Research & Commentary: Pre- and Post-Election Health Care Decisions

Published October 25, 2012

As President Barack Obama and Republican nominee Mitt Romney vie for the presidency, state elected officials are preparing to determine which health care policies they should pursue with the future of the Patient Protection and Affordable Care Act (PPACA) dependent on the upcoming election.

Key decisions for states have been whether to implement a health insurance exchange and expand their Medicaid programs. Proponents argue these measures will allow for greater access to health care at lower costs. Opponents say that regardless of who wins the election, it will not be beneficial for states to take either step.

Health insurance exchanges consistently have failed to cut costs for consumers and state governments. In Utah’s health insurance exchange, for example, which is not subject to the heavy regulations of the federal health care law, health insurance was more expensive than on the open market. And Massachusetts spent more than $29.4 million in 2009 alone on the Commonwealth Connector, in addition to the program’s significant administrative costs.

Implementing a state-crafted exchange will not give a state greater authority over its health care system, because all exchange operations are subject to federal approval and oversight.

Similarly, expanding Medicaid programs will not benefit a state even if Obama is reelected and PPACA is fully implemented. According to a Heritage Foundation report, Medicaid populations in 33 states will increase by 30 percent and in 10 states by 50 percent if they go through with expansion. A study from Americans for Prosperity showed expansion would cost states approximately $21 billion just from 2014 to 2019, and full federal coverage of new enrollees will end in 2020, leaving states to pay the difference.

No matter who wins the presidency in November, states should not implement an exchange that will further bury their residents with higher health care costs, nor expand Medicaid, a program already proven financially unsustainable.

The following documents provide additional information about health insurance exchanges and Medicaid expansion.

Research & Commentary: HHS Final Exchange Rules
Heartland Institute Policy Analyst Kendall Antekeier explains the final health insurance exchange rules from the U.S. Department of Health and Human Services and identifies what information is still missing. She writes, “the final rules give no information regarding how a federally run exchange would function or how it would be funded.”

State Insurance Exchanges: The Case Against Implementation
Benjamin Domenech, a research fellow of The Heartland Institute and managing editor of Health Care News, provides several reasons states should avoid implementing a health insurance exchange. He writes, “Any exchange created to pass muster with HHS Secretary Kathleen Sebelius and the current rules within Obama’s law will be fundamentally flawed.”

Policy Tip Sheet—State Health Insurance Exchanges Post-SCOUTS
Heartland Institute Policy Analyst Kendall Antekeier outlines the arguments against state health insurance exchange implementation and provides facts about previously attempted exchanges. Antekeier writes, “If a state moves forward with implementing an exchange, it could invest valuable time and taxpayer dollars in developing a system only to discover it does not comply with final federal regulations.”

Medicaid: To Expand or Not To Expand
Nicole Kaeding of Americans for Prosperity argues states should avoid expanding their Medicaid programs because doing so would support the federal health care law, place heavy financial burdens upon the state, and extend an already-broken system.

The End of Federalism: How Obamacare Will Impact States
The Heritage Foundation outlines the consequences of expanding state Medicaid programs to match federal requirements.

Mario Loyola: Challenging the Constitutionality of Obamacare’s Medicaid Expansion
In a podcast for Coffee & Markets, Mario Loyola describes why he and many other analysts consider the federal health care law’s Medicaid expansion to be unconstitutional.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database at

If you have any questions about this issue or the Heartland Web site, contact Heartland Institute Manager of External Relations Kendall Antekeier at [email protected] or 312/377-4