Senator Coburn (R-OK) and Senator Barrasso (R-WY) have released a report, Grim Diagnosis, analyzing the effects of new federal health care law. It is chock full of important information but one section should be especially worrisome to state governments: Washington mandates will send state costs skyrocketing. Of eight states profiled, the 10-year cost of expanding Medicaid amounts to $41.7 billion dollars. The report also notes a byproduct of Medicaid expansion is increased wait times and overcrowding in the Emergency Room (ER). Doug Holtz-Eakin, former director of the Congressional Budget Office, estimates that Medicaid patients will use the ER 68 million times costing an additional $36 billion through 2019 due to the new health care law.