A big part of the health insurance reform that was passed last month provides coverage through Medicaid by raising the Medicaid qualification limits.  In Mississippi, this means than an additional 500,000 to 600,000 people will be added to the Medicaid rolls. As Gov. Barbour pointed out this weekend in his CNN interview, that requires another $150 to $200 million that the state simply does not have.  Ultimately, this is going to lead to one of two results:  Either the state must increase taxes to pay for the newly insured, but since we were promised that health reform was being accomplished with no tax increases on the middle class, this must be contra to what congress and the president intended.  Or it will lead to reduced pay for services, which are already low compared to Medicare and private pay rates and will lead to all but the most desperate or compassionate of physicians having to pull out of the Medicaid system altogether, which will in turn result in no service providers for these newly insureds, and will likely result in them receiving no primary care and getting crisis care the same place they are getting it now – emergency rooms. So much for bending the cost curve down.