This in-depth report compares and reviews linkages among costs, access, and utilization of health care services for individuals covered by Medicaid with those covered by private insurance, and those who have no health insurance. The report examines the evidence on whether the growth in Medicaid spending is greater then what has been observed in the private sector. It then considers how well Medicaid works at providing health care to program beneficiaries, relative to both the care Medicaid beneficiaries would have received if uninsured and the care they would have received with private insurance.