The twelve reasons why Virginia should not expand its Medicaid Program are the following. 1. Virginia’s Medicaid spending will explode 2. Medicaid harms the poor. 3. Medicaid’s access problems will get worse, as more doctors drop out. 4. Will the Medicaid expansion create 30,000 jobs in Virginia? 5. Will 400,000 people be denied coverage if Virginia turns down the Medicaid expansion? 6. Medicaid raises premiums on those with private insurance. 7. Medicaid’s undercompensated care is a bigger problem than uncompensated care for the uninsured. 8. Expanding Medicaid will expose Virginia to immense amounts of fraud and waste. 9. Virginia will be exposed to higher Medicaid costs when Washington recalculates its matching payments. 10. By rejecting the Medicaid expansion, Virginia encourages other states to do the same, reducing waste of taxpayer dollars. 11. Medicaid will worsen the cycle of dependence and harm the economy. 12. Exchanges will provide better health outcomes, far less fraud, and fiscal certainty.