Texas, Louisiana and 12 other U.S. states that are declining to expand Medicaid under President Barack Obama’s health overhaul will lose at least $8.4 billion in federal funding in 2016 alone, a study found.

About 3.6 million people who would have been eligible for Medicaid coverage under the Affordable Care Act will be left without health insurance, costing the 14 states an additional $1 billion in uncompensated care, according to research from the Rand Corp. published in the journal Health Affairs. States “would do best to expand Medicaid,” the researchers said.

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