New Jersey Governor Chris Christie is in. Florida Governor Rick Scott is too. So far, seven Republican Governors have aligned with Governor Jan Brewer, and today a total of 24 states are publicly declaring steps toward Medicaid expansion. Of course, expansion is formally adopted through legislative process, so there is still much work to do, but one gets the impression that sentiment may be turning toward the practical aspects of offering more cost-effective care to more people in order to stem the rising tide of delayed and costly uncompensated care.

There is sincere but misguided protest that this really comes down to budgets, and whether states or the federal government can handle what’s characterized as unaffordable spending. Those who push such ‘economic’ responses are not considering economic opportunity cost. Studies have demonstrated again and again that the impact of expanding is to reduce health care costs, boost the economy and improve health. In other words, Medicaid expansion is – pardon the pun – right on the money.

Jan Brewer asked lawmakers to “do the math.” Chris Christie characterized his conclusion as “a financial decision.” Rick Scott called it “a compassionate, common sense step forward.” With a few more expansive thoughts along these lines, we could finally be on our way to re-developing a more efficient and effective, more supportive and supported health care system.