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.

If Tennessee’s, Maine’s, and Massachusetts’s ambitious attempts to expand health coverage through taxpayer subsidization are any guide, ObamaCare’s costs would soon spiral out of control.

Medicaid mandates under Obamacare leave states with an unpleasant choice.

Ohio taxpayers will be on the hook for $1.45 billion in new Medicaid spending over 10 years as part of the unfunded mandates of ObamaCare. This new spending comes as the state faces a $8 billion budget shortfall over the next two years.

A new report by Blue Cross Blue Shield of Massachusetts reports that low-income state residents could see their premiums jump up, as ObamaCare’s Washington-driven regulations overturn existing state systems. “The report reveals that, despite the promised increase in federal funding, some Massachusetts residents might end up facing higher premiums.”

Ohio’s state government came out with a new estimate of the effects ObamaCare will have on it’s Medicaid program. The massive expansion will cost taxpayers $1.45 billion in the first 5 years after it starts, in 2014. Given that Medicaid is currently a budget-busting problem for most states, this huge new cost will crowd out other spending, or force tax increases.

Gov. Daniels gave a presentation demonstrating how ObamaCare would hurt state budgets and undo many innovative and successful state reforms already in place. Under ObamaCare, the Healthy Indianans Program, which covers the uninsured, will be replaced with a forced expansion of the state’s Medicaid program, which will provide inferior care and reduce flexibility for consumers.

Indiana Governor Mitch Daniels expressed his dissatisfaction with ObamaCare during a speech at the American Enterprise Institute — claiming that the health-care overhaul is anything but “reform,” and stating that Indiana is “only just beginning to grapple — reeling might be the term — with what this will mean at the state level.”