Billion here, billion there
If you doubt the number, here is something to ponder. Just for the Pittsburgh MSA here is the time series just for Medical Transfer Payments annually since 1970. The total number went over $10 billion annually for the first time in 2011. So yes, probably a lot of $$ being left on the table by Pennsylvania skipping this potential Medicaid expansion.
Medical transfer payments are not even all health care, just that publicly funded to include Medicare, public assistance, which includes Medicaid and some military retirement benefits.
Yes, those are nominal numbers. When I get time I will append an inflation adjusted graph below. Does not really change the trend all that much.