The real work of implementing health care reform was left up to the state governments even though it was clear that the majority of the cost has to be borne by the federal government. A majority of states oppose health reform as passed by the federal government and 27 have taken legal action against the federal government to stop the 2010 law. State governments fear that if the federal government does not come through to financially support the new law, states will be left “holding the bag” without any means of funding the new expensive mandates. Yet as of August 2011 all but three states have initiated new health reform actions in response to the federal Affordable Care Act.
Three states-Alaska, South Dakota and Wyoming-have not taken any action to comply with the new federal law.
Eight states have introduced bills but not passed any health care reform laws. These include Florida, Michigan, New Jersey, Ohio, Pennsylvania, South Carolina, Texas and West Virginia.
The other 39 states and the District of Columbia, including those who are suing the federal government to stop implementation of the health care reform act, have all passed new health reform laws. Part of the reason is to gain access to the hundreds of millions of dollars the federal government is offering to states that implement portions of the law especially the development of state-run health insurance exchanges to sell insurance to individuals and small businesses. States keep the money even if part or all of the health reform bill is repealed.
Meanwhile, other key parts of the federal law were abandoned or scaled-back by the U.S. Department of Health and Human Services this week in recognition that costs were too high or the law, as originally envisioned, is too expensive.
The US Supreme court is expected to rule on another expensive part of the law called the individual mandate. It that part of the law is overturned then the most substantial remaining effects of the law may the the state laws already passed up to that date. It is too soon to know whether the states will reverse their new health care laws if the federal government withdraws financial support but most health care commentators seem to believe that this is inevitable due to the heavy cost of of the newly expanded health care mandates.