TOLEDO, Ohio (AP) -- The price tag of the health care program that covers Ohio's poor and disabled has more than doubled during the last dozen years to just around $19 billion.
That's more than the state and federal government spends on the Ohio's public schools and universities combined.
The staggering growth of Medicaid is a big reason why state lawmakers are uneasy about going along with the governor's proposal to add thousands of more low-income state residents to the program as allowed by the nation's new health care law.
One state lawmaker compares the Medicaid program to the Pac Man video game, eating its way through the state budget at the expense of everything else.
"It has crowded out funding for a lot of other things we'd like to do as a state," said state Rep. Robert Sprague, a Republican from Findlay who sits on the Ohio House's finance committee.
Committee members for the past few weeks have been hearing from state health officials who are trying to convince them to expand Medicaid. Gov. John Kasich's administration is appealing to both their financial and emotional sides.
The administration says expanding Medicaid would allow the state to get $13 billion from the federal government during the next seven years to cover those newly eligible for Medicaid. Turning down the expansion would send that money to other states, Kasich has said.
But there are several reasons why expanding Medicaid will be a tough sell among the governor's fellow Republicans.
Many conservatives are simply philosophically against the idea of expanding government programs and opposed to the federal health care law that calls for mandated health coverage.
Even Kasich has criticized the law while calling for expanding Medicaid -- a key component of the Affordable Care Act pushed by President Barack Obama -- and said he understands why lawmakers are hesitant.
"Anything that involves something this massive is something that people want to think about," the governor said last week. "And there's reasons why people are concerned about it."
"Trusting the federal government is not exactly something that most people would do," Kasich said. "But I'm confident that we can handle the twists and the turns. And we don't want to turn this money down."
Ohio's upcoming budget projects that Medicaid spending will grow to $23 billion in two years. The federal government will pay for most of that while the state will pick up roughly one-third of the cost.
Although the price tag is still rising, state health officials say they've been able to slow down the growth rate of Medicaid spending and will continue to do that in the next two years through better oversight and streamlining.
What worries many Ohio lawmakers is whether the federal government will keep up with its share of the costs or pass along a bigger chunk of the bill to the states.
Greg Moody, the director of the governor's Office of Health Transformation, told a gathering of religious organizations at the Statehouse on Tuesday that he's been talking one-on-one about the Medicaid expansion with every Republican in the Ohio House and many Democrats too. Some bring up the costs while others mention the possibility of facing an election challenge if they support the governor's plan, he said.
"Often what I hear underlying the concern is fear," Moody said. "'Can we pay for it? Will my decision result in a primary?' But we can't act out of fear."
Ohio's Medicaid program has grown so much that it's become the largest health insurer in the state, providing care for one of every five residents.
It's a trend seen nationwide.
The number of people receiving Medicaid has swelled as changes in eligibility allowed more people into the program, especially low-income children. Lately, increasing health care costs and the loss of health benefits for millions of people have pushed the cost of Medicaid beyond what anyone imagined when it was created in 1965.
State Rep. Jim Buchy said Medicaid was allotted $3 billion in the first budget he was involved with in 1983.
"We're walking a fine line here where we have to be sensitive to the needs of the population that we're talking about here, served by Medicaid," said Buchy, a Republican from Greenville. "While at the same time being able to have the wherewithal to pay for it."
Associated Press Writer Ann Sanner in Columbus contributed to this report.