Medicaid continues to drive state budgets across the country. Texas is no exception. Without reform, Medicaid threatens to consume an ever increasing share of the state budget, potentially jeopardizing every other important service. While spending on Medicaid has risen sharply – many argue drastically – Texas has remained at the very bottom of the rankings nationally in terms of the uninsured. Policymakers in Texas must take action both to contain Medicaid spending and decrease the number of uninsured. In addition to recommending changes to the Medicaid program, the report calls for incentives to encourage small businesses to provide health insurance plans to employees.