The cost of rejection

What's the downside to turning down Medicaid expansion?

Not only would a Medicaid expansion significantly reduce the number of uninsured, Dorn and other liberal analysts say, it would reduce uncompensated care, a major factor influencing statewide premiums.

“In states that don’t, hospitals will get stuck with all of the pain and only half of the gain,” he said.

Moreover, it would bring billions in new federal funds into Tennessee because Washington would pay 100 percent of the cost of expansion the first three years, with the federal share decreasing to no less than 90 percent afterward. Some Republican governors have said the cost of covering 10 percent of the tab for people added to Medicaid in the future would be a burden on state budgets.

The Urban Institute says Tennessee will be leaving $22.5 billion in federal funds on the table through 2022 by not participating.