More than one in five Americans, or 68 million people, will receive their health coverage through Medicaid this year — more than any other government health program. But as it adds millions of beneficiaries as a result of President Obama’s healthcare law, there is mounting evidence that Medicaid is broken.

Medicaid is administered jointly by the state and federal government, offering health coverage to Americans earning up to about $16,000 in the states participating in Obamacare’s expansion of the program and up to roughly $12,000 in the states that do not.