The low-income insurance program garnered a dozen mentions during Wednesday night's debate, the first of three, as the candidates argued with some substance about whether moving Medicaid to a block grant model would be a good move.
For reference, Medicaid -- which frequently plays second fiddle to Medicare politically -- earned only three references across three debates between Obama and Sen. John McCain in 2008.
Obama charged that turning Medicaid into a block grant, which would place a hard cap on federal dollars given to states in exchange for greater flexibility in how they're spent, would lead to a 30 percent cut to the program. Romney's running mate, U.S. Rep. Paul Ryan, has included a Medicaid block grant in his House budget the last two years.
According to estimates from the Kaiser Family Foundation, Ryan's plan could save the federal government and state governments as much as $750 billion combined over the next decade. But the estimated cuts to enrollment could lead to as many as 13.8 million people (out of 52 million current enrollees) losing coverage.
"Governors are creative. There's no doubt about it. But they're not creative enough to make up for 30 percent of revenue on something like Medicaid," Obama said. "What ends up happening is some people end up not getting help."
Romney countered that the block grant idea has seen bipartisan support in the past -- though 17 Democratic governors sent a letter to Ryan in 2011 stating their opposition to his plan. Romney would cap federal Medicaid spending at the previous year's levels, plus inflation, plus 1 percent, he said.
The block grant concept does have broad support from GOP governors. At least five said, after the Supreme Court's ruling on the Affordable Care Act (ACA), that they would consider expanding their Medicaid rolls in exchange for a block grant.
"One of the magnificent things about this country is the whole idea that states are the laboratories of democracy.," Romney said. "Don't have the federal government tell everybody what kind of training programs they have to have and what kind of Medicaid they have to have. Let states do this."