I don’t think there’s much question the biggest lie that’s been widely told about the Affordable Care Act is the McCaughey/Bachmann/Palin “death panel” meme. I mean, it’s just a total fabrication. And the second biggest lie is probably the “government takeover of health care” bit.

But number three is likely the claim, asserted against all the available evidence, that “ObamaCare” will involve a monstrous expansion of the federal budget deficit. So today’s news via Jonathan Cohn is worth repeating and emphasizing:

The Congressional Budget Office just published a newly updated estimate of the Affordable Care Act and its impact on the budget. The estimate largely tells us what we already knew: The law, when fully implemented, will dramatically reduce the number of Americans without health insurance. It will also reduce the deficit.

This last part remains a big deal, if only because so many conservatives—and, yes, so many members of the public—refuse to believe it. Over and over again, you hear people saying that Obamacare will run up the deficit. The CBO, which is our most reliable guide on such matters, begs to differ….

But this latest CBO estimate comes with an asterisk previous ones lacked. Thanks to the Supreme Court, states are more likely to opt out of the law’s expansion of Medicaid. The non-participation of some states won’t worsen the budget picture: If anything, the federal deficit should come down even more if some states keep their Medicaid programs as they exist today, with more limited enrollment. But if states don’t participate int he expansion, more Americans will end without health insurance.

The whole idea behind the ACA was to expand coverage and begin reducing the health care cost spiral associated with inefficient cross-subsidies, insurance abuses, and archaic ways of practicing medicine–ultimately getting control of both public and private costs, without just shifting them to other levels of government or to Americans as consumers. That should happen if ACA is allowed to be fully implemented. Rejecting the Medicaid expansion just adds injustice to an already screwed up system.

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Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.