I wonder if those "costs" we read about are the actual fees charged by the doctors, hospitals, etc, and not the actual payouts that medicaid and medicare actually pay. I know for a fact my internal medicine doc gets about $22 for every medicaid patient he sees -- and he has to wait 60 days for the payment. Hospitals get less than 25% of the total bill for medicaid/medicare patients as well (it's the same with insurance -- has to do with contracted pricing for various procedures, etc.) In SC the medicaid patient now has to pay for the tests to be done, or at least a portion of them, so now there will be fewer tests to reimburse as well.