The nation's sickest and poorest residents and their high-cost medical care place an untenable financial burden on states and the federal government. Because they are poor and disabled, they qualify for both the federal Medicare program and the state-federal Medicaid program, called Medi-Cal in California. These patients — 1.1 million in California alone — are some of the country's priciest government healthcare consumers. Called dual eligibles, they accounted for close to 40% of Medicaid spending in California in 2009, nearly $10 billion, but constitute only about 15% of enrollees. Nationwide, the nearly nine million dual eligibles have similarly disproportionate outlays and cost roughly $250 billion annually in Medicare and Medicaid funds. Now, as federal officials look for ways to control costs under healthcare reform, they are zeroing in on millions of these patients. But system reform is a sensitive issue.