By Martha Heberlein

As many states are nearing or have reached the end of their legislative sessions, it’s a good time to take stock of who will implement the Medicaid expansion and the far-reaching implications of these decisions.

Twenty-four states have decided to move forward with the expansion, 21 will not, and 6 continue to debate.

Nearly two-thirds of those who would have gained coverage under the expansion live in the 27 states that are either holding back or remain undecided, according to the report. These states already strictly limit eligibility for Medicaid and their current rate of uninsurance is far higher than the national average. That disparity will persist as a result of this decision, with 6.4 million fewer people gaining coverage.

States that turn down the expansion are also giving up $50.2 billion in federal dollars in 2016 alone and would face only modest increases in their own spending if they chose otherwise.

The Medicaid expansion is still a good deal for states, so why are they turning it down?