Missouri Gov. Jay Nixon wants the state to expand its Medicaid program, marking the strongest stance the Democratic governor has taken to date on the state’s pending decision.

Nixon previously said he was evaluating the issue to see what’s best for Missouri.

Speaking to a packed crowd of hospital and clinic leaders in Kansas City on Thursday, Nixon said an expansion is the right thing to do and that it makes fiscal sense. The federal government would fully subsidize an expansion during the first three years, he emphasized, with the state kicking in about 10 percent of the cost in 2020.

“It’s the smart thing to do, because if we take a pass on billions of health care dollars — dollars I should note which come out of Missourians’ paychecks when they pay their [federal] taxes — the money will go to other states,” Nixon said. “They’ll get the benefit. We’ll get the bill. That’s not smart.”

A report out yesterday by the Missouri Hospital Association projects Missouri would get about $8 billion dollars in federal funds during the first six years of an expansion. The state would spend an additional $300 million from its general revenue budget.

Moving forward with an expansion won’t be easy. State lawmakers have long opposed it, whether that be because of the unpopularity of the entire health law in the state, or because of worries over expanding an already large state health program.

This story is part of a reporting partnership that includes KCUR, NPR and Kaiser Health News.