“Dr. Donald M. Berwick, the new chief of Medicare and Medicaid, survived his first confrontation with Republican lawmakers on Wednesday, brushing aside criticism of the new health care law and denouncing efforts to repeal it.”

“The Patient Protection and Affordable Care Act (PPACA) will place unprecedented fiscal pressure on states, several of which are already suffering from multibillion-dollar budget deficits. Although many of the law’s most costly requirements will not take effect until 2014, some states are bracing for billions in new spending, while others have already started to take costly steps toward implementing the new law.”

The state of Texas is considering ending their Medicaid program entirely rather than dealing with new Medicaid costs from ObamaCare. The law’s “maintenance of effort” provisions prevent Texas from modifying eligibility requirements or implementing most other cost-saving measures. This could require new federal spending to offset the reduction.

“While hospital leaders admit the economy sparked this problem, it says the Obama Health Care Reform Act gave the hospital a one-two punch. While more people may soon get more health coverage, Obama’s plan cuts reimbursement dollars for hospitals at a time administrators say they could use them most.”

“The new health care law specifically targets reimbursement for new drugs and devices as a way to save money in programs like Medicare and Medicaid. These savings, in turn, are used to pay for new health coverage for the uninsured. But the legislation doesn’t take down drug and medical device prices directly. Rather, it creates a series of new agencies, boards, and authorities that separately will be empowered to construct new rules to impact how medical products are priced, as well as to restrict their use by defining when and if products are covered by insurance.”

“As the details of this massive government-led health care overhaul begin to trickle out, let me be clear (to borrow the president’s go-to phrase): The medical system is about to be overwhelmed because there are no disincentives for overuse.”

“In his ruling, Vinson criticized Democrats for seeking to have it both ways when it comes to defending the mandate to buy insurance. During the legislative debate, Republicans chastised the proposal as a new tax on the middle class. Obama defended the payment as a penalty and not a tax, but the Justice Department has argued that legally, it’s a tax.”

“Government, at both the federal and the state levels, is no longer merely an umpire. It is not just setting rules and impartially enforcing them, government all too often is taking sides and picking winners and losers. Overall, Americans accept and expect government as a regulator, but in the world of health care, it is also a purchaser and competitor. There are countless examples in Medicare and Medicaid in which the federal government and states have re-written the rule book to favor a particular hospital or type of provider, or block competition. Special accommodations that were justified (or rationalized) in the past as ‘one-time deals’ or ‘transitional’ somehow become embedded parts of the program.”

“When a federal program is hemorrhaging taxpayer dollars and delivering poor results, policymakers should reform it. Fundamental Medicaid reform is desperately needed. Market-based principles should be introduced to re-align incentives of doctors and patients so that quality can increase and cost can decrease. Instead of addressing the many problems of Medicaid, Obamacare doubles down on the broken program and greatly adds to its rolls.”

Texas doctors will be unable to accept new Medicaid patients under scheduled reimbursement cuts. ObamaCare further squeezes these physicians with more across the board cuts, which will lead to access problems.