At a recent AEI conference entitled “Health Care Reform: An Initial Checkup,” experts from a range of sectors discussed the implications of the provisions of the PPACA that are already defined, and pondered the many that are not. The early morning discussion revolved around the new law’s impact on low-skilled workers, possible drag on future employment expansion, and additional strain placed on state resources. The mid-morning panel addressed the myriad of questions surrounding the regulatory rule-making sequence and speculated that a capricious system of penalizing employers could undermine the current employer based health coverage system.

Representatives from small to large businesses shared deep concerns that the law is setting up a complex and unsustainable system that does little to address the underlying cost of care. In contrast, the keynote delivered by Gov. Mitch Daniels [R-IN] highlighted a major initiative [Healthy Indiana Plan (HIP)] made in his state to inject more consumerism into health care to address the cost issue.

Each day that passes since the signing of the PPACA new and disturbing information surfaces pertaining to provisions buried in the bill or the regulations that should cause pause for policy makers. Going forward states should be aggressive in setting up a health exchange on their own terms that best serves their residents, instead of waiting for the federal government’s top down cookie cutter approach that is emerging.

In a Heritage Foundation report “Facing Obamacare: What the States Should Do Now,” Former Director of the Center for Medicaid and State Operations at the U.S. Department of Health and Human Services Dennis Smith lays out a few simple actions that States should take in the short-term in response to the new law.

  1. Make federal officials explain themselves in broad daylight.
  2. Insist on rational rule-making for Medicaid.
  3. Take the Feds to court, if necessary, to protect state interests.
  4. Keep citizens fully informed every step of the way.

Visit for full video of the AEI conference.