Echoing what President Obama and other Democrats have been saying for more than three years now, a new report urges the 19 Republican-run states that have not embraced the Affordable Care Act’s expansion of Medicaid to reverse course for the sake of their economies and the health of their citizens.

The study by the Washington, D.C.-based Urban Institute reiterates a number of familiar arguments in favor of the Medicaid expansion, including the fact that states only fund about 10 percent of the expansion of services to those making between 100 percent and 133 percent of the federal poverty level. The federal government picks up the rest of the tab.

But it also reports that the states resisting the expansion could save their hospitals $27 billion in uncompensated care if they swallowed their pride and accepted Obamacare, a proposition that many of those states’ Republican leaders cannot bear to contemplate.