The expansion of Medicaid under Obamacare reached a tipping point on Thursday.

Utah on Thursday became the 26th state to agree to expand the program for low-income residents when Gov. Gary Herbert (R) made clear in a news conference that refusing the expansion was not an option.

“Doing nothing … I’ve taken off the table. Doing nothing is not an option,” he said at his monthly news conference, according to The Salt Lake Tribune. Herbert didn’t say how the state would expand Medicaid, according to The Tribune. A full expansion is estimated to cover 111,000 low-income Utah adults. A Wednesday report found that 6.3 million people have joined the program nationwide since Obamacare launched in the fall.

Expanding Medicaid assistance to a wider range of low-income citizens was a major part of the landmark federal health-care law. But, the Supreme Court last year ruled that states had the right to refuse the expansion.

Under the law, the federal government is required to pay 100 percent of the costs of expanding Medicaid for three years. After that, it will cover 90 percent of the costs of expansion, but Republicans have voiced fears that the funds may be clawed back in the future. Researchers have concluded that by refusing the expansion, states could face big costs for uncompensated care—when the uninsured use emergency rooms, for example.