The Obama administration is not giving up on its goal toexpand Medicaid services inall 50 states. Its latest ploy: Convince the mostly Republicangovernors of those states that expansion will save billions indownstream treatment for substance abusers.

The U.S. Department of Health and Human Services unveiled areport Monday stating that nearly 2 million uninsured people in the20 non-expansion states suffer from mental illness or substance abuse. That’s nearlya third of the uninsured low-income residents of those states. Andthese states’ refusal to expand Medicaid as permittedunder the Patient Protection and Affordable Care Act (PPACA) willleave 4 million people uninsured this year.

“While some of these individuals had access to some source ofhealth insurance in 2014, many will gain access to coverage only iftheir states expand Medicaid, and others would gain access to moreaffordable coverage,” the report stated.

Under Medicaid, people with mental health and substance abusechallenges tend to get treatment. Without it, they don’t, thereport said.

“Medicaid expansion could dramatically improve access totreatment for people with mental and substance use disorders,thereby improving health outcomes,” HHS said. “Research shows thatlow-income adults with serious mental illness are significantlymore likely to receive treatment if they have access to Medicaidcoverage, with benefits for their health. If all states expandedMedicaid, an estimated 371,000 fewer people each year wouldexperience depression, and 540,000 more people would report beingin good or excellent health.”

Medicaid expansion has already reduced state spending ontreatment for the uninsured, by as much as $190 million in oneinstance 2015. And there are less quantifiable ancillary benefits,HHS argued.

“States can also expect to have a more productive workforce,because expanding treatment will permit a reduction in adverseworkforce outcomes stemming from mental and substance usedisorders,” the report said.

“Research shows that depressed employees incur significantlymore disability days than do otherwise similar employees, andsubstance use disorder treatment was associated with $5,366annually in employer savings from reduced absenteeism alone.”

Whether this new approach will sway GOP governors remains to beseen. Most have taken a hard line against expanding Medicaid ongrounds that, over time, it will lead to much greater spending onhealthcare for the states as federal support diminishes.