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While the White House highlights their favorite parts of ObamaCare, the real work is being done in the depths of the federal bureaucracy. “Track two is the regulatory process, where Obamacare is sinking its roots deeper and deeper into the bureaucracy and the health sector. This is below the radar of most Americans, but the implementation rules are beginning to frighten many industry groups that thought their seat at the table would inoculate them against the wrath of the regulators.

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.

“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.

In addition to the direct costs of ObamaCare’s $500 billion in new taxes, there are also indirect costs from the new tax regulation. Section 9006 of the law puts vast new reporting requirements on businesses, forcing them to dramatically increase their administrative costs as they now have to report nearly every single business relationship.

By tying its subsidy program to the federal poverty rate, ObamaCare strongly discourages marriage. The level of subsidization is based on a family’s income as a percentage of the federal poverty level, which changes based on a person’s marital status. Thus two individuals living together would receive a substantial decrease in their subsidy were they to get married.

ObamaCare’s new tax on indoor tanning is now in effect, causing the 18,000 tanning salons around to country to worry about shedding jobs or going out of business.

Dr. Don Berwick will now head the Centers for Medicare and Medicaid without Senate confirmation, or even a single hearing, after Obama’s recess appointment. “The recess appointment was somewhat unusual because the Senate is in recess for less than two weeks and senators were still waiting for Dr. Berwick to submit responses to some of their requests for information.

Emergency room visits in Massachusetts have skyrocketed since their health care system was changed in 2006. “[E]xpanded coverage may have contributed to the rise in emergency room visits, as newly insured residents entered the health care system and could not find a primary care doctor or get a last-minute appointment with their physician.” ObamaCare will create similar results nationally, as its massive coverage expansion will exacerbate the existing doctor shortages.

Real health-care reform — of the kind that would lower costs, rather than raise them — would require increasing Americans’ control of their own health-care dollars and making prices more transparent, but ObamaCare would merely increase government control and funnel more of Americans’ money to insurers, whether they want it to go there or not.

As a doctor writes, a financial tsunami is on the way for everyone in the path of ObamaCare, and the overhaul’s squeezing of doctors, hospitals, and insurers would likely put America on the path towards a government-controlled health-care system and the decreased quality and availability of care that comes with it.