In a report on its website, the credit rating firm Moody’s pushes for Medicaid expansion. The firm warns that states who do not expand Medicaid will face “political and budgetary pressure.”

“The upcoming reductions called for in the Affordable Care Act to federal disproportionate share hospital (DSH) payments, estimated to rise to $17 billion annually by 2019, will lead to political and budgetary pressure on state governments as they seek to replace the lost funds says Moody’s Investors Service. Hospitals providing high levels of charity care and with heavy Medicaid loads will be most vulnerable to budget shortfalls because of the DSH reductions,” the firm’s summary of the report reads.