The report examines federal and state Medicaid options following the United States Supreme Court's ruling in NFIB v Sebelius and appears in the August issue of the journal Health Affairs.

"Some states will use the court's decision as an excuse to delay or refuse to participate in the expansion of Medicaid as outlined in the Affordable Care Act," says lead author of the report, Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy, George Washington University School of Public Health and Health Services in Washington, D.C. "The ruling allows states to decline the expansion yet still continue to collect federal funding to operate a status quo Medicaid program, leaving millions of impoverished children and adults at risk for lack of coverage."

At the same time, the expansion would create new jobs as federal funding to pay for health care begins to flow into poor communities. Between 2014 and 2016 the federal government will pay for 100 percent of the cost of the Medicaid expansion and 90 percent of the costs by 2020 and thereafter. That influx of federal funds would represent a much-needed boost to thousands of communities affected by poverty, elevated unemployment and other signs of economic distress, according to the analysis.