By J. Robert McClure, PhD., President & CEO of The James Madison Institute and John Q. Seibler, JMI Intern
Posted July 17, 2012
Floridians are finally discovering what’s in the Affordable Care Act (ACA), which is also known as “Obamacare.” Details of this 2,700-page bill were shrouded in mystery from its inception. Indeed, as then-House Speaker Nancy Pelosi famously remarked, “We have to pass it to find out what’s in it.”
Now that Americans are learning more about the ACA’s specific provisions, however, public opinions polls suggest that they aren’t exactly enthusiastic about what they see. Indeed, public approval has decreased over time, and the law is still a point of contention among Democrats and Republicans.
Currently, polls show that 50 percent of Florida’s voters oppose the U.S. Supreme Court’s decision upholding the constitutionality of most of the law, while only 39 percent agree with the Court’s ruling. Moreover, a mere 20 percent of the poll’s respondents said they think Obamacare will improve their health care, and 47 percent said they think it will get worse.
The partisan divide is especially evident in this national poll: 
For states already burdened by the rising cost of the current Medicaid program, there was one silver lining in the U.S. Supreme Court’s majority opinion on Obamacare: A 7-2 majority of the justices ruled that the federal government may not threaten to withdraw its share of the funding for the current Medicaid program in order to coerce the states into taking part in the greatly expanded Medicaid program contemplated by the law.
In addition, the law itself stops short of forcing states to set up health insurance exchanges – basically a menu of available coverage. In the states that refuse to do it, the federal government will step in and set up the exchanges.
No doubt this comes as a relief to Florida Governor Rick Scott, who has repeatedly declared that “Florida will not implement two provisions of the U.S. healthcare law involving an expansion of Medicaid for the poor and creation of a private insurance exchange.” Wisconsin’s Gov. Scott Walker and Louisiana’s Gov. Bobby Jindal have taken the same position.
Even so, resisting the law may be an uphill battle – especially in the long run if it’s not repealed within the next year or so. That’s why these governors have said they hope the law is repealed before it takes full effect in January 2014. At which time, Governor Scott says, “Florida will comply with the law if it remains in effect.” However, he remains adamant that “the healthcare law would not aid economic growth,” adding that, for now, “since Florida is legally allowed to opt out, that’s the right decision for our citizens.”
Does the ACA offer any advantages for Floridians?
Obamacare would potentially add hundreds of thousands of currently uninsured residents to the Medicaid rolls, including those with pre-existing conditions and families that could previously not afford health insurance. Proponents argue Governor Scott is mistaken to turn down the millions of dollars the federal government would provide to implement the expansions and set up the exchanges. He disagrees, arguing “That’s still Florida tax payers paying that, it’s not like there’s free federal money. Every program cuts back, and you create this dependency [on federal grants], and then they cut back like they did with our schools.”
What will Floridians lose because of this law?
Critics of the law say one thing Floridians will lose is some of their individual liberties. The law includes economic penalties in the form of 18 new taxes and/or increases in existing taxes – and that’s just those on the surface of this legislation. Meanwhile, the real devil is in the details. Here is just one of the dangers written into the 2,700+ pages of this legislation. From the Goldwater Institute:
“In 2010, the Patient Protection and Affordable Care Act (PPACA) created the Independent Payment Advisory Board, or IPAB. When the unelected government officials on this board submit a legislative proposal to Congress, it automatically becomes law: PPACA requires the Secretary of Health and Human Services to implement it. Blocking an IPAB “proposal” requires at a minimum that the House and the Senate and the President agree on a substitute. The Board’s edicts therefore can become law without congressional action, congressional approval, meaningful congressional oversight, or being subject to a Presidential veto. Citizens will have no power to challenge IPAB’s edicts in court…. IPAB may be the most anti-constitutional measure ever to pass Congress, and it is therefore tempting to dismiss IPAB as an absurdity that the body politic will soon reject. Until that occurs, IPAB will potentially empower just one unelected government official to impose any tax or regulation, to appropriate funds, and to wield other lawmaking powers.”
What’s next for the states in this ongoing battle?
There are currently numerous efforts to repeal the law. That decision ultimately will be up to the next Congress. Indeed, the U.S. Supreme Court’s majority opinion, Chief Justice John Roberts explicitly said that this is an issue for the nation’s elected officials rather than its appointed judges to decide. That ruling was a setback for the states and other entities that had filed lawsuits and amicus briefs challenging the law, which the Goldwater Institute aptly termed “the greatest expansion of federal involvement in medicine since the creation of Medicaid and Medicare.” Moreover, as noted by Florida’s U.S. District Judge Roger Vinson, who had ruled portions of the law unconstitutional, the real issue “is not really about our health care system at all. It is principally about our federalist system” and “the Constitutional role of government.” 
Although Florida took the lead in challenging the constitutionality of this law, many other states joined in, as this chart shows.  Moreover, after the Court’s ruling, different lawsuits were filed challenging Department of Health and Human Services regulations that required employers’ health insurance plans to cover certain kinds of procedures – including contraception – that are contrary to the religious beliefs of Catholics and various faith-based entities. Therefore, as early as next June, the ACA – if it’s not repealed by then — may once again be the subject of a highly anticipated ruling from the nation’s highest court.
 Goldwater Institute. Independent Payment Advisory Board. (also: Coons Vs. Geither) http://goldwaterinstitute.org/article/independent-payment-advisory-board-ppacas-anti-constitutional-and-authoritarian-super