“Roughly half of the anticipated gains in insurance coverage from the Patient Protection and Affordable Care Act (PPACA) are achieved through a massive expansion of Medicaid, the joint federal–state health insurance program for the poor. The Medicaid program, with its soaring price tag and dubious level of care for recipients, is in serious need of reform, not expansion. Increasing enrollment in this program by a third is a major flaw of the new health care law.”