The Center on Budget and Policy Priorities combines some studies, crunches some numbers, and concludes that Medicaid expansion is a good deal for states. The Congressional Budget Office has estimated that Medicaid expansion would increase state spending by just 2.8 percent over what they would have spent on Medicaid from 2014-2022 otherwise, with the federal government picking up nearly 93 percent of the costs. But that's not the whole picture.
This 2.8 percent figure significantly overstates the net impact on state budgets because it does not reflect the savings that state and local governments will realize in other health care spending for the uninsured. The Urban Institute has estimated that overall state savings in these areas will total between $26 and $52 billion from 2014 through 2019. The Lewin Group estimates state and local government savings of $101 billion in uncompensated care.That's just what states could save from not having to pay for caring for the uninsured. It's not even considering the economic benefits that states would enjoy from creating more health care jobs and having more people with money to spend on things other than trying to pay off huge medical bills.
Other independent analyses show similar or even more favorable results for states. An Urban Institute analysis finds that state Medicaid expenditures would likely increase by 1.4 percent over what states would otherwise spend on the program from 2014 through 2019, before taking offsetting savings in uncompensated care and other health services into account, while the Lewin Group estimates an increase in state Medicaid expenditures of 1.1 percent over that period. These estimates reflect the increased state costs for Medicaid but not the offsetting savings states will also secure in uncompensated care and other health services. […]
In short, the Medicaid expansion will cover 17 million low-income people at a very modest cost to states — a cost that will be at least partly offset by savings in uncompensated care and other state-funded services for the uninsured.
The Republicans' excuse in the red states for not expanding Medicaid is usually that the additional costs would break them. That's demonstrably not true. The real reason they won't take the expansion, no matter how much it might help their budgets, is that they want to sabotage the law. It doesn't matter that they're leaving millions uninsured, as long as they're keeping their tea party base happy.