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States that don't expand Medicaid will take a fiscal hit, according to a RAND Corporation study released Monday.

The legislature passed a bill earlier this year to not expand Medicaid, which Gov. Pat McCrory signed.

The RAND study did not look at North Carolina on its own, but analyzed the fiscal impact on 14 states that aren't expanding Medicaid under the federal health care law. Those states will spend $1 billion more on uncompensated care in 2016 than they would if Medicaid is expanded, the report said. Additionally, the states are giving up $8.4 billion in annual federal payments, the report said.

The federal government and the states pay for Medicaid, but under the expansion, the federal government would pay all the costs for most of the new people from 2014 to 2016, and then gradually cut reimbursement to 90 percent.

About 500,000 more low-income people would have been eligible to use Medicaid if the state had decided to expand the program.

Senate Republican leaders have said they do not trust the federal government to keep its payment promise. Legislators are frustrated by Medicaid cost increases that have come from poor state budget forecasting.

The bill, which had been in conference committee, also prohibits the state from setting up online exchanges where people can buy health insurance, allowing the federal government to set up the exchanges in North Carolina.

There is now a fiscal note attached to the legislation that estimates it will cost $45.7 million to develop "an interface with the federally facilitated Health Benefits Exchange."

But the state expects to pay for only 10 percent — or $5 million — of that with federal funds paying for the other 90 percent. The bill allows the state to apply for the federal funds.

Killing the state's chance to get more people health insurance, mostly on the federal government's dime, is a rotten idea, said doctors, nurses and medical students who spoke at a news conference Monday.

They came to Raleigh to speak against a bill that would prevent the state from expanding Medicaid under the Affordable Care Act.

'It's nutty," said Dr. Charles van der Horst, a professor of medicine at the University of North Carolina in Chapel Hill. "It's terrible for the citizens of North Carolina."

The Senate passed a bill last week preventing expansion and a state House committee is set to debate it Tuesday.

About 500,000 more people would be insured under the expansion, with the federal government picking up all the costs for most of the new people for the first three years and 90 percent afterward.

Republican governors in Arizona, Michigan and Nevada are going for the expansion in their states, van der Horst noted, because they've determined it makes fiscal sense.

Dr. Mohan Chilukuri, a Durham family physician, called the Senate bill "a travesty of justice" and morally wrong."

State Rep. Jim Fulghum, a neurosurgeon from Wake County, said he did not know how he would vote on the bill, and was looking forward to more debate.

"I just think we have a lot more to learn," said Fulghum, a Republican.

Fulghum said the bill has enough votes to pass, and that the tone of the press conference speakers didn't help their cause.

"I think they want to leave town just as soon as possible."

That was Senate Minority Leader Martin Nesbitt's parting words on Thursday, a day that saw Republicans speed-voting two major pieces of legislation toward quick approval with little public discussion.

Nesbitt, an Asheville Democrat, and Rep. Larry Hall, the House minority leader from Durham, were joined by a couple dozen other General Assembly Democrats to complain about two bills that would cut unemployment benefits and reject expanding Medicaid under the federal Affordable Care Act.

Picking up on a theme from last session, the Democrats said GOP committee chairs are not allowing public comment, sharing information with Democrats only at the last minute and then rushing into law bills crafted in private with help from business interests.

House Republicans, meanwhile, countered that the unemployment insurance bill has been studied and debated in the open for several months leading up to Thursday's committee meeting.