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When the government passed the Affordable Care Act, many analysts expected states to begin cutting back on Medicaid spending. The most likely result was that the uninsured population would shrink in the short term. That is precisely where we are now, with an estimated 16 million people still without insurance. This new Medicaid-reform plan is not going to result in significant changes in health insurance coverage — and it will probably do more harm than good. As the Urban Institute recently told us in their latest report on Republican ideas around health care, “The major elements of Obamacare’s Medicaid expansion are a huge financial risk.” [Read the study here. Also note: The Urban Institute also reported the same in a much longer report last February, and they are still out there explaining how Obamacare failed.]

Obamacare will likely lead to fewer people signing up for Medicaid, and it is likely more people will drop coverage in states that adopt a more comprehensive Medicaid system.

If Republican governors think their states’ Medicaid expansion can cut costs and reduce the uninsured, they are not thinking clearly. In fact, states that embraced the Medicaid expansion often have seen the number of uninsured drop dramatically after the expansion began.

For example, Medicaid coverage for children began in Georgia as a part of its Medicaid expansion. This resulted in an increase in the number of uninsured individuals there. By 2010, the number of uninsurance children in Georgia had declined by almost two-thirds. When the Georgia Medicaid expansion was rolled back, the uninsured rate remained near the lowest level it had been at when the expansion began, just under 18% by 2007. However, when the state did not expand Medicaid the following year, the number of uninsured fell by two-thirds to near 13%.

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In another case, Colorado expanded Medicaid, and by 2004, the number of people with health insurance was stable. A year later, after more than 400,000 Colorado residents became uninsured, the uninsured rate dropped by two-thirds. This suggests that some, but not all, of the uninsured that would have resulted from the expansion actually disappeared once the expansion was no longer on the table.

There seems to be little doubt that expanding Medicaid is responsible for those declines and for Colorado’s recent drop in the unemployment rate. This supports the “free ride” argument against the expansion. But it also indicates that the expansion should also be supported with caution.

In a 2007 survey of Medicaid program managers by the Kaiser Family Foundation, more than 40% said they expected

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