“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.

State budgets are already in the red, and ObamaCare saddles them with new costs for Medicaid expansions and to establish and implement new insurance exchanges.

“I note with special sadness that first and foremost amongst the bill’s consequences will be the probable demise of the Healthy Indiana Plan (HIP). This program is currently providing health insurance to 50,000 low-income Hoosiers. With its Health Savings Account-style personal accounts and numerous incentives for healthy lifestyle choices, it has been enormously popular and successful. Obamacare’s expansion of Medicaid, soon to cover one in every four citizens, will not only scoop up most of HIP’s participants, but will also cost the state between $3.1 and $3.9 billion over the next decade. It is hard to see how my successors as governor will be able to avoid a steep state tax increase to pay for it.”

The presidents of Texan medical schools are concerned about new costs from ObamaCare that will cause them to train fewer doctors. Teaching hospitals rely on Medicare and Medicaid patients, and they will be reimbursed less per patient by the government according to ObamaCare’s new payment schedules. Given that new insurance subsidies will drive up the demand for medical services, a restriction in supply could result in higher premium costs or rationing of care.

“Under Obamacare, Medicare and Medicaid can be expected to add 35-40 million enrollees in the next ten years, with cost projections amounting to a 35 percent increase of the current state burden of $190 billion. States will face massive cost-sharing increases, with a disproportionate increase in the Mountain States.”

Nationally, over half of those newly insured by ObamaCare will be added to Medicaid. This government-run program reimburses doctors at such low rates, that many providers refuse to treat enrollees. “The Kentucky Hospital Association said in a report on Monday that Kentucky hospitals will lose $1.2 billion in revenues in the next 10 years because of health care reform. Because Kentucky has one of the lowest income levels in the nation, the majority of uninsured Kentuckians will be covered under Medicaid rather than private health insurance, leaving the state with 25 percent of its population on Medicaid, the report said. Medicaid is jointly financed by federal and state tax dollars.”

“Indiana’s Medicaid chief told lawmakers Thursday that the federal government has largely left states in the dark on implementing the federal health care overhaul because it hasn’t yet provided needed guidelines. Medicaid Director Pat Casanova told the Health Finance Commission that key parts of the overhaul take effect in 2014 — about 3 1/2 years away — but states will need several years to pass their own rules and implement the overhaul.”