Arkansas House Majority Leader Rep. Bruce Westerman, R-Hot Springs, signals his intention to speak against a Medicaid funding bill. The funding provision passed. (AP Photo/Danny Johnston)

WASHINGTON — Rejecting the Medicaid expansion in the federal health care law could have unexpected consequences for states where Republican lawmakers remain steadfastly opposed to what they scorn as “Obamacare.”

It could mean exposing businesses to Internal Revenue Service penalties and leaving low-income citizens unable to afford coverage even as legal immigrants get financial aid for their premiums. For the poorest people, it could virtually guarantee that they will remain uninsured and dependent on the emergency room at local hospitals that already face federal cutbacks.

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