Trying to apply federal law to state regulated business was a republican idea called free enterprise. Capitalism. The Republicans wrote this law the voted against it. GIYF and you'll be in for a shock.
Limbaugh may be right, but we should be happy. Medicaid is Gov run and works perfectly fine. In fact it can somtimes be the gold of all plans. Medicare and Veteran Affairs are getting quality care. [Please jump on me after finding some bad news storied problems here and there. I'm talking generally speaking]
Romney couldn't argue against it because a lot of it was modeled after what he did in MA.
A simple tweak such as allowing insurance to be sold across state lines might have brought about competition amongst states for the insurance business.
As for Medicaid being gold - you're out of your mind. At least in NYC it's platinum+. While private employers might be penalized for providing "Cadillac" plans, medicaid could easily be classified as such, and so are many union plans that are exempt from penalties for providing "Cadillac" plans.
Lastly, just like Fannie Mae and Freddie Mac exist despite the fact that they were insolvent several years ago (and might also now be insolvent if sound accounting principles were applied), so too Medicaid and Medicare would be shut down if they were private program. But in government and politics there is always a future where we can tax, cut benefits, etc etc. Ask any accountant and they will tell you that the can of insolvency can be kicked down the road with just a few accounting adjustments. No problem is solved, it's just kicked down the road to when the current politicians won't have to pay the price of hard choices.