Costly Calorie Counting. In his column today, AWB president Don Brunell lays out some of the lesser-known but not inconsequential costs associated with the ACA.

For example, tucked away in the 2,000-plus pages of the legislation is a requirement that restaurants and “similar” food retailers display calorie counts on their menus. Sounds reasonable in this health-conscious age, but according to the Office of Management and Budget, the calorie display requirement was the third most burdensome statutory requirement passed in 2010. OMB estimates it will take more than 14.5 million work hours every year to comply and $69.8 million for recordkeeping alone.

He notes that the Food and Drug Administration interpreted the regulation more broadly than the White House. Imagine … a regulatory agency that overreaches. Who knew? Please read the column for more.

Medicaid Expansion Costs States That Don’t Expand. A new study from the Kaiser Family Foundation concludes that even states that choose not to participate in Medicaid expansion will face higher costs from a boost in new enrollees. Press release. Study.

Beginning next October, people will find it easier to sign up for Medicaid because of new online health insurance marketplaces set up under the law, as well as simplified enrollment methods, said Diane Rowland, executive vice president of the foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured.

And this.

State eligibility for Medicaid today varies nationwide. Under the federal law, starting in 2014, nearly everyone under 133 percent of federal poverty level (about $31,000 for a family of four) will be eligible.

The federal government picks up most of the new costs, making the expansion initially fiscally attractive for many.

The study projects that Medicaid spending across all states would increase by 0.3 percent from 2013 to 2022, while federal spending on the program increases 21 percent.

The impacts vary. Some states actually save money; other will experience sharper increases.

Overall, the new Medicaid spending represents a 0.1 increase in total state spending relative to the overall state general fund, through 2022. Even among states such as Florida and North Carolina that are projected to see the biggest increases in state spending, the increase in new spending is projected to be about 1 percent of state general fund spending, after the savings in uncompensated care are included.

That may not sound like much, but …

Alan Weil, executive director of the National Academy for State Health Policy, said a 1 percent increase in spending for states is still significant for those struggling after the economic downturn. “A lot of states are still digging their way out of the fiscal downturn,” he said.

We may be in for a lot of surprised over the next few years.