This morning, the George Washington University Center for Health Policy Research released a comprehensive county-level study of how blocking Medicaid expansion has affected North Carolina. Leighton Ku, Brian Bruen, Erika Steinmetz, and Tyler Bysshe have accounted for every dollar and job lost in every county across the state. Here are the five things you need to know about what they found.

1)    North Carolina has already lost billionsand stands to lose billions moreby not expanding.
The Affordable Care Act guarantees significant federal funding for states that choose to expand Medicaid. By opting out in 2014, North Carolina lost out on $2.7 billion, and will lose $3.3 billion more in 2015. If we stay on this road, the state stands to lose an estimated $21 billion between 2016 and 2020.

2)    Losing federal funding means losing out on serious job creation at the state and county levels.
Those lost billions in federal funding would have created over 23,000 jobs for the state in 2014, and about 29,000 more in 2015. Guilford, Mecklenburg, and Wake Counties alone have over 6,800 fewer jobs this year than they would have if we had expanded. And North Carolina will keep creating fewer jobs than we need for a real “Carolina Comeback” if lawmakers continue to block expansion.

3)    Those missing jobs translate to missing revenue – and every county will feel it.
North Carolina counties lost a total of $17 million in county revenue this year, and will lose over $23 million more next year. If we don’t expand by 2016, we’re looking at $161 million in lost revenue – and that’s just for the counties. The state will miss out on $862 million between 2016 and 2020.

4)    Missing state and county revenue means less business activity and a weaker economy.
Medicaid expansion would help fuel economic and employment growth in the state. By choosing not to expand, North Carolina lawmakers are choosing a smaller, less capable economy. North Carolina’s gross state product was smaller than it would have been with expansion by about $1.7 billion. Guilford, Mecklenburg, and Wake Counties lost $988 million in potential business revenue; the state lost a total of $2.6 billion.

5)    North Carolina could save hundreds of millions if we do expand.
Not only would expanding Medicaid cover more residents and create more jobs – it would wind up saving the state money. Almost $200 million in 2016 alone, in fact. That amount takes into account the $1.7 billion in additional state Medicaid costs that North Carolina would have to cover. It also includes the gains in state revenue, and offsetting healthcare savings in things like uncompensated hospital costs. North Carolina stands to gain a lot more than it would lose by expanding.

Click here to read the full report.