If you’ve been following the ongoing political battles over Medicaid expansion in Republican-controlled states across the country, then you know that the Koch brothers’ chief political arm, Americans for Prosperity, has been a vocal opponent of expanding Medicaid coverage in states like North Carolina. Their effort to block Medicaid coverage for hundreds of thousands of uninsured is bad enough on face, but even worse is the sheer glee with which AFP has heralded the defeat of Medicaid expansion proposals. In North Carolina, the state AFP chapter offered Governor McCrory their “congratulations” for signing a bill blocking Medicaid expansion into law, and now this week in Tennessee, that state’s chapter has declared it a “victory” that 200,000 Tennesseans will remain uninsured.

NBC News has a must-read rundown of AFP’s “aggressive” effort to make Republican Governor Bill Haslam’s widely popular Medicaid expansion proposal, Insure TN, politically unpalatable for conservatives in the state legislature. It’s impossible to read the account of AFP’s blitz against the bill — which included radio ads, aggressive Facebook posts calling out members of their own party, and filling a legislative hearing with dozens of activists — without coming away with the impression that AFP will stop at nothing to ensure that Republicans adhere to Koch-approved AFP policy positions. AFP succeeded in brow-beating Republicans into opposing Insure TN, with the bill ultimately not making it out of committee. But even lawmakers sympathetic to AFP’s cause were bristled by their tactics; NBC News quotes an influential Republican lawmaker who criticizes AFP’s “politics of intimidation,” even though he also opposed Medicaid expansion.

In the NBC account of AFP’s clamoring against Medicaid expansion in Tennessee, there’s a broader point that can’t be missed about the Kochs’ political activity:

When the coalition of conservative groups allied with Charles and David Koch announced recently they would spend $889 million over the next two years, much of the discussion was about how that money could shape the upcoming presidential election. But AFP and other Koch-backed conservative organizations may be having their biggest impact on state politics, where targeted advertising and a strong organization can make a huge difference.

We couldn’t agree more, which is why Real Koch Facts will continue to stay abreast of not just the Kochs’ impact on the upcoming presidential race, but also spotlight the tremendous influence their billions have had in critical state policy debates like this one in Tennessee.