North Carolina's refusal to expand its Medicaid program has left many thousands of North Carolinians without health insurance and has imposed unnecessary costs on all of the state's residents through higher premiums in the state's health insurance marketplace. Expanding Medicaid is the most efficient way to extend coverage to the state's uninsured population, and expansion would bring a substantial amount of new federal money into the state. This money can serve as a catalyst for ambitious reforms to the Medicaid program that can lower costs, improve quality of care, and increase value for patients and taxpayers alike.