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sumes nearly a quarter of state government budgets -- a significant driver of state budget crises.” Health Reform Made Medicaid the First Responder Medicaid is the country’s largest health care program for poor people. It is jointly funded by federal and state governments, political dysfunction in high definition.  Medicaid is also the single largest source of federal revenue to the states, who manage this system and are now experiencing a national nervous breakdown due to health reform. Health reform tightened the federal government’s grip on state budgets via new restrictions on how Medicaid is managed, stopping the states from common‐sense measures that could protect both the poor and taxpayers, says the new report from the House Committee on Energy and Commerce and Senate Finance Committee. For example, as many as one in five Medicaid enrollees in Oregon may not even be eligible for the Medicaid program, but health reform restrictions prohibit the state from updating its eligibility determination procedures to correct this problem, the report says. Health and Human Services Secretary Kathleen Sebelius acknowledged the problems states are facing in a letter to governors on February 3, 2011. “Unfortunately, the letter simply reiterated the limited options available under current law” to fix this concern, the new Congressional report says. Meanwhile, health reform’s legal handcuffs on state Medicaid programs are crowding out state budgets, as the states opt instead to make Draconian cuts in budgets for education, public safety and transportation, and “in many states, new taxes have also been imposed,” says the Congressional report. Deficit Spending on Cruise Control And this is why federal deficit spending, which Congress has put on cruise control, is a dire issue now. Today, the United States spends roughly 75 cents of every federal tax dollar on just four things: Medicare (the federal insurance program for seniors), Medicaid, including the Children’s Health Insurance Program ($732 billion total for all three), Social Security (another $707 billion) and interest (about $200 billion) on the $14 trillion debt. That leaves a quarter out of every buck of federal revenue to pay for everything else the federal government does. Think about that. The U.S. pulled in $2.162 trillion in total federal tax and other revenues in 2010--76% of that is $1.639 trillion. Left remaining is a dwindling $523 billion for everything else, for the Defense Dept., for Homeland Security, for the Dept. of Labor, of Education, Housing and Urban Development, the wars in Iraq and Afghanistan. Meanwhile, the federal government spent $3.5 trillion in fiscal 2010, which is a little less than a quarter of GDP. Of that sum, the U.S. borrowed about $1.3 trillion. The new health reform bill will increase spending even more. Creeping Costs of Health Reform Health reform enacts new eligibility rules that say states must extend coverage in Medicaid to people with incomes at or below 133% of the federal poverty level by 2014, and it says new health insurance exchanges must be launched, subsidized by taxpayers. “The Congressional Budget Office (CBO) estimates the direct cost of premium and cost-sharing subsidies to be $350 billion from 2010 to 2019, and $8 billion in indirect costs,” says the Kaiser Family Foundation. That's just for those costs alone. But the Administration touts a future crackdown on waste, fraud and abuse in the Medicare and Medicaid systems as offsetting those costs. A recent report issued by the Centers for Medicare and Medicaid Services claims that health reform launches “new tools and resources for combating health care waste, fraud and abuse": which "will save taxpayers $120 billion over the next five years.” Submarined in the Report But drill down into what’s behind the $120 billion, and you’ll see ephemera such as “reforming provider payments [and] rewarding quality and efficiency, $55 billion,” or “reducing excessive Medicare payments to insurance companies, $50 billion” and “investing in patient safety – lowering hospital re admissions and hospital-acquired conditions, $10 billion through 2013.” You’ll also see in a heavily footnoted section called “cracking down on fraud and abuse in the Medicare system,” you’ll see just $1.8 billion.” The Administration says in a footnote submarined in the report that these are merely “estimated savings” for “integrity provisions in the Affordable Care Act,” though it does not include other, ongoing government anti-waste and fraud initiatives.” The Problem With Medicaid So you may ask, what exactly are the issues with Medicaid?  Health Reform Worsens an Already Broken Medicaid System, Driving the U.S. Deeper into Debt  The experts and economists at the Heritage Foundation, a conservative think tank, who have made it their life’s work to study Medicaid. Robert E. Moffit, a senior fellow, and Audrey C. Jones, assistant director in public relations, relayed the following: • Between 1990 and 2010, national Medicaid spending increased from $72 billion to over $400 billion. • Federal spending alone increased from $40 billion in 1990 to an estimated $271 billion in 2010. • At the state level, Medicaid spending has increased four times faster than elementary and secondary spending, five times faster than higher education, and nine times faster than transportation spending over the past two decades. Doctors are Ditching the Medicaid Program • Doctors are ditching working with Medicaid patients because of low reimbursement rates (often getting paid just a third of commercial rates) and an enormous amount of required paperwork. Just half of all doctors now accept Medicaid patients. There is evidence of poor quality care. • Medicaid is in large part conditional upon low income and lack of assets, meaning that homes that work can be penalized with a cutoff. Research Shows Expanding Medicaid Could Worsen Already Poor Quality Care • Low provider payments (again, a third of commercial rates) mean Medicaid recipients have a hard time finding a doctor. • Only 10% of primary care physicians believe that new Medicaid enrollees in their area will find a suitable primary care physician after health reform kicks in, one survey shows. This massive inflow of patients with few providers will necessarily mean worse care. • Medicaid recipients already have a hard time finding a doctor, forcing many to rely on expensive and overcrowded hospital emergency rooms for non-emergency care. • They frequently receive inferior medical treatment, are assigned to less-skilled surgeons, receive poorer post-operative i