The conservative case against Obamacare can take a lot of different forms but it often focuses on the expansion of government regulation and spending.
Obamacare significantly expands the government’s oversight of the health care system. For the first time ever, the feds have the authority to require health insurers to accept all customers and offer them a specific set of health benefits. In Medicare, Obamacare creates the Independent Payment Advisory Board, or IPAB, which has unilateral authority to cut the rates that Medicare pays.
Conservatives argue that this is the wrong way to go about health reform: by requiring so much uniformity in the market, it could stifle innovation. Many of their policy alternatives include a bigger role for more consumer-driven healthcare plans — ones that give enrollees a set amount of money, rather than covering a standard set of benefits. Research shows these types of health plans tend to result in lower spending — although they do raise some concerns about patients skipping out on needed care to save money, or getting tricked by insurers into buying plans that don’t cover their needs.
Second, conservatives see Obamacare as an unsustainable spending commitment for federal and state governments. The health law’s insurance expansion costs over $1 trillion over the next 10 years. While Obamacare contains spending cuts and tax increases that appear to cover those costs, there’s worry (some of it shared by federal officials) that these painful policies won’t work as intended — or will be reversed by future congresses.
This concern is especially acute with the Medicaid expansion, which, for many states, is already their largest budget item. The federal government covers the majority of the expansion’s costs (93 percent, the Congressional Budget Office estimates, in the first decade), but many state legislators worry that, in the future, the federal government will cut that spending and leave them to pick up the tab.