When the Supreme Court ruled on the constitutionality of the Affordable Care Act, it upheld the law but allowed for states to opt out of one of the cornerstones of the bill, the expansion of Medicaid.

Medicaid’s expansion was supposed to fill in gaps in coverage for the poorest Americans by creating a minimum Medicaid income level. An individual under the age of 65 would have to earn below 133 percent of the current poverty level in order to qualify for Medicaid under the expanded rules.

The federal government would fund 90 percent of the coverage cost for citizens newly enrolled in to Medicaid starting in 2014. The state of Alabama would only have to cover the additional 10 percent.

However, Alabama is one of 21 states that will not be taking advantage of the Medicaid expansion. The Advisory Board Company estimates that between nearly 10 percent of Alabama’s population is currently without health insurance. Signing the Medicaid expansion in to law could help to decrease this number.

Gov. Bentley has said he is opposed to expanding Medicaid because it will be too expensive for the state. In order for Alabama’s economy to be healthy, however, Alabama’s citizens and workers need to be healthy.

And a majority of Alabama residents support the expansion of Medicaid. Sixty-four percent of responders to a Joint Center for Political Economic Studies poll said they supported the expansion of Medicaid in to Alabama.

By not expanding Medicaid, Alabama will forfeit almost $1 billion in federal money in the year 2022, a study by the Commonwealth Fund finds. In addition, the study determined that Alabama taxpayers would still pay taxes to cover the uninsured in other states, but Alabama would not receive any benefits from these taxes. The authors of the study ultimately concluded that refusing to expand Medicaid would not save states any money.

It feels like the state’s decision to not expand Medicaid has less to do with money and more to do with the state’s unhappiness with the President.