Gonshorowski says that shifting the cost of Medicaid to the federal government really isn't much of a long-term solution. "All the expansion is going to accomplish is a massive expansion of federal spending and a shift in cost from the states to the federal government," he says. "Even in this most recent study, you're looking at $1 trillion in spending—$950 billion of which is federal spending. That is a massive increase in federal spending."
In the end, however, Weil says the Medicaid expansion isn't just about the numbers.
"We all know that this is far more than a fiscal exercise, and looking at the cost in the context of the numbers [of people] that would gain coverage is critical," he says. "We know that being uninsured leads to excess illness burden and premature death. We know that many states for decades have been working using either their own funding or options provided by the federal government to try to reduce the numbers of people who don't have health insurance. So while figuring out the cost of this policy is very important, there is a human dimension that needs to be part of the discussion far beyond the dollars."