A new report from the Urban Institute and the Robert Wood Johnson Foundation lays out in detail the consequences to the twenty-four states so far not expanding Medicaid.  Earlier analyses have detailed some of the financial hit states take by refusing the new federal Medicaid funding, but this new report takes a much more comprehensive look.  Among the most startling conclusions:

 1.  Looking at comprehensive state-level fiscal analyses that have been done in 16 different states, the authors found that every single analysis was unequivocal in concluding that Medicaid expansion would only help state budgets.  In every case, state savings and new revenues exceeded increased state Medicaid expenses.

 2.  Hospitals in states not expanding Medicaid are losing billions of dollars.  For example, Florida hospitals will lose $22.6 billion over the next ten years, while Texas loses $34.3 billion, Pennsylvania $10.6 billion and North Carolina$11.3 billion.

 3.  Only once in over 30 years (in 1981) has Congress ever moved to cut the federal matching rate to states for Medicaid because strong bipartisan resistance from Governors has made this option a nonstarter for decades.

 4.  Overall, non-expanding reluctant states are foregoing over $420 billion in federal funds through 2022, hospitals are losing $167 billion in funding over the same time period, and 6.7 million state residents will remain uninsured next year.