This is actually not too surprising. First. under costbased reimbursement. hospitals found it easier to cross subsidize the care they provided to those without insurance by creative accounting and increasing charges to those insurers who paid full charges. Second. the community and migrant health center network provided a backstop for those who fell through the Medicaid safety net for nonhospital care. And. third. with health care costs skyrocketing throughout the seventies. there was little opportunity for States or the Federal Government to reassess the program while everyone was running fast simply to meet the bill for the program. But now the limitations of Medicaid need to be reviewed.