “Scared that it could go either way. I’m scared I’m going to die before [Medicaid expansion] comes.”

There are two threads of conventional wisdom heading into Tuesday's midterm election. The first is that the election doesn't much matter. Regardless which party controls the Senate, President Barack Obama will still occupy the White House, which means gridlock will remain, if not escalate. The second is that, when it comes to Obamacare, the status quo will remain in place for at least the next two years. Senate Republicans may push for repeal votes. But Obama will veto them. Smaller reforms may pass. But the law will mostly remain intact.

What these threads ignore is that for millions of Americans, Tuesday's election may have life-altering consequences on the issue of Obamacare. At least six states have close gubernatorial elections featuring an incumbent Republican who has resisted expanding Medicaid -- an option states were given by the Supreme Court in 2012. Avalere Health, a strategic advisory services firm, has estimated that in Florida, Georgia, Kansas, Maine, and Wisconsin, almost 2.3 million people have been left uninsured because of that resistance.