Of course, we don't know who will win this tug of war. Along the way, we can expect state governments to threaten and bluff their way toward a smaller Medicaid obligation. The current state-level threats not to accept federal dollars to expand Medicaid are arguably part of that game. In any case, as the Medicaid expansion receives more publicity, voters may realize that they want to spend less money on it. There are several potential outcomes. Along one possible path, Medicaid survives this added scrutiny and grows anyway, perhaps because the federal government takes over more of its funding or federalizes it altogether.