Dr. Don Berwick will be recess appointed as head of the Centers of Medicare and Medicaid Services, without even a single committee hearing. “This way, Berwick will assume his post without having to explain statements such as this: ‘Cynics beware, I am romantic about the (British) National Health Service; I love it.’… Obama could have announced his CMS appointment at any time after winning the election in November 2008 if it were so urgent, but he waited almost a year and a half — until April of this year — to name Berwick. Conveniently, this was after the health care law had already passed. Had he appointed Berwick during the health care debate, it would have exposed how much Obama’s ultimate vision for U.S. health care borrows from the British model.”

“If implemented as enacted, Obamacare will impose significant new Medicaid costs on states and constitute a major federal usurpation of long-standing state authority in regulating private insurance. This will be expensive and disruptive for those Americans who rely on individual or employer-based insurance for their health insurance. While some of the most expensive and disruptive provisions of the massive legislation do not take effect until 2014, other provisions are already going into effect and state lawmakers need to act right away if they are to implement their own Medicaid and private insurance market reforms to mitigate the harmful effects of Obamacare. State lawmakers must recognize that states are not mere agents of the federal government. They are not powerless, and there is nothing that requires them to assist in implementing this new, misguided federal health care agenda. They should assert their rightful authority, and represent and protect their citizens by resisting the disruptions entailed in Obamacare—taking actions that pressure the next Congress to scrap or redesign this harmful federal legislation.”

Dr. Don Berwick will now head the Centers for Medicare and Medicaid without Senate confirmation, or even a single hearing, after Obama’s recess appointment. “The recess appointment was somewhat unusual because the Senate is in recess for less than two weeks and senators were still waiting for Dr. Berwick to submit responses to some of their requests for information. No confirmation hearing has been held or scheduled.” Berwick would have had to face tough questions about his views on rationing and his support for the British socialized health system, which would have been difficult since ObamaCare was guaranteed to not limit Medicare benefits.

ObamaCare is predicted to result in over 30 million more Americans getting insurance, but what exactly does that mean if they don’t have access to actual medical care? Emergency rooms are expected to be severely overcrowded because of the law, even though they are currently over capacity. “The biggest users of emergency rooms by far are Medicaid recipients. And the new health insurance law will increase their ranks by about 16 million. Medicaid is the state and federal program for low-income families and the disabled. And many family doctors limit the number of Medicaid patients they take because of low government reimbursements.”

The history of federal health-care programs shows that costs have surpassed estimates by tremendous margins.  The exception has been the Medicare prescription drug program, which has controlled costs by injecting the sort of private competition and choice that ObamaCare would dramatically diminish.

ObamaCare’s mandate that states reimburse primary-care doctors under Medicaid at the same rate as under Medicare, creates a funding cliff in 2015 — when the federal government’s promise to pick up the tab would expire, leaving states on the hook for an estimated $5.5 billion a year.

If not repealed, ObamaCare would expand and cement a system that is replete with fraud, without getting serious about reducing that fraud.

Medicaid mandates under Obamacare leave states with an unpleasant choice.

President Obama’s pick to head Medicare and Medicaid highlights the choice we face regarding Obamacare: repeal or rationed care.

Richard Epstein argues that ObamaCare would unconstitutionally coerce the states.