Sick citizens cost a state, not in on-the-book expenditures, but in lost productivity and higher hospitalization costs -- especially because of the large number of very sick people covered by hospitals' indigent care pools. This directly translates into higher dollar costs in health care and insurance.
The same insurance that would cost my family $8811/year in Massachusetts would cost an unbelievable $12576 in Mississippi, even though everything else is much more expensive here. Mississippi has the lowest cost of living in the country; Massachusetts is among the highest. Yet they pay 40% more for the same health insurance, when all things being equal you'd expect them to pay 30% less. Why? Is medical care cheaper here? Absolutely not. We're chock full of very expensive, high tech teaching hospitals where the cost of an aspirin would give you a stroke. We have the most expensive cost for medical procedures in the country of any state but Alaska.
So why is health insurance such a relative bargain here? Because we have by far the lowest rate of uninsured people in the country (4.0%) thanks to Mitt Romney's implementation of what later came to be called "Obamacare". Yes, our medical care is more expensive here but because we get preventive care and screening we use less of it.
Mississippi's uninsured rate is 15%, and consequently it's full of poor, unnecessarily sick people. the number of unnecessarily sick people. Here in Massachusetts when you hit 65 you can expect to enjoy 15 years of *healthy* life before your health fails. In Mississippi it's 10.8 years. Mississippi has a shocking infant mortality rate -- a total of 1% of live births. And all those unnecessarily sick babies who didn't get prenatal care cost people living in Mississippi a fortune.
So while Mississippi saves immediate cash outlay by not expanding Medicaid, that's penny wise and pound foolish. People carrying insurance end up spending so much more they could expand Medicaid for a fraction of the costs, and if you're a Mississippian you can expect to get more sick and die younger than any other state in the country. Some deal.
Mississippi has one of the highest rates of infant mortality in the country -- a shocking 1% (10 per 1000 live births) of newborns in Mississippi don't make it. Sick, uninsured babies are very expensive.