When President Obama tours the country and touts Obamacare, one thing you never hear him highlight is that half of Obamacare’s projected decrease in the number of uninsured comes from people who would simply be dumped into Medicaid at taxpayer expense. Of the 32 million people that the Congressional Budget Office says would gain insurance under Obamacare (a demonstrably false number in the first place), fully half — 16 million — would simply be added to the Medicaid rolls (see Table 4). According to the CBO’s projections, the cost of this massive Medicaid expansion would be nearly $1 trillion over Obamacare’s real first decade (2014 to 2023). 

Rather than increasing Medicaid spending dramatically (a key reason why the CBO says Obama’s 10-year budget would increase the national debt from $14 trillion to $28 trillion) Republicans have proposed giving states a specified amount of federal Medicaid funding that they could then use to tailor their Medicaid programs to the specific needs of their residents — something that governors have long been requesting. By adopting this approach, the Paul Ryan-authored House Republican budget would save $201 million a day on Medicaid spending in relation to Obama’s budget.