important. the medicaid numbers in and of themselves are staggering. to ron's piece about the rural aspect of all of this, there are nuances and differences between rural medicaid health care and urban health care. lots of people look into this health care policy experts have done studies and there are subtle differences between the two but nonetheless very important. rural patients to be older and sicker and hospitals are typically there in rural areas not for profit. you don't have that much margin for error and rethey rely on public funding. >> could those differences make an argument for shifting this to state coverage. people made the argument to us, what works for maine doesn't work for california. is there an argument to be made each state should make the decision? >> intuitively i would say yes, a state is going to say this is my bucket of money and we happen to have more under age births