Cutting Off Your Nose?

Mystery After the Health Care Ruling: Which States Will Refuse Medicaid Expansion? - ProPublica

I'm curious.  If it means covering almost all of their citizens for only 7 % of the cost would it not be cheaper overall for the state to do so?  Seems like a gimme. Seems like it would take the state off the hook for indigent care they now assume in other ways.  Looks like cutting off your nose to spite your face as my Mom used to say.