Not all decisions are easy, nor do they fall into neat ideological packages.

The Missouri General Assembly was confronted with just such a decision last session. Because Medicaid expansion is part and parcel of the hated Obamacare package, legislators ignored the pleas of cash-strapped hospitals and chambers of commerce around the state and declined to include necessary language in the state budget. Thus Missouri became one of 20-odd states to refuse federal health-program money come Jan. 1, 2014.

That means hospitals stand to no longer receive millions of dollars in reimbursement for care provided those who cannot or will not pay. It means 300,000 Missourians who are currently uninsured will not have Medicaid expanded to include them, and they will continue to use emergency rooms as free medical clinics at a cost of millions of dollars to the hospitals they visit. The cycle will continue.

Missourians who pay for their health care will pay more as the cost of that care increases to cover the expense of picking up the tab for those who don’t pay. Some Missouri hospitals will very likely go out of business.

The legislature decided to hold committee meetings around the state to see what the voters think. By most accounts, the voters think the legislature made a mistake by not expanding Medicaid. According to the Missouri Hospital Association – an extremely conservative organization – 56 percent of Missourians think Medicaid expansion is at least an acceptable idea.

Legislators have reasonable fear on their side. While Medicaid expansion is fully federally funded through 2016, after that the states will be responsible for a small but increasing percentage of the cost.

Legislators also have an unreasonable belief that if they look away Obamacare will go away. It is obvious that it will not. There are not enough votes in Congress to kill it despite all the noise being made in that direction. And if there were, a president who has hung his legacy on the health-care star would likely veto any legislation aimed at stopping Obamacare.

Whether, like Social Security and Medicare, the Affordable Health Care Act will become something that seemed like the end of the world in the beginning but eventually worked out cannot be known. Obamacare is not perfect, but it is the law. No amount of huffing and puffing will blow that fact down.

Missouri should have joined the other 20-odd states that have accepted Medicaid expansion, kept the federal dollars flowing and awaited events. Instead, federal taxes that Missourians pay will go elsewhere while our hospitals bleed out.

GateHouse News Service