As many as 17,000 Americans will die directly as a result of states deciding not to expand Medicaid under Obamacare, according to a new study.

Researchers from Harvard University and City University of New York have estimated that between 7,115 and 17,104 deaths will be “attributable to the lack of Medicaid expansion in opt-out states” in a study published in Health Affairs.

“The results were sobering,” Samuel Dickman, one of the authors, said, according to the Morning Call. “Political decisions have consequences, some of them lethal.”

They projected that 423,000 fewer diabetics would receive medication to treat their disease. If opt-out states had expanded Medicaid, 659,000 women who are in need of mammograms and 3.1 million women who should receive regular pap smears would have become insured, the study found.

“Low-income adults in states that have opted out of Medicaid expansion will forego gains in access to care, financial well-being, physical and mental health, and longevity that would be expected with expanded Medicaid coverage,” the authors wrote.

In terms of health coverage, expanding states will experience a 48.9 percent decrease in their uninsured population compared to a 18.1 percent decrease in non-expanding states. Eight million people will remain uninsured because their states didn’t expand Medicaid, according to the study.

According to the Kaiser Family Foundation, 25 states plus the District of Columbia are expanding Medicaid under Obamacare, and 23 states are not. Two states, Indiana and Pennsylvania, are seeking to move forward with expansion in 2014, but their proposals have not been finalized. Those states were considered non-expanding states in the Health Affairs study.

A full methodology is available here.