The Affordable Care Act will cost states conservatively at least $118 billion through 2023, according to a report released by House and Senate Republicans during a recent House committee hearing on Medicaid. Medicaid currently covers nearly 54 million Americans, but the Administration's chief health actuary has estimated that expansions included in the law could increase the nation's Medicaid rosters by at least 20 million beginning in 2014. Governors soon will be "forced with the choice to either cut state spending in other priority areas or to increase taxes" to pay for the federally required expansion of the Medicaid program, Mississippi Gov. Haley Barbour (R) told this panel. He said that states "need the flexibility and authority to craft innovative programs" to provide medical care to its "neediest citizens." Below is the Republicans' report.