“Republican Gov. Phil Bryant says the 2010 federal health care overhaul is slowing Mississippi’s economy because business owners are confused about how much it will cost them to meet demands of the law.”

“Since passage of the Affordable Care Act (ACA), the American Action Forum (AAF) has tracked the state of its regulatory implementation. To date, the ACA has imposed a total of $27.6 billion in new regulations – at least $20.4 billion in lifetime costs on private entities and $7.2 billion in increased burdens on state budgets. In this paper AAF examines how this $27.6 billion in new costs break down on a state-by-state level. The data show that five states will endure at least $1 billion in ACA regulatory costs.”

“The experts believed states would want to tailor the exchanges to their own populations. But the task has proved exceedingly complicated. Participating states must set up a call center as well as a Web site that allows people to easily find and understand health plans, in much the way that Orbitz and Travelocity help people find airline flights.”

“A D.C. board has voted to require individuals and small-business owners in the District to purchase their health insurance through the newly minted health exchange it oversees. The D.C. Health Benefit Exchange board approved the regulations late Wednesday, with just one modification to shrink the size of businesses that would come under the regulation.”

“The concerns are also damning in the context of the the normal tug of war between the states and Washington DC. That’s because in his testimony, Mr. Consedine states he wrote to HHS weeks ago and has not received a reply. While its’ not unusual for the Feds to stiff politically inconvenient inquiries, I am fearful that the reason why HHS seems unwilling to provide a timely reply is because it doesn’t know the answers.”

“PPACA is poised to radically expand Medicaid coverage beginning in 2014—adding to an already crushing state burden of Medicaid costs. The “perfect storm” of Medicaid overspending, excessive regulation, and PPACA expansion is leading to serious discussions among governors and state Medicaid directors about block-granting federal Medicaid funding in return for significant state flexibility in Medicaid program design and administration.”

“But as they gathered here this weekend at a meeting of the National Governors Association, most governors in both parties said that faced with a choice they did not expect to have, they needed to study how to proceed with this significant change in federal-state relations. Not all Democrats were leaping at the chance to expand their programs, and not all Republicans were ruling it out.”

“The Patient Protection and Affordable Care Act (PPACA) provides tax credits and subsidies for the purchase of qualifying health insurance plans on state-run insurance exchanges. Contrary to expectations, many states are refusing or otherwise failing to create such exchanges. An Internal Revenue Service (IRS) rule purports to extend these tax credits and subsidies to the purchase of health insurance in federal exchanges created in states without exchanges of their own. This rule lacks statutory authority. The text, structure, and history of the Act show that tax credits and subsidies are not available in federally run exchanges. The IRS rule is contrary to congressional intent and cannot be justified on other legal grounds. Because the granting of tax credits can trigger the imposition of fines on employers, the IRS rule is likely to be challenged in court.”

“If the courts were to accept Adler’s and Cannon’s argument, that could effectively enable states to kill federal exchanges by empowering them to cut off the subsidies. Without subsidies, the federal exchanges would not be economically viable because they couldn’t get as many people to sign up for coverage.”

“While the resistance of Republican governors has dominated the debate over the health-care law following last month’s Supreme Court decision to uphold it, a number of Democratic governors are also quietly voicing concerns about a key provision to expand coverage. At least seven Democratic governors have been noncommittal about their willingness to go along with expanding their states’ Medicaid programs, the chief means by which the law would extend coverage to millions of Americans with incomes below or near the poverty line.”