It’s budget season in the political world and as Republican governors tell their legislators how wonderful it is to restrain spending, 15 GOP governors are sweeping under the rug a major moral failing, if not a scandal, by refusing to expand Medicaid—state-run healthcare—to 4 million poor people, including 1 million children.

If you attended Wisconsin Gov. Scott Walker’s 2015 state of the state address, you would have heard a typical boast that everything is fine and on track. “Our plan is to help more people live their piece of the American Dream—right here in Wisconsin,” he said in his highest-profile annual legislative speech. “We will build off of our successes.”

Walker, a 2016 presidential candidate, did not say one word about poverty, or inequality, or his refusal to accept federal funds to expand Medicaid under Obamacare, even though his state has at least 566,000 residents without health insurance, of which 116,000 adults and 62,000 children lack coverage but are eligible for Medicaid, according to a recent Kaiser Family Foundation analysis.

Nationwide, 15 states have refused to expand Medicaid under Obamacare, which uses federal dollars to pay for almost all of its costs. Republican governors, like Walker in his 2014 state of the state address, have said they do not want to “expose” taxpayers to unexpected future costs. In fact, there is growing evidence that perpetuating poverty ends up hurting people and costing the state more in the long run.

“Many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced alleviation of toxic stress in childhood,” the American Academy of Pediatrics wrote in a 2012 paper.

“Medicaid generally has favorable effects on eligible children,” said a January 2015 report by the National Bureau of Economic Research. “We find that by expanding Medicaid to children, the government recoups much of its investment over time in the form of higher future tax payments. Moreover, children exposed to Medicaid collect less money from the government… women have higher cumulative earnings by age 28… [and children] also experience decreases in mortality and increases in college attendance.”

The academic evidence finds that access to healthcare, especially for children, means they will live longer, healthier, more productive lives, and have less reliance on government safety nets in later life. But that has not stopped 15 red-state governors, many of whom tout their Christian values while campaigning, from not only ignoring the poor, but intentionally perpetuating poverty.

“It may be a tough slog to get the public and their representatives to listen to arguments about investing in poor people’s health right now to reap financial benefits for the state years down the road,” the Columbia Journalism Review wrote in a January piece. “Those covering Medicaid expansion need to try to broaden the discourse beyond the all-too-typical story quoting opponents versus supporters that rarely clues us in to what’s at stake.”

But if anything, since the 2014 elections the political winds in red states are blowing even harder against the poor when it comes to Medicaid. In states such as Arizona and Arkansas that expanded their Medicaid programs under Obamacare, new governors have been talking about making it harder for recipients, with a mix of new monthly fees and co-pays (Indiana), work requirements (Utah, Arkansas), or a combination of these including canceling coverage if a recepient misses a monthly payment.

Ironically, the White House’s just-released 2016 federal budget proposal gives these punitive efforts cover, because President Obama is proposing to raise fees and charges for Medicaid’s first cousin, Medicare—government healthcare for seniors. Obama’s proposal is touted as squeezing “$399 billion over the next 10 years out of Medicare, Medicaid and other [safety net] programs,” the New York Times noted.

What’s lost in all the economics-only framing is the morality of choices involved. The human costs of not providing access to Medicaid are substantial, stacking the decks against a disadvantaged person for what could be a lifetime. Clearly, these GOP governors, many of whom tout their religious morals, do not care about longer-term benefits but only about short-term politics.

As the Kaiser Family Foundation noted, many red-state governors are not even telling residents in their states who are now eligible for Medicaid about enrolling—Obamacare or not.

A “large majority of individuals in states not expanding Medicaid are children who are eligible but not yet enrolled in coverage,” Kaiser reported last April. “Not all Medicaid-eligible individuals are enrolled in the program due to lack of knowledge about their eligibility and historic enrollment barriers.”

These states could take steps to help millions of poor people, including children, live better lives where they will be less likely to need government assistance. But they don’t and won’t, despite their professed political vanities about less government dependency and moral posturing about serving society.

As the British medical journal, the Lancet, reported last July after studying 20-year public health trends, “Investing in health has stimulated shared economic growth as citizens live longer and with greater capacity to pursue they lives they value.”