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Lawmakers in Georgia and Kansas have just passed bills that will effectively prevent Medicaid from expanding in those states, according to Talking Points Memo. And yet, both states saw an increase in Medicaid enrollments this year. The states, along with several others that declined the expansion, will enjoy the worst parts of Medicaid: increased costs from new enrollees who were already eligible for Medicaid and thousands of uninsured residents still in the coverage gap.

The new bills would require any Medicaid expansion to be explicitly approved by the state's (likely) Republican legislature. So even if Democrats win the governor's race this year, they won't be able to approve the expansion. That means roughly 400,000 Georgians and 77,000 Kansans will remain without Medicaid coverage for the foreseeable future. But as Bill Toland at the Pittsburgh Post-Gazette writes, the overall increase in Medicaid enrollment in states that opted out means that states like Kansas and Georgia will still end up insuring more people, but without 100 percent federal support. "It’s a positive for health overhaul advocates," Toland writes. "But for those who were against 'Obamacare' to begin with, it’s a case study in unintended consequences since new enrollees will mean new expenses for the state."