The ongoing debate over health care reform in Washington, D.C. and across the nation generally focuses on the following issues: creating a government-run health insurer, how much regulation should be placed on private health insurers, and the cost of the proposals. While these issues are all important, another important issue is often overlooked: the expansion of Medicaid. Health care reform legislation from both the House and the Senate expands this government health program, and if this expansion is enacted into law, it will have far-reaching consequences.

Since Medicaid is such a large proportion of states' budgets, many governors have expressed concern about the proposed expansion. If federal health care legislation is enacted, there will almost certainly be some form of Medicaid expansion as part of it. Such an expansion, unless fully funded by the federal government (a highly unlikely proposition), will mean even more pressure on state budgets that already suffer from expenditures that outstrip tax revenue.