Louisiana lawmakers need not implement costly, unpopular law

The Supreme Court decision to uphold much of President Obama’s Affordable Care Act (ACA) was disappointing on several fronts. The ACA takes the wrong approach to expanding access and lowering costs, and it continues the unfortunate trend of concentrating too much power in the hands of a few. The law is particularly unpopular here in Louisiana, where people maintain a healthy skepticism towards Washington technocrats.

Much remains to be learned about the long-term legal and policy implications of the decision. Further, the law itself is still in the implementation process. But there are several key points in the decision that should be noted by Louisiana policymakers:

The federal government cannot bully states into expanding their Medicaid programs by threatening to withhold funds. Louisiana, with a large Medicaid-eligible population, is facing a fiscal disaster. The state Department of Health and Hospitals estimated expanding Medicaid enrollment would cost the state $7 billion over the first ten years of implementation. It now appears that Louisiana can avoid this onerous provision of the health care law by refusing to expand a program that is in desperate need of reform.

States do not need to implement insurance exchanges. Governor Jindal and the legislature acted wisely by not rushing to implement a state-based insurance exchange. While such exchanges will ultimately be funded by the states, their benefits are uncertain at best. There is no reason to move forward with implementation at this time.

Limits have finally been placed on the federal government’s use of the Commerce Power. Although this will not have an immediate impact, in the long run it could prove to be the most significant portion of the ruling. States could find new opportunities to challenge bad federal policy on Commerce Clause grounds.

Categorizing the insurance mandate as a tax provides voters with a degree of clarity in November. The ACA effectively imposes a tax hike on the middle class – something President Obama and his supporters took pains to deny they were doing. While the SCOTUS decision was important, voters will make the final decision on whether higher taxes, increased spending and more regulation will improve our health care system.


Although the Supreme Court let most of the ACA stand, Louisiana policymakers can still play an important role in the health care reform debate. Most importantly, they should refuse to expand the state’s Medicaid rolls and take a wait-and-see approach to state insurance exchanges.

Aside from not implementing these costly features of the ACA, policymakers should seek to introduce consumer-driven reforms at the state level and seek greater freedom to innovate from the federal government.

While Chief Justice John Roberts’ decision has been criticized on many fronts, one thing it did do is place the future of reform squarely in the political arena. Louisiana boasts a number of elected officials with health care expertise. Their voices should be heard as voters contemplate better alternatives to the expensive bureaucracy empowered with rationing Americans’ health care.