You answered the question already. I live in SC and we can NOT afford to expand medicaid. We already have too many on it as it is. We can barely keep our teachers employed. Where is the billions of dollars going to come from? I have a two part plan to fix it all but it will not happen. First legalize marijuana so we can gain millions in tax revenue. Then drug test every adult person applying for any form of government assistance (except disabled and elderly). If they fail their drug test then we take them off benefits. With those two things we would have enough money to expand medicaid to those who really need it (underemployed, job seekers, and lower middle class).