So far, eight states have said they will turn down the expansion, while 13 states plus the District of Columbia have indicated they will accept it. The eight declining are Alabama, Georgia, Louisiana, Maine, Mississippi, Oklahoma, South Carolina, and Texas. Nearly 2.8 million people would remain uninsured in those states, according to Urban Institute estimates, with Texas alone accounting for close to half the total. Hospitals aren't taking "no" for an answer in the states that have turned down the expansion. Although South Carolina's Republican Gov. Nikki Haley has had her say, the Legislature has yet to be heard from, said Thornton Kirby, president of the South Carolina Hospital Association. [...] "Obamacare" was once assailed as a job killer by detractors, but on Wednesday in Missouri it was being promoted as the opposite. Missouri's hospital association in released a study estimating that the economic ripple effects of the Medicaid expansion would actually create 24,000 jobs in the state. The University of Missouri study found that about 160,000 state residents would gain coverage. "This is not a political issue for us ... this is the real world," said Joe Pierle, head of the Missouri Primary Care Association, a doctors' group. "It makes no sense to send our hard-earned federal tax dollars to our neighbors in Illinois."

Last summer's Supreme Court ruling on the Affordable Care Act gave states the opportunity to turn town the expansion of Medicaid, and a handful of Republican governors and legislatures have decided that by punishing their citizens by keeping them uninsured is the way to go. The problem is, that isn't just punishing their uninsured, it's punishing health care providers and taxpayers, too. Hence, some big fights are brewing in those states.In the real world, hospitals and health care workers have to provide care to everybody who demands it, and often don't get paid for it. And quite frequently, the really sick people to whom they are providing care could have avoided getting sicker if they'd had access to affordable health care all along. In the real world, the status quo that these Republicans are fighting for has created a major crisis, and is draining state budgets. The pragmatic, smart policy thing for all states to do is to take the Medicaid money, and through it realize benefits like a healthier population, job creation and significant savings.

It's an absolute no-brainer, unless you're a crazy tea partier. And it's going to be the major fight for Republicans in those states that are resisting, because in most of these states there are fewer more powerful interest groups than the health care industry.