Written By: Sen. John Thune, Rep. Kristi Noem and Gov. Dennis Daugaard

On the eve of the second anniversary of the passage of the sweeping health care law, Americans are evaluating the impact the law has had on cost and quality of care in our country. When Washington began debating changes to health care in this country, Americans were promised legislation that would lower costs and improve care.

Instead, Americans have discovered that this partisan law — which represents the largest expansion of government in half a century — will do exactly the opposite, and at an astonishingly high cost to taxpayers. In fact, just last week the nonpartisan Congressional Budget Office confirmed that the cost to taxpayers has increased significantly compared to the estimate that was issued by CBO when the law was passed in 2010.

President Obama promised Americans that his law would cost around $900 billion over 10 years, while somehow simultaneously reducing the deficit. Instead, the cost estimate has ballooned to $1.76 trillion. The artificially low cost was largely the result of accounting tricks, including delaying full implementation of the law until 2014, used to make the bill appear less expensive under the CBO’s standard 10-year budget window.

After strong-arm tactics, which included backroom deals and rushed votes, Americans were left with a law that not only leaves Americans facing health care costs that will increase faster than if no legislation had passed, but that also saddles states with additional costs the federal government was unwilling to bear.

One of the most constitutionally questionable facets of the law is its burdensome requirement that states must expand their Medicaid programs. This requirement will force states to add beneficiaries to their Medicaid rolls, even if a state objects.

In South Dakota, the cost of this Medicaid expansion is nearly $100 million from 2014 through 2019, and will cost tens of millions more beyond 2019. This obligation forced upon the state leaves fewer dollars for K-12 education, law enforcement, and other existing state programs. Even worse, the health law also prohibits the state from making changes to the program in an effort to increase efficiency.

This inflexibility and the mandate itself may result in rate cuts to health care providers. Providers who cannot absorb these cuts may stop taking people eligible for Medicaid or may stop providing services altogether. This would have a detrimental effect on our very rural state, particularly on those who rely on Medicaid.

In addition to the Medicaid mandate, the law requires either that our small state establish a health insurance exchange, or allow the federal government to force a federally-operated exchange upon us. In either case, this will undoubtedly add further costs to be borne by our citizen consumers.

Most Americans agree that this law will not deliver on the promises made by the law’s supporters. According to a recent Gallup poll, 72 percent of Americans expect that the law will not improve health care in this country, and 75 percent of small businesses that offer health insurance to their employees do not believe the law will slow the rise in health care costs. In fact, a report from the McKinsey Group found that more than 50 percent of employers with high awareness of the law say they will stop offering health insurance coverage to their employees as a result of changes made by the law.

Further, Americans of all political stripes believe the centerpiece of the health care law, the requirement to purchase health insurance even if they can’t afford it, or face a penalty or tax, is unconstitutional. The Gallup poll found that 72 percent of Americans believe this provision is unconstitutional, with over 50 percent of Democrats agreeing.

The constitutionality of the individual mandate is at the core of the case that the U.S. Supreme Court will hear next week. The Supreme Court has dedicated an unprecedented amount of time — six hours instead of the usual one — to oral arguments in order to determine whether various aspects of the health law are constitutional. The last time the court took six hours to hear a case was in 1966.

Whatever the outcome of the Supreme Court case, we believe that the burdens on South Dakota and other states and the unprecedented intrusion into the pocketbooks of all Americans, coupled with the stark reality of rising health care costs and lower quality of care, mean that Congress should repeal this law and start over with solutions that actually lower costs and improve access to health care.

U.S. Sen. John Thune, 51, U.S. Rep. Kristi Noem, 40, and Gov. Dennis Daugaard, 58, all represent the state of South Dakota.