CHARLESTON,W.Va. -- A few years back, when health-care reform was on the agenda, Sarah Palin came up with the rather loopy comment that this would involve the creation of "death panels" whose members would decide who gets to live and who gets to die.

The weird thing is, she was kind of right, although not in the way she thought.

There really are people who get to decide whether some people live or die. They can be found in governor's mansions around the country.

As part of the U.S. Supreme Court decision about the Affordable Care Act (ACA), states get to decide whether to expand the Medicaid program to cover low income working adults, one of the key provisions of the law. So far, 24 states and the District of Columbia plan to expand the program, including eight governed by Republicans, the most recent additions being Florida and New Jersey.

However, governors of 14 states have indicated they would not expand the program. This pretty much guarantees that some people in each of those states will die sooner than they would have if their governors had acted otherwise. Ironically, this no doubt includes quite a few people who voted for the governors who made this decision.

Make no mistake. There is no dispute that thousands of Americans die prematurely each year because they lack health coverage. The only disagreement is about how many. Back in 2009, a Harvard public health study estimated that number to be around 45,000. Families USA in 2012 came up with the smaller but still significant number of 26,100 early deaths per year, with about 223 of those deaths taking place in West Virginia, a rate of around four people per week.

Our own Gov. Tomblin has not yet made the decision about Medicaid expansion, but I understand that this is partly because he is moving with caution and is waiting to see the results of an actuarial study about the impact of the expansion on the state. I am hopeful that he will ultimately expand coverage and open the gates of health care to the hard-working people who currently have none.

For what it's worth, there are lots of different reasons to take that step, reasons that speak to several bedrock American and West Virginia values: the heart, faith, the flag -- and the bottom line.

Reasons of the heart had something to do with the decision of Florida Gov. Rick Scott, an ardent opponent of the Affordable Care Act, to expand coverage. According to the New York Times, Scott said "While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care."

 Scott reportedly was also influenced by the recent death of his mother and memories of her struggles to raise five children "with very little money." He said that "Losing someone so close to you puts everything in a new perspective, especially the big decisions."

When it comes to faith and putting it into action, it would be hard to top Ohio's Republican governor John Kasich's statements about his reasons for expanding Medicaid in his state of the state address: 

"My personal faith in the lessons I learned from the Good Book, they're like, run my life. I mean I'm serious they're very important to me. Not just on Sunday, but just about every day. I gotta tell you, I can't look at the disabled, I can't look at the poor, I can't look at the mentally ill, I can't look at the addicted and think we ought to ignore them.

"For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them. And I want all of you to think about this."

Expanding Medicaid will also benefit many non-elderly veterans who are uninsured and can't or won't use health care from the Veteran's Administration. The Robert Wood Johnson Foundation and the Urban Institute recently released an issue brief that found that this was true of about one in 10 non-elderly veterans. This would mean about 11,000 in West Virginia alone.

Of these, "Nearly half of the uninsured veterans (48.8 percent) have income levels below 138 percent of the FPL [federal poverty level] and thus would be eligible for expanded Medicaid under the ACA."

Stepping up for those who have sacrificed so much is one way of distinguishing deep patriotism from cheap patriotism.

In the event that none of those other reasons resonate, there is also the bottom line. Expanding Medicaid would bring in hundreds of millions of dollars to West Virginia and would have a huge direct and indirect effect.

According to a new report jointly released by Families USA and West Virginians for Affordable Health Care, if Medicaid expansion is enacted in 2014, by 2016 the influx of money would create around 6,200 new jobs, not just in the health-care sector, and would generate around $664 million in economic activity. All of this would help generate sales and income tax revenue for the state.

Expanding coverage would also reduce the cost of providing uncompensated care to the uninsured, some of which gets passed on to state and local governments. Medicaid expansion would result in $281 million in savings for the state from 2013 to 2022.

Hospitals would also realize savings as the cost of uncompensated care drops. In 2010, for example, West Virginia hospitals had to absorb $279 million in costs due to caring for low-income people who were uninsured. These costs also get passed on to consumers, which in 2008 raised family health insurance premiums by over $1,000.

In a word, reducing the number of uninsured West Virginians would lower costs to the state, to health-care providers and to those with private coverage.

Finally, expanding coverage for working people will mean healthier, happier and more productive lives for the people who live here.

Whether you look at it with head, heart, soul, or calculator, expanding coverage makes sense.

Wilson is director of the American Friends Service Committee's West Virginia Economic Justice Project and a Gazette contributing columnist.