On June 28, the Supreme Court released its long awaited decision on the Affordable Care. Many, including me, were deeply disappointed by the Court's decision to uphold the healthcare law. In Texas, we are beginning to put together the pieces of what the ruling means for our state and what the next steps might be. Below are five issues Texas will face in the coming year and where I stand on the issues.

1. Should the state set up an insurance exchange?

President Obama's healthcare legislation called on the states to set up exchanges in order to sell health insurance. These exchanges would categorize and compare different insurance programs that meet the requirements of the individual mandate. If the state does not set up an exchange, the federal government will do it for us. While it is tempting to try to act before the feds act for us, any control over the exchange would be extremely limited. Even if the state sets up an exchange, the federal government will dictate how we do it.

Additionally, I believe setting up an exchange is a disservice to an entire industry of Texans who already buy and sell health insurance. These business people, who have relationships with their clients, will be displaced. Twenty-five million individuals will not fit well into a one-size fits all matrix dictated by the government. I do not think the state should support this government takeover of a service already provided for in the private sector.

Finally, as someone who believes we should repeal the healthcare act, I think it sends a mixed message for our state to work to change the law while setting up an exchange at the same time.

2. Should the state expand Medicaid eligibility?

One bright spot of the Supreme Court decision is the Court's finding that the federal government cannot force states to expand who is eligible for Medicaid by withholding all Medicaid funds. Instead, new funds for newly eligible Medicaid recipients could be denied if states do not comply with the federal expansion requirements. While this is good news, it is not the end of the debate. The state will face pressure from many groups to expand Medicaid in order to reap additional federal dollars. What is important to understand is that expanding Medicaid would cost the state almost $27 billion in state funds over the course of 10 years with the potential cost to grow exponentially higher. Texas simply cannot afford to expand its Medicaid rolls.

3. How will the state afford care for illegal immigrants?

Under federal law, states are required to provide emergency care for anyone, regardless of immigration status. Experts estimate Texas spends $800 million a year in emergency care for illegal aliens. The healthcare act fails to address healthcare for illegal immigrants and offers no savings to the state. By failing to defend the border and to recognize the large costs to states from illegal immigration, the healthcare act ignores one of the biggest drivers for the increasing cost of healthcare in the United States.

4.What else will the federal government use its taxing authority to do?

While the Court struck down expanding the commerce clause as a way for the federal government to circumvent states' powers, it did uphold the healthcare law under Congress' power to tax. What other federal programs will now be pushed through taxation? As a state senator and strong supporter of limited government and the 10th Amendment, I will follow this issue closely.

5. How can we get rid of the law?

While many, including me, hoped the Court would strike down the law in its entirety that was not the case. The Court is rightfully limited in what actions it may take regarding legislation. The Court can only rule on the lawmakers' rights to enact policies and laws, not if those policies and laws are good or bad for our country. Ultimately, if you want to change the law, you must have a majority of lawmakers to change it.

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