The Heritage Foundation has repeatedly and misleadingly claimed that Urban Institute research shows most states would experience budget problems if they implemented the ACA's Medicaid expansion. In fact, every comprehensive fiscal analysis done at the state level has concluded that expansion would yield net state budget gains, with revenues and savings that exceed increased state costs. All states must pay for national health reform but only those that expand Medicaid will receive large, offsetting allotments of federal Medicaid dollars, with resulting economic activity, jobs, and state revenue. Solid research shows that Medicaid expansion saves lives and improves access to care.