THE AFTERMATH: States that reject the Medicaid expansion in the federal health care law could face unexpected consequences, including exposing businesses to Internal Revenue Service penalties.
MAKING A CHOICE: As originally written, the Affordable Care Act required states to accept the Medicaid expansion as a condition of staying in the program. Last summer's Supreme Court decision gave each state the right to decide.
THE TALLY: So far, 20 mostly blue states, plus the District of Columbia, have accepted the expansion, and 13 GOP-led states have declined. They say Medicaid already is too costly, and they don't trust Washington to keep its promise of generous funding for the expansion.