States stand to lose a lot more than Medicaid funding by refusing the expansion

Republican governors of the teabagger variety are falling all over themselves to prove their extreme bona fides by vowing to forego lots and lots of federal money that will provide increased Medicaid coverage for their constituents, not to mention vowing to let all those people who won't be getting the coverage to just fend for themselves. These governors say that the expansion will lead to a major budget hit, eventually, when the federal government could stop picking up the full bill for the expansion.

But, via Greg Sargent, here's a 2011 study [pdf] from the Urban Institute that shows just how much states could save in other budget areas by taking on this expansion. The bottom line: "state would spend $92 to $129 billion less under the ACA than without it [...] between 2014 and 2019."

Those savings come from a variety of sources. Notably, they project that spending on uncompensated care'the care the uninsured get at emergency rooms that has to be paid for by states and localities'will be halved. Patients with mental illnesses will be moved from programs covered by states' general funds to the Medicaid, as well as populations like pregnant women and people in long-term care. Having those groups covered by the federal funds will achieve big savings in state Medicaid obligations for all states, including those where the governors are balking.

The Urban Institute, in fact, did look at potential savings for individual states, and Sargent pulls out the highlights:

* Wisconsin could save as much as $3.7 billion from 2014-2019
* Iowa could save as much as $1.9 billion from 2014-2019
* South Carolina could save as much as $678 million from 2014-2019
* Indiana could save as much as $1.7 billion from 2014 to 2019
* Nevada could save as much as $443 million from 2014-2019

So it's not just the people who would be left out of Medicaid coverage who would be screwed if these governors decide to refuse the funds. The federal spending won't just add people to Medicaid rolls, it will ease pressure on the existing obligations the states under the program. States will be saving money, and will be able to use those funds for other programs. Or, hell, allow for tax cuts since these governors are so obsessed with them.

Bottom line, refusing the funding that could save thousands of lives in these states to make a political point isn't just immoral, it's just stupid.