A friend of the wife works for a state run (medicaid) hospital as an admissions/payment counselor....basically she helps people get state aid for their medical care through Medicaid.
In years past, her clients were what you would normally think of for a state run hospital; drug addicts, prostitutes, mentally ill, by and large the lower strata of society.
However, here in 2012, she says it's a totally different deal...formally "middle class" people are now walking through the door on a daily basis...they've lost their job, or they're working but at a fraction of their old pay with no health insurance benefits...for whatever reason, they need care and their income isn't covering it...there's your 20% increase!
If the states don't expand Medicaid, the people that get shut out will just show up at the regular hospital with no (or little) ability to pay. They will be patched up and then sent to the state hospital where they will run up more bills they can't pay.
Game over folks, the number of people with someone else to pay their insurance bills is dropping dramatically...the system is going to die...ObamaCare repeal or not.