Given the focus on the disastrous launch of the Obamacare insurance Exchanges in 2013, many people don’t know that most of Obamacare’s coverage gains have come not through those Exchanges, but through a new expansion of Medicaid to able-bodied, working-age adults.

Medicaid was originally intended to provide important safety net coverage to vulnerable populations such as individuals with disabilities, low-income children and the elderly, among others.  But Obamacare’s massive expansion of this entitlement to able-bodied adults has placed added strain on an already stressed program in many states.

Even prior to Obamacare, Medicaid stood in desperate need of reform. In many states, low physician reimbursement rates resulted in poor access for beneficiaries. One supporter of the program called a Medicaid card a “hunting license”—the chance for beneficiaries to try to find a doctor who will treat them.

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