The Affordable Care Act requires health insurers to pay a tax to help funded the implementation of the law.  Over the past four years, this tax totaled $150 billion.  The tax is based on an insurers market share and expected to raise premiums up to 2.5% for individuals who purchase individual insurance.  Now, health insurers are attempting to recoup that expense by cost shifting within its Medicaid contracts with state and federal governments.  Some estimates suggest this cost shifting may add $36 to $39 billion to the cost of Medicaid over the next decade.