Three-quarters of emergency physicians say they’ve seen ER patient visits surge since Obamacare took effect — just the opposite of what many Americans expected would happen.

A poll released today by the American College of Emergency Physicians shows that 28% of 2,099 doctors surveyed nationally saw large increases in volume, while 47% saw slight increases. By contrast, fewer than half of doctors reported any increases last year in the early days of the Affordable Care Act.

Such hikes run counter to one of the goals of the health care overhaul, which is to reduce pressure on emergency rooms by getting more people insured through Medicaid or subsidized private coverage and providing better access to primary care.

A major reason that hasn’t happened is there simply aren’t enough primary care physicians to handle all the newly insured patients, says ACEP President Mike Gerardi, an emergency physician in New Jersey.

In the 34 states that did not establish Obamacare exchanges, Governors nervously await a Supreme Court ruling that could throw their health insurance markets into chaos. Meanwhile, many of the Governors who did establish exchanges are regretting their decision.

More than five years after its enactment, Obamacare has proven a bitter brew for many states. Nowhere is this more evident than in health care exchanges.

Exchanges began as a figment of Washington’s imagination. The fertile minds of health policy analysts had conjured a bewildering system of cross-subsidies that involved charging young people unfairly high premiums to reduce premiums for older workers, overcharging healthy people to subsidize unhealthy ones, taxing middle income people to subsidize lower-income people (what the President likes to call “middle class economics”), cutting Medicare to enlarge Medicaid, taxing the uninsured for being uninsured, taxing employer-sponsored health plans and taxing employers for not sponsoring health plans, all garnished with tens of billions in new taxes on medicines, medical “devices” (everything from tongue depressors to defibrillators) and, of course, on health insurance itself.

On March 4, 2015, the U.S. Supreme Court heard oral argument in King v. Burwell,[1] a tremendously important case involving the administration of the Patient Protection and Affordable Care Act, also known as Obamacare. King is important for a number of reasons. It’s important because a lot of money is at stake.[2] It’s important because it may require fundamental changes to be made to Obamacare.[3] And it’s important—indeed, perhaps it’s most important—because of its significant implications for the rule of law. In this Essay, I explain why the president’s actions in King were unlawful and why a ruling striking down the president’s actions is crucial to ensure the continued vitality of the rule of law.

From the early days of the Republic, a core component of our constitutional character has been the idea that our government is a government of laws and not of men.[4] This means that our leaders—elected and appointed—are constrained by the words in our statute books and in our Constitution.[5] Government officials must follow the law, even when their personal predilections would lead them in a different direction. This prevents arbitrary decision making and keeps executive discretion within proper bounds.