In all the confusion involved in implementing the federal Affordable Care Act, Alabamians deserve a clear answer to one question.

What will happen if Gov. Robert Bentley continues to say no to the federal government?

Parts of the law will go into effect anyway. This includes health care insurance exchanges for people who, as defined by the law, can afford insurance.

Taxes to help fund the reforms and reduce the deficit will go into effect in all states, including Alabama. Federal funding that helps hospitals cope with uninsured patients is being cut in all states.

The part of the law in which Bentley can refuse to participate involves the expansion of Medicaid for those who cannot afford insurance. This will harm both the estimated 300,000 people who fall into this category and the state as a whole, which stands to lose nearly $12 billion in federal funds.

Contrary to what many would have us believe, most of these folks are not freeloaders looking for a handout. About 60 percent work in low-income jobs. They are the workers who serve our food, check us out at the grocery store, reroof our houses and fix our cars.

Republican Gov. Rick Scott of Florida, a leading opponent of the Affordable Care Act who last week announced his support for Medicaid expansion, put it this way:

“To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

The human tragedy in saying no to Medicaid expansion is just the beginning.

If Alabama continues to fight against this part of the health care law, the state will save $771 million on Medicaid expansion through 2020, but give up $11.7 billion in federal matching funds and $20 billion in private-sector growth, according to a study by the University of Alabama at Birmingham.

What state, or private business for that matter, would balk at such a generous rate of return on investment? How much would Alabama be willing to spend to attract that kind of industrial development? Who can explain the belligerence of Alabama’s elected officials?

In an op-ed piece, state Sen. William “Billy” Beasley, D-Clayton, blames the hold that the tea party has over the GOP majority in Alabama.

They “seek to curry favor with the tea party — a group of nihilist know-nothings who will not be satisfied until our entire system of governance is burned down, and all incumbents are removed from office,” Beasley writes. “To let the decisions of our state and the impact on our economy be affected by such a group is insanity bordering on criminality.”

Those are strong words from a senator who, as a small-town pharmacist and independent businessman, says he sees the negative effects every day on people who do not have health insurance.

We wonder if the governor and the legislative majority can see the same effects on people who bus our tables and tune our engines.

We wonder if their vision reaches beyond the next election.