Following the Supreme Court ruling two years ago that made the Affordable Care Act’s Medicaid expansion basically optional, several states around the country are still in the process of deciding whether they will expand the program or not.

Although Florida, Utah and Virginia have signaled their interest in a full Medicaid expansion, governors in Pennsylvania, Tennessee, Indiana and Missouri are exploring different approaches using waivers or so-called “private option” type plans modeled after Arkansas recent expansion. Either way, it would be a mistake.