Progressive researchers continue to pump out survey and study results that forecast gloom and doom for the American public should the U.S. Supreme Court gut health care reform by eliminating premium subsidies in 20 states in the King. v. Burwell case.

The latest comes from the Urban Institute, with funding from the Robert Wood Johnson Foundation. This one comes with a twist: It also looks at the effects of the states’ decisions not to expand Medicaid as allowed by the law.

Read: 5 things to know about SCOTUS subsidies case

The conclusion:

• In total, 9.8 million people in the 20 states would go without insurance in 2016;

• 4.2 million would have had Medicaid coverage if their state expanded the program;

• Another 5.6 million would have purchased marketplace insurance, most with the help of federal tax credits;

• From 2016 to 2025, these 20 states will miss out on $483 billion in federal Medicaid funding and $238 billion in federal spending on tax credits and cost-sharing reductions to help people purchase health insurance through the marketplaces;

• Total cost: $721 billion.

“A ruling for King in the King v. Burwell Supreme Court case would effectively negate the impact of the ACA’s coverage expansion provisions in those 20 states that have not expanded Medicaid,” said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation. “In addition to the loss of tax subsidies, the almost inevitable collapse of the individual insurance market would truly add insult to injury for residents and health care providers in states that will suffer under a ruling for King.”