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Monday, July 10, 2017

How States Can Help Bring Down Obamacare


How States Can Help Bring Down Obamacare

States can and should help end Obamacare whether Congress does its job, or not.
Will Republicans in Congress actually send Pres. Trump a bill to repeal Obamacare?
At this point, it seems highly unlikely. The changes to the ACA proposed by the U.S. House and Senate keep the basic the framework of Obamacare in place. It’s not even repeal and replace. It’s more like tinker around the edges and keep it in place. So far, the Republican-controlled Congress hasn’t shown any signs of being able to get even these modest “reforms” passed.
In light of Congress’ apparent ineptitude, it’s important to note states can take action right now that will set the stage to bring the Affordable Care Act down, no matter what Congress does.
By refusing to provide any state or local cooperation with the implementation or administration of Obamacare – or whatever version of national healthcare Republicans create.
The ACA was predicated on state cooperation. Any Republican “replacement” will be as well. By ending all state actions that support the ACA and refusing to enforce any of its mandates, a state can make it nearly impossible to run Obamacare within its borders.
The federal government never intended to run the healthcare system alone, and ultimately, it can’t do it without state help. It even tried to compel states to expand Medicaid under the act, but that portion was struck down in the famous “Obamacare case,” NFIB v. Sebelius.
Additionally, we’ve seen the difficulties created for the Act by the number of states that simply refused to set up exchanges for the federal government. 
Refusing to expand Medicaid or set up an exchange are two essential steps states should take. West Virginia took the first step in the last legislative session, scrapping its state-run insurance exchange.This will force the feds to run the exchange themselves, and will just increase the strain and burden on federal resources.
But states can go even further. Judge Andrew Napolitano noted that if a number of states were to refuse to participate with the ACA in a wholesale fashion, that multi-state action would “gut Obamacare.”
Napolitano said that if enough states follow suit, “it will gut ObamaCare because the federal government does not have the resources or the wherewithal […] to go into each of the individual states.”
States can pass legislation to completely end any and all state participation in the Affordable Care Act (or any other national healthcare scheme). Here is an example of some simple model language that would effectively shut down all management and implementation of the ACA in a state.
That the general statutes be amended to repeal all statutes implementing health care mandates required under the Affordable Care Act, prohibit the state from participating in any program under or appropriating or expending any moneys in furtherance of said act, and dissolve all programs related to said act.
“The federal government can barely manage running a website,” Tenth Amendment Center Executive Director Michael Boldin said, noting that this kind of legislation would ban a state’s department of Insurance from investigating or enforcing violations of federally mandated health insurance requirements. He said this would “prove particularly problematic for the federal government.”
Insurance commissioners serve as the enforcement arm for insurance regulation in the states. The federal government has no enforcement arm. The feds assumed the state insurance commissioners would enforce all of the provisions of the ACA.
So, when people have issues with their mandated coverage, they would have to call the feds. At this point, it remains unclear who they would even call should the state be prohibited from carrying out this essential task. Issues the state insurance department would not address include prohibiting a denial of insurance for preexisting conditions, requiring dependent coverage for children up to age 26, and proscribing lifetime or yearly dollar limits on coverage of essential health benefits.
This strategy rests on a well-established legal principle known as the anti-commandeering doctrine. Simply put, the federal government cannot force states to help implement or enforce any federal act or program. The anti-commandeering doctrine is based primarily on four Supreme Court cases dating back to 1842. Printz v. US serves as the cornerstone.
“We held in New York that Congress cannot compel the States to enact or enforce a federal regulatory program. Today we hold that Congress cannot circumvent that prohibition by conscripting the States’ officers directly. The Federal Government may neither issue directives requiring the States to address particular problems, nor command the States’ officers, or those of their political subdivisions, to administer or enforce a federal regulatory program. It matters not whether policy making is involved, and no case by case weighing of the burdens or benefits is necessary; such commands are fundamentally incompatible with our constitutional system of dual sovereignty.”
In a very real sense, this kind of state action would set the stage to effectively repeal the Affordable Care Act within that state. It will also place more pressure on Congress to completely repeal the healthcare act. And in the event of a partial repeal, state action could finish the job.
Conservatives have vigorously opposed Obamacare from the beginning. With the way things have unfolded in Congress, many seem to have just given up in despair. Or worse, embraced horrible Republican alternatives. But options remain. Quit relying on D.C. to fix a problem that was caused by D.C. Focus on your state legislatures.
“Alabama, Tennessee, Utah, Alaska, Oklahoma, Indiana, Kentucky – these are just a few of the many so-called ‘conservative states,’” Boldin said. “Bills to withdraw support from Obamacare should be introduced and passed in every state possible, as soon as possible.”
Some may find it tempting to wait and see what Congress does, but why delay when you can take effective action now? Congress may or may not do anything. If enough states take action, it won’t even matter.
Contact your own state rep and senator, and urge them to introduce legislation to end state cooperation with federal healthcare.  Find your state legislator’s contact info at this link

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