Last week we wrote about how Medicaid costs and enrollment have exploded under Obamacare, driving home yet again the need for reform in the program. But Medicaid was broken long before the Affordable Care Act became law, and the program has been eating into state budgets steadily over the years. According to the Pew Charitable Trusts, state Medicaid spending as a percentage of state tax revenue grew in nearly every state in the country between 2000 and 2013. Worse still, our home state of Missouri ranked fourth overall in the growth of state revenue paid to support Medicaid, behind only Maine, California and Minnesota.

Missouri was one of only seven states that spent "more than one-fifth of their own-source revenue on Medicaid in 2013" at 22.3%, topped only by New York, which spent a whopping 27.2% of its state revenue on the program.

Given this fiscal threat, Missouri should be especially sensitive to the cost of its broken Medicaid program. State dollars are the primary source of funding for lots of government programs, including primary and secondary education, and as the cost of the state contribution to Medicaid mushrooms, so do the threats to other state priorities. It is time to reform Medicaid, not only for the patients it should be helping, but also for the others—including our kids—who will get squeezed if the state sits on its hands and does nothing.