From Alaska to Tennessee, there are renewed calls for Medicaid expansion from activists in Republican-controlled states after the U.S. Supreme Court’s decision upholding a key provision of the Affordable Care Act (ACA).

The Supreme Court last week issued a 6-3 decision ruling that the ACA does not prevent federal tax subsidies from assisting low-income people in purchasing health insurance in states that have refused to set up insurance exchanges under the health-care reform law.

The ruling could present new opportunities for supporters of Medicaid expansion in the 20 states that have not expanded the program.

Several studies and reports have documented the consequences of GOP-dominated legislatures that have chosen not to expand Medicaid. Under the ACA, the federal government covers the full cost of the expansion for the first three years, and 90 percent of the cost in subsequent years.

Data released last year by the U.S. Census Bureau’s American Community Survey shows that seven out of 11 major metropolitan areas with rates of uninsured people higher than the national average are in states that have refused to expand Medicaid under the ACA. A 2014 joint report by the Robert Wood Johnson Foundation and the Urban Institute found that Texas has a projected loss over ten years of $65.6 billion in federal funds by refusing to expand Medicaid.

Alaska state Sen. Bill Wielechowski (D-Anchorage) said that Gov. Bill Walker, an Independent, should move to expand Medicaid in the state without approval from state lawmakers, now that the Supreme Court has upheld insurance subsidies.

“It’s time for the governor to exercise leadership and just do it. We’ve got legal opinions saying he can do that and I think he should do that. I think that’s where Alaskans are, and that’s what Alaskans want,” Wielechowski told Alaska Public Radio.

Wielechowski points to two legal opinions, issued by the Alaska Department of Law and the legislature’s own legal office, charging that any attempt by state lawmakers to block the governor from unilaterally expanding Medicaid is unconstitutional.

Meanwhile, health-care advocates and business leaders are calling for Medicaid expansion in Kansas.

Gene Meyer, president and CEO of Lawrence Memorial Hospital, told the Lawrence Journal-World that Medicaid should be expanded in the state, no matter the result of the latest Supreme Court ruling.

“Regardless of the decision, there is no reason for Kansas not to expand Medicaid,” Meyer said. “Kansas should expand Medicaid.”

Gov. Sam Brownback and the Republican-controlled state legislature have refused to expand Medicaid through the state’s KanCare program as the state GOP’s economic policies have created a deep fiscal crisis in recent years. Sen. Mary Pilcher-Cook (R-Shawnee), chair of the Senate Public Health and Welfare Committee, said in a statement that it was not the state’s responsibility to expand the program.

“We will not spend one more penny fixing Congress’ mistakes, whether that means rejecting Medicaid expansion or a state exchange,” Pilcher-Cook said, reports the Lawrence Journal-World.

Renewed calls for expansion have also been seen in Utah, Virginia, and North Carolina. And a debate between a Republican governor and Republican state lawmakers appears to have been reignited in Tennessee.

“Now that the Supreme Court has given us the green light, it’s time for the state Legislature to move forward,” said Tennessee Congressman Jim Cooper (D-Nashville), reported the Chattanooga Times Free-Press.

During a press conference Monday at Saint Thomas Midtown Hospital in Nashville, state lawmakers joined with business leaders and other supporters of Medicaid expansion, and called for state lawmakers to take action as Tennessee Republicans steadfastly reject the expansion of health-care services.

Charlie Howarth, executive director of the Tennessee Business Roundtable, said that while they are “delighted with the Supreme Court decision,” there still are hundreds of thousands of people that remain without access to health care, reported the Chattanooga Times Free-Press.

Tennessee Republican Gov. Bill Haslam’s “Insure Tennessee” plan to expand Medicaid coverage to an estimated 280,000 low-income residents was rejected by fellow Republicans in the legislature.

Republican lawmakers, including Lt. Gov. Ron Ramsey, opposed the expansion of Medicaid because they claim it would be too expensive and they distrust assurances from the federal government that the state could opt out of the program. Some lawmakers have called for waiting until the election of the next U.S. president, whom they hope will be a Republican, before further discussion of the program.

Conservative organizations like Americans for Prosperity Tennessee (AFPTN) oppose any expansion of Medicaid under the ACA.

Andrew Ogles, the state director of AFPTN, said in statement after the high court’s ruling that the organization will continue to oppose any efforts to expand Medicaid in the state.

“Today’s decision only adds to the anxiety of Tennesseans who have already been harmed by Obamacare’s burdensome mandates and out-of-control costs,” Ogles said. “Our efforts to encourage Congress to bring state-based and patient-focused reforms to healthcare will not stop.”

State Sen. Richard Briggs, (R-Knoxville) said that those in favor of Medicaid expansion include a diverse coalition of business groups and health-care advocates, including the Tennessee Chamber of Commerce and the Tennessee Hospital Association.

Briggs said that the most powerful group of those in favor of Medicaid expansion was his constituency. ”We really have the most powerful group of all, and that’s the millions of Tennesseans who understand this is very important,” said Briggs, reported the Chattanooga Times Free-Press.

House Minority Leader Craig Fitzhugh (D-Ripley) told the Nashville Tennessean that there is building momentum in support of Medicaid expansion. “The momentum for Insure Tennessee didn’t stop when the special session was over and when the regular session of this General Assembly was over; it has really just gotten stronger,” Fitzhugh said. “So I think there is a groundswell.”

President Obama will visit the state to promote the ACA and the expansion of Medicaid, and will speak Wednesday at Taylor Stratton Elementary School.

The president said during a Tuesday press conference that the success of expanding Medicaid will be a decisive factor in determining the impact of his signature health-care law.

“If we can get some governors that have been holding out and resisting expanding Medicaid, primarily for political reasons, to think about what they can do for their citizens to have health insurance…then we could see even more improvement over time,” Obama said, reported the National Journal.