North Carolina's decision not to expand Medicaid coverage as part of Obamacare will cost the state nearly $51 billion in federal funding and reimbursements by 2022, according to research funded by the Robert Wood Johnson Foundation.
The nonprofit foundation focuses on improving public health.
It notes that North Carolina stands to lose $39.6 billion in federal funding between 2013 and 2022.
The decision also will result in $11.3 billion in lost reimbursements to the state's hospitals by 2022, the foundation says. That includes a projected $1.1 billion in 2016.
By comparison, the 10-year total cost for North Carolina to expand coverage would be nearly $3.1 billion.
"States are literally leaving billions of dollars on the table that would support their hospitals and stimulate the rest of their economies," says Kathy Hempstead of the Robert Wood Johnson Foundation.
The report notes that for every $1 a state invests in Medicaid, it will receive $13.41 in federal funds.
Expanding Medicaid also stands to generate state savings and revenues that exceed the costs tied to expansion. In addition, it would support job growth in the health-care sector, while increasing the number of individuals with health insurance coverage.
In total, 24 states have chosen not to expand Medicaid and will miss out on $423.6 billion in federal funding between 2013 and 2022. Hospitals in those states also will lose out on $167.8 billion in Medicaid reimbursement payments over that time, the foundation says.
The decision not to expand Medicaid coverage will leave 6.7 million U.S. residents uninsured in 2016. That includes 414,000 people in North Carolina.