“So, by refusing to go along with Obamacare’s Medicaid expansion and by blocking state-run exchanges, governors are not just saving state taxpayers money. They are potentially reducing future federal spending by as much as $1.5 trillion over the next ten years. While congressional Republicans have been reduced to taking symbolic repeal votes, and Mitt Romney struggles to determine whether or not the individual mandate is a tax, governors — and state legislators — have become the real heroes of the fight against Obamacare.”

“Much attention has been given to the argument that without the individual purchase mandate, other parts of the health care law would become unworkable. Much less attention has been given to the fact that without the states forced to be on board with the Medicaid expansion, the law’s health exchange subsidies might be fiscally unworkable. The Supreme Court may have just set in motion of chain of events that could lead to the law’s being found as busting the budget, even under the highly favorable scoring methods used last time.”

“The Roberts court declared this threat unconstitutional, finding that Washington could use the carrot (dangling new money) but not the stick (withdrawing old money). The states, when they initially signed up for Medicaid, could not have anticipated that Congress would one day enact a law that caused Medicaid to be ‘no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage,’ the Court reasoned.”

“For states, this is a clear winner – covering more individuals and saving budget dollars at the same time. For the taxpayer this is a nightmare. The taxpayer would save some money on the Medicaid expansions that would not take place (where the feds pay 90 percent of the cost) but they will pick up the full cost of the additional and generous insurance, bearing an additional $500 billion over ten years.”

“Medical specialists are urging regulators to slow implementation of an initiative funded by the 2010 healthcare law that aims to streamline care for some low-income elderly and disabled patients. “

“The health reform law changes that: It raises Medicaid rates for primary care to match those of Medicare for 2013 and 2014. That, the Obama administration hopes, will lure doctors to accept Medicaid patients — and also prevent some costly emergency room visits down the line. But there’s a problem: The payment boost runs out at the end of 2014. While the federal government estimates that it will spend $11 billion raising provider rates for 2013 and 2014, no additional federal funds are appropriated beyond that. There’s already some thinking, among the health-care provider community, that a fierce lobbying battle could play out as doctors look to turn a short-term pay boost into a permanent one.”

“As you may know, the Affordable Care Act raises taxes on pretty much everyone, directly or indirectly, in order to fund its expansion of coverage for the uninsured. Most of these new taxes are unwise policy. But one Obamacare tax increase stands out for sheer boneheadedness: the law’s tax on insurance premiums, a provision that will raise taxes paid by the government itself, and make insurance less affordable.”

“The Patient Protection and Affordable Care Act (PPACA) is designed to extend health-insurance coverage to tens of millions of uninsured Americans. Rarely is it mentioned, however, that Medicaid, the government-run health-insurance program for the poor, will provide more than half of that new coverage under the law. The PPACA assigns Medicaid this central role, despite long-standing concerns about Medicaid’s costs and the quality of its care.”

“This means that by 2020, Medicaid enrollment will reach 85 million, or approximately one in four Americans. This level of dependence distorts the original purpose of the government program, which was intended to serve as a safety net for only the most vulnerable. As a result of the expansion, the report shows, Medicaid spending between 2011 and 2020 will increase under Obamacare by $619 billion. The federal government will initially pay for most of the new spending, totaling $572 billion. But the expansion will increasingly strain state budgets as well, since the federal contribution decreases overtime. The Medicaid expansion will bring total state Medicaid spending to $2.3 trillion through 2020.”

“About 16 million people — half of the 32 million who are expected to get health coverage under the new health law — will be enrolled in Medicaid in January of 2014, with almost no changes to improve or modernize the cumbersome, complex, and wasteful program. This large Medicaid expansion could have catastrophic effects on those who provide society’s health care safety net.”