President’s health care law highlights ‘a conflict of visions’

June 29, 2012

James Pethokoukis of the American Enterprise Institute says that with its decision yesterday on the president’s health care law, the U.S. Supreme Court has just turned the 2012 election into “a conflict of visions”—market capitalism versus Obamanomics.

Indeed, the reactions to yesterday’s decision were fairly predictable. Those on the left had good things to say about the decision and/or the law. Those on the right, not so much.

From the left, praise came from the likes of the National Education Association, the Service Employees International Union and several other labor unions, the Economic Policy Institute, the Center for American Progress, Planned Parenthood, Michael Moore, the Oklahoma Policy Institute, the National Abortion Rights Action League, the Human Rights Campaign (which advocates for lesbian, gay, bisexual and transgender rights), the National Organization for Women, People for the American Way, the Tulsa World, The Nation, People’s World, the American Civil Liberties Union, the American Federation of Teachers (AFL-CIO), state Sen. Al McAffrey, state Sen. Tom Adelson, state Rep. Mike Brown, several members of the Religious Left, and Oklahoma Democratic Party chairman Wallace Collins. Even President Obama himself took time to celebrate (albeit in a manner unbecoming of the President of the United States; don’t let your children click here).

From the right, criticism came from the likes of The Heritage Foundation, the Cato Institute, the Family Research Council, the Oklahoma Council of Public Affairs, National Review, The Weekly Standard, The Wall Street Journal, Sen. Tom Coburn, Sen. Jim Inhofe, Oklahoma Attorney General Scott Pruitt, state Rep. Mike Ritze, the Ethics and Religious Liberty Commission of the Southern Baptist Convention, Americans for Tax Reform, the National Right to Life Committee, the American Legislative Exchange Council (ALEC), Americans for Prosperity, Concerned Women for America, the National Taxpayers Union, various Tea Party organizations, and Oklahoma Republican Party chairman Matt Pinnell.

As this conflict of visions unfolds, what should state policymakers do? Opinions differ, but The Washington Free Beacon reports today that Louisiana Gov. Bobby Jindal “will not implement any part of the controversial healthcare law, including state insurance pools and Medicaid expansion. ‘We’ve refused to set up the insurance exchanges, and we’re not going to start implementing Obamacare [now],’ he said.”

For his part, Wisconsin Gov. Scott Walker said bluntly: “Wisconsin will not take any action to implement ObamaCare.” Neither will Florida, according to Gov. Rick Scott.

“States have no requirement to implement any remaining parts of the federal health care law, including exchanges,” adds John Nothdurft, director of government relations at The Heartland Institute.

As state lawmakers consider what to do next, they should consider what moving forward with implementation could mean to their state budgets.

According to the Congressional Budget Office, the Medicaid expansion, if implemented in whole, was set to add 16 million new people to state Medicaid programs. The Supreme Court’s ruling allows states to decide for themselves whether they can afford to add millions of people to their already financially strained Medicaid programs. As the minority opinion explains, “acceptance of the offer will impose very substantial costs on participating States.”

It also brings up the question as to whether states should move forward on implementing health insurance exchanges. As a Heartland Policy Tip Sheet explains, “Financial assistance from the federal government will end by 2014, forcing states to try and find ways to compensate, increasing state spending.”

States should resist implementing these costly provisions and focus their efforts on restructuring their Medicaid programs with consumer-driven health care reforms that make it easier and more affordable for people to get quality health insurance.

Make no mistake, the president’s health care law—which Pethokoukis rightly says is “the purest synthesis of all the various experimental facets of Obamanomics”—is at the center of this conflict of visions. “State capitalism and top-down planning or market capitalism and bottom-up innovation. The Supreme Court has defined the choice.”

Brandon Dutcher can be reached at or