“The individual mandate may be getting more attention, but in a time of persistently high unemployment there needs to be just as much concern about the employer mandate. While these results are specific to Indiana, there are likely other states where small and mid-size businesses are responsible for a significant portion of the job growth. Reforming healthcare need not compromise jobs and small businesses, but unfortunately the Affordable Care Act will do just that.”

“Under the health care overhaul, the federal government will start taxing itself and the states beginning in 2014. And that’s giving state Medicaid directors heartburn. A report released Tuesday by the actuarial firm Milliman Inc. said the tax will cost the Medicaid program between $36.5 billion and $41.9 billion over 10 years. At least $13 billion will be borne by states, and at least $23.5 billion by the federal government, based on the state-federal Medicaid matching formula.”

“Nineteen rural state hospital associations have signed onto a letter urging President Obama to nix the healthcare reform law’s special deal for Massachusetts hospitals in his 2013 budget proposal next month. The hospital groups say a provision in the law shifts $367 million annually in Medicare funding from 49 states to the Democratic-led commonwealth. The provision’s aim was simply to increase Medicare payments for a single, 15-bed hospital in Nantucket but ended up raising payment rates for the state’s 60 urban hospitals by 8 percent.”

“Because, even if one were to accept the White House’s accounting (which one shouldn’t), that would mean that 22 states — roughly 40 percent of the country — are not ‘on their way’ toward erecting the Obamacare exchanges. Isn’t that a problem? Further, upon closer inspection, it’s clear that many of the 28 states that are supposedly ‘on their way’ really aren’t ‘on their way.’ That’s just comical White House spin, in which the truly inconsequential — the acceptance of minor federal grant money, or the setting up of a committee to “study” the question — is elevated into a sure sign that Obamacare is a fait accompli. It’s ridiculous.”

“That is, states must now accept a comprehensive reorganization of Medicaid or forfeit all federal Medicaid funding—even though the spending power is circumscribed to preserve a distinction between what is local and what is national. If Congress is allowed to attach conditions to spending that the states cannot refuse in order to achieve an objective it could not outright mandate, the local/national distinction that is so central to federalism will be erased.”

“Twenty-six states on Tuesday asked the Supreme Court to overturn the health care reform law’s mandatory state expansion of the Medicaid program, a sleeper issue in the health care reform lawsuit that could determine how much leverage the federal government has with the states on any issue.
The states, led by Florida, argue that the federal government can’t force them to expand the Medicaid program, which has operated as a partnership between the feds and the states, as part of the 2010 health reform law. They argue that the Medicaid expansion is possibly more coercive than the law’s individual mandate.”

“In an action with major implications for health reform in Michigan, the state House has voted to turn down — at least for now — nearly $10 million in federal funds to create a statewide health exchange by 2014 to sell more affordable, standardized health insurance to consumers and small businesses.”

“New Hampshire has a high percentage of Medicare Advantage enrollees. Last month, 7,600 of them received notices that their coverage was being cancelled. Obamacare and another federal law passed in 2008, the Medicare Improvement for Patients and Providers Act, are killing Medicare Advantage to steer senior citizens back into regular Medicare, which offers fewer choices and is more heavily controlled from Washington.
As a result, thousands of Granite State seniors are being forced to switch doctors because they have to switch coverage.”

“Before ObamaCare’s state-based high risk pool program—the pre-existing condition insurance plan (PCIP)—went into effect, critics (including me) warned that enrollment in the program would run high and that as a result the program would go over budget. In California, at least, it turns out that prediction was half wrong. Enrollment in the program is much lower than expected. But program administrators are now worried it might go over budget anyway.”

“State officials are pushing back hard against what they view as shortcomings in the healthcare reform law for fear they’ll be barraged with complaints when people have trouble affording insurance. Federal regulators are writing the rules governing key aspects of the law, including the guidelines to determine who’s eligible for subsidies to buy private insurance. Those benefits will be delivered through state-based exchanges, however, leaving state officials on the receiving end of angry phone calls if glitches in the law aren’t ironed out by 2014.”