To understand where Medicaid is and where it should go, consider welfare reform. As I wrote for USA Today back in late 2005,

"Ironically, for the past decade, most governors have been trying to get people off the welfare rolls and into productive private-sector jobs. So why isn't the goal to get people off the Medicaid rolls and into private-sector insurance?

One reason is money. The federal government provides a generous subsidy for people on Medicaid — between 50 and 77 cents of every Medicaid dollar a state spends. But the federal government also subsidizes cash welfare payments.

To understand why Medicaid is different, let's go back a decade to Wisconsin.