Dozens of states are refusing to participate in the pro-abortion Obamacare scheme and several states have still yet to make a decision about it. Leading pro-life and conservative activists are calling on voters in states yet to decide to ask their governors to reject participation.
The Obamacare legislation does not contain and language preventing taxpayer funding of abortions and it contains the HHS mandate that compels religious groups to pay for drugs that may cause abortions.
Ken Klukowski, a legal analyst with the Family Research Council, breaks down the process of how states are deciding:
First, Obamacare expands taxpayer-funded healthcare under Medicaid. The one part of Obamacare that the Supreme Court struck down was the provision allowing the federal government to withdraw all Medicaid funds from states that decline to go along with the expansion. As a result, states can either stay with Medicaid as it currently is, for citizens up to 100% of the poverty line, or they can join Medicaid 2.0, which goes up to 133% of the poverty line, with billions of extra federal dollars to pay for much of the expansion, but leaving states to pay collectively $50 billion more per decade.
Second, Obamacare requires insurance exchanges where people can buy coverage, but the Constitution forbids the federal government from commanding the states to pass legislation or run a federal program. States must choose to do so.
If states set up the exchanges, then people between 134% of the poverty line and 400% of the poverty line can get taxpayers to subsidize their insurance—with massive subsidies at 134% of poverty and trailing off as income increases—and dropping to zero at 400%.
But the way the statute is written, those tax subsidies only flow through exchanges set up by a state. If a state refuses, then the U.S. Department of Health and Human Services (HHS) will set up the exchange, but there will be no subsidies. This issue is currently in court, where the states are very likely to prevail because of the plain wording in the statute and the clear legislative history that Democrats in Congress deliberately chose, in order to push states in the direction of choosing to create exchanges on their own.
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.
Tony Perkins, the head of the pro-life Family Research Council, says many governors are rejecting Obamacare.
“As we speak, conservative governors from across the country are meeting in Nevada with one burning question on their minds. Will they bar the door from ObamaCare or give in to the temptation to join the health care exchanges in their states?” he says. “Because of how the policy is structured, the road to ObamaCare leads straight through the governors’ desks. Based on the Supreme Court’s decision, the federal government has to implement the President’s program, but it cannot force states to run it.”
“With 60% of states under GOP management, 180 million people have plenty of reasons for optimism,” he said.
In fact, 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.
Perkins says there is a massive financial incentive for states to reject Obamacare.
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“That’s because there is absolutely no guarantee that the federal government will have the money to hold up its end of the bargain in states every year,” he said. “That opens up these governors to huge liabilities in the future. If Washington runs out of ways to finance its 90% share of the exchange, then it will simply transfer the burden to states. Governors who agree now are permanently putting their states on the hook for the 2,700-page law and the thousands of regulations issued by HHS in the years to come.”
“The deadline for the governors’ decisions is this week, although Republicans have asked for an extension. While this sounds like a no-brainier, even conservative governors have a lot to lose,” Perkins concluded. “Remember what happened to Governor Rick Perry when he zeroed out Planned Parenthood? The Obama administration retaliated by stripped his state’s Medicaid funding. There is no telling what the President will threaten by way of federal programs or assistance if states refuse to join his exchange. But if these governors have the strength to withstand the pressure now, they’ll be glad they did in five years, when other states are going bankrupt from the influx of poor people, the lack of federal help, the exodus of doctors to states without big government medicine, and the loss of sovereignty on a whole host of issues (like conscience).”