“Missouri voters dealt Obamacare a significant setback yesterday, approving a statewide ballot measure by an overwhelming 3-to-1 margin. The vote was the first time citizens had an opportunity to cast a ballot on the unpopular health care law. Missouri’s measure prohibits the federal government’s enforcement of the individual mandate to buy health insurance. The victory sends a strong message about Obamacare in a bellwether state.”

Missouri voters overwhelmingly passed a referendum prohibiting ObamaCare’s individual mandate. About 3 in 4 voters rejected this key provision, which would force individuals to buy health insurance or pay a tax.

Even though ObamaCare was thousands of pages of legislative text, tens of thousands more pages of regulations are required to be written to implement the new law. Much of that is at the discretion of Administration bureaucrats and state officials. “Congress has left some of the most difficult decisions about health care reform to state insurance commissioners — handing a group of relatively obscure officials enormous power over the implementation of the law and the success or failure of President Barack Obama’s signature legislative achievement.”

ObamaCare will raise costs for existing insurance policies. The state of Arizona recently notified employees that their costs will go up as a result of the new law. “The Department of Administration cited federal health reform as the reason the state’s health plans will carry ‘greater expenses and higher premiums for members,’ according to a June 30 letter sent to about 135,000 state and university employees and their dependents.”

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.”

Maine’s Insurance Commissioner is requesting an exemption from the onerous new “medical loss ratio” regulations in ObamaCare. It would likely force one of the state’s larger insurers out of the market, greatly restricting choice and competition.

The Patient Protection and Affordable Care Act represents more than a federal takeover of health care; it is a direct threat to federalism itself. Never before has Congress exercised its power under Article I, Section 8 of the Federal Constitution to force American citizens to purchase a private good or a service. Congress is also intruding deeply into the internal affairs of the states, commandeering their officers, specifying in minute detail how they are to arrange health insurance markets within their borders, and determining the products that will be sold to their citizens. If allowed to stand, this unprecedented concentration of political power in Washington will reduce the states to mere instruments of federal health policy. State legislatures and sympathetic Members of Congress should consider (among other actions) crafting a constitutional amendment to guarantee the personal liberty of every citizen in the area of health care. Given the trajectory of federal policy, state officials should take the lead in the next phase of the national health care debate, reclaim their rightful authority, and change the facts on the ground for Congress and the White House.

“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.”

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.