“The Supreme Court has spoken, but problems built into the Affordable Care Act (ACA) have not been resolved by the decision and may have worsened. Even accepting the law’s assumptions about how the health system should be reformed, actually putting all the pieces in place is exceptionally expensive and difficult. If President Obama wins a second term, fiscal pressures and practical challenges will force him to scale back the unaffordable spending and slow down the unrealistic implementation timeline.”

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“Reconciliation allows a bill to pass the Senate in a limited time period, with limited amendments, and with only 51 votes; filibusters are not permitted. In 2010, Democrats split their health-policy changes into two bills, one of which they enacted through this fast-track process. In 2013, a Republican majority could use the same reconciliation process to repeal those changes.”

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“With Thursday’s Supreme Court ruling upholding President Obama’s landmark health-care law, debate has shifted to whether deadlines key to the law’s goal of expanding coverage to tens of millions of Americans will be pushed back. Some say states and the federal government are facing such complex technical and political realities that some deadlines need to be relaxed, including the Jan. 1, 2014, opening of online marketplaces where individuals and small businesses will be able to shop for coverage. And there may be pressure in Congress to delay some spending on the law to help reduce the federal budget deficit.”

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“When the Supreme Court upheld the Affordable Care Act in a 5-4 ruling Thursday, the American Medical Association was quick to release a statement in support of the ‘historic’ decision that will give more people access to health coverage.
But (and there’s always a ‘but’) medical professionals across the country are wondering: When an additional 32 million Americans get medical insurance, who exactly is going to treat them?”

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“The Roberts court declared this threat unconstitutional, finding that Washington could use the carrot (dangling new money) but not the stick (withdrawing old money). The states, when they initially signed up for Medicaid, could not have anticipated that Congress would one day enact a law that caused Medicaid to be ‘no longer a program to care for the neediest among us, but rather an element of a comprehensive national plan to provide universal health insurance coverage,’ the Court reasoned.”

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“For states, this is a clear winner – covering more individuals and saving budget dollars at the same time. For the taxpayer this is a nightmare. The taxpayer would save some money on the Medicaid expansions that would not take place (where the feds pay 90 percent of the cost) but they will pick up the full cost of the additional and generous insurance, bearing an additional $500 billion over ten years.”

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“The Affordable Care Act will expand the reach of government into our personal health-care choices, while exacerbating the problems with our current health-care system. Market forces, if allowed to work properly, are the best means for reducing the growth in health costs, encouraging continued innovation, and ensuring that consumers have access to quality health care.”

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“Though the ultimate disposition of the case was disappointing, today could become a turning point of constitutional law, so long as the public maintains its current level of interest in the constitutional limits on congressional power that have been affirmed by the court. To see why, we need to step back.”

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“The Supreme Court’s ObamaCare decision is both a triumph and a tragedy for our constitutional system. On the plus side, as we have long argued in these pages and in the courts, the justices held that Congress’s power to regulate interstate commerce cannot support federal requirements imposed on Americans simply because they exist. The court also ruled that there are limits to Congress’s ability to use federal spending to force the states to adopt its preferred policies.”

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“What the Court has done is not so much to declare the mandate constitutional as to declare that it is not a mandate at all, any more than the mortgage-interest deduction in the tax code is a mandate to buy a house. Congress would almost surely have been within its constitutional powers to tax the uninsured more than the insured.”

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