Avik Roy makes a frequently overlooked point: Numerous studies suggest that Medicaid, the federal-state partner program that provides health coverage to low-income individuals, produces sub-par health outcomes. And that’s not only when compared with private insurance. In numerous studies looking at health outcomes for patients with specific maladies, Medicaid recipients fare worse or no better than those who have no insurance at all. And the cost for those outcomes is enormous; in 2008, according to the National Association of State Budget Officers, Medicaid accounted for more than a fifth of total state spending.

Care to take a guess where fully half of the health insurance expansion in ObamaCare comes from? That’s right: According to the CBO’s projections, 16 million individuals are expected to enter Medicaid by the end of the decade. In some cases, that means that individuals who were previously on private health insurance will end up being shifted to Medicaid. And more broadly, it means that, thanks to the new health care law, taxpayers will be dramatically expanding their commitment to a struggling, government-run health insurance system that in many cases provides demonstrably worse patient outcomes.