“Whatever the reason for the reluctance of the state created exchanges to include private business participants, the end result is that taxpayers will spend millions of dollars unnecessarily while fewer people are likely to be enrolled in qualified health insurance programs—and that is just wrong.”

“If all states implement the Affordable Care Act, 18 million more people will be enrolled in Medicaid by the end of 2016. Even if some states opt out, the program is poised for a huge expansion. But having insurance does not guarantee access to health care. Policymakers need to explore and reduce the barriers Medicaid patients face as millions join an already overburdened system.”