“Our analysis shows it’s in the best economic interests of states to expand Medicaid under the terms of the federal Affordable Care Act,” said Carter Price, the study’s lead author.

The 14 states included in the Rand analysis are also passing up a chance to cover 3.6 million uninsured people, the study said.

Several Republicans governors have embraced the Medicaid expansion, but others have staunchly refused to implement any part of a healthcare law they strongly oppose.

ADVERTISEMENT

Governors rejecting the Medicaid expansion often cite the costs to the state, but the Rand analysis said rejecting the expansion will actually raise those states' healthcare costs without covering the uninsured.

“State policymakers should be aware that if they do not expand Medicaid, fewer people will have health insurance, and that will trigger higher state and local spending for uncompensated medical care,” Price said. “Choosing to not expand Medicaid may turn out to be the more-costly path for state and local governments.”

The federal government initially pays the entire cost of the expansion, dropping to a 90 percent share by 2020.