ACA Roadblocks: What’s Still Unknown

Healthcare, Politics

With President Obama sticking around for another term, it looks like the Affordable Care Act (ACA) is here to stay awhile. However, many questions remain concerning how — and if — the ACA program can be implemented as planned.

Medicaid Expansion: Where Do States Stand?

How the ACA will function in states not supporting Medicaid expansion remains to be seen. Several states have already stated that they will not participate in the costly program, while just as many support the experiment. A study by the Kaiser Family Foundation claims that the $1 trillion plan to expand Medicaid would raise state costs by only 3 percent and extend health coverage to more than 21 million low-income people, but many states claim they can’t afford the program. The Kaiser study also reports that Florida, for instance, will spend $8.9 billion over 10 years to insure an extra 1.6 million people if they implement the program. However, if Florida opts out, Obamacare still makes it easier for people to apply and qualify for Medicaid, costing Florida several billion whether they implement the Medicaid expansion or not.

Will Everyone Be Ready Next October?

States have until December 14 to decide whether they will run their own healthcare exchanges — on their own or with federal help — or leave the federal government to run the show. Enrollment is scheduled to begin October 2013 so that the ACA can be fully operational by 2014. Many states — often citing lingering questions — will opt for a federally-run exchange to save some headache.

What About the Deficit?

Ongoing pressures to curtail the federal budget deficit (especially for Medicare and Medicaid) will only strengthen the resolve to hold down states’ Medicaid expansion under the ACA. Many studies claim that federal funding for Medicaid expansion will actually provide an economic boost to states. Many argue this is just increasing the federal deficit. Others see states getting money back from the feds as a good thing.


Dozens of plaintiffs have filed suits claiming aspects of the ACA are unconstitutional. While the Supreme Court upheld most of the ACA’s mandates in June, other issues have yet to be addressed on appeal, such as claims that President Obama’s healthcare overhaul violates the Constitution’s guarantees of religious freedom. The Supreme Court has asked a federal appeals court to reconsider its dismissal of claims that many would be required to go against religious beliefs by being forced to fund a healthcare system that funds abortions.

While many states seem dazed and confused — and sometimes outraged — as the Affordable Care Act rolls out, many are hopeful about the many jobs that could be (temporarily) created as a result. Whether or not our healthcare system becomes more efficient, the coming months will be a bit hazy as states learn the ropes of Obamacare.