States would irrevocably surrender critical aspects of their sovereignty if they agree to either of these new programs. Once you’re in, a state’s programs must not only conform to the words of the Obamacare statute—the 2,700-page Affordable Care Act—but must also comply with all regulations issued by HHS. New regulations are coming out all the time (such as the now-infamous HHS contraception mandate), so the federal government has a blank check to profoundly change the system anytime it chooses.
Among other things, healthcare providers will become subject to vast new regulatory regimes in those states. Doctors and providers in those states will be far more limited in how they can practice medicine, especially if they want to be reimbursed for their services.
As a consequence, you’ll see two mass migrations after Obamacare’s major provisions go into effect in 2014.
First, states that adopt these massively-expanded entitlements will become magnets for low-income people. Many will choose to move to states where they can get “free” healthcare—meaning healthcare paid for by other people.
Second, doctors and healthcare providers will flock to states that resist these big-government programs, since doctors will be free there to practice medicine as they know best, without bureaucratic controls. So “Obamacare states” will see a growing shortage of doctors, while free-market states will see an increasing abundance of doctors. This trend will only accelerate if these states also enact medical tort reform and other pro-doctor laws.
States that have officially said no to Obamacare include: Alabama, Alaska, Georgia, Indiana, Iowa, Kansas, Louisiana, Maine, Missouri, Nebraska, Ohio, South Carolina, Texas, Virginia and Wisconsin. Undecided states include Arizona, Idaho, New Jersey, Oklahoma, Pennsylvania, and Tennessee.
(read full article)