Right Wing Obstruction of Health Care in the States? #ALECFAIL

PSN on Health Care:

Op-Eds by State Legislators:


Opposing Health Care Nullification Efforts:

Health Care Implementation in the States:

More on ALEC:

42: The number of states claimed by the American Legislative Exchange Council (ALEC) to have "defended health care choice" through the actual or proposed introduction of health care nullification bills intended to "oppose Obamacare."

4: The number of states where health care nullification bills have actually been enacted.

25 (and counting): The number of states where health care nullification bills or constitutional amendments have failed:

Health Care Nullification Map


(The states highlighted in blue have enacted health care nullification bills. A ballot measure in Missouri requires approval by voters in August. Ballot measures in Arizona and Florida require approval by voters in November. Updated 6/3/10.)

In recent months, the health insurance industry-funded American Legislative Exchange Council (ALEC) has claimed that over 40 individual state legislatures have "defend[ed] health care choice" by being witness to the proposed or actual introduction of their model legislation intending to attempt to nullify the recently passed federal reforms in the Patient Protection and Affordable Care Act.

Despite their model legislation's patent unconstitutionality, ALEC has persisted in pushing nullification bills in state capitals across the nation, promising those who want to obstruct reform that they will "protect citizens from ObamaCare" and "stop ObamaCare at the state line."

In fact, nullification bills have already been rejected or failed to pass in at least 25 states where ALEC claimed legislators would defy federal law. ALEC style bills or proposed constitutional amendments have failed in Alabama, Alaska, Arkansas, Colorado, Delaware, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Oklahoma, Nebraska, New Hampshire, New Mexico, North Dakota, South Dakota, Tennessee, West Virginia, Washington, Wisconsin, and Wyoming.

In other states where ALEC has claimed success, such as Montana, Rhode Island, and Texas, health care nullification bills have yet to even be introduced.

Additionally, nullification proposals have met significant opposition in many other states where they have been introduced:

  • In Iowa, the 2010 session ended with the House minority leader conceding the failure of conservative efforts to nullify federal health care reform.
  • In Arkansas, the 2010 session ended without action on a non-binding bill intended to "prevent involuntary enrollments in health care insurance programs."
  • In Delaware, legislative leaders directed a nullification effort to a committee described in a recent news report as a "favored burial ground for bills."
  • In North Dakota, a proposed constitutional amendment failed in 2009.
  • In Maryland and Michigan, attempts at nullification through constitutional amendments failed in committee.
  • And in Maine, where a nullification bill has not been introduced, legislative leaders defeated a resolution promoted by conservatives calling on the Attorney General to join a lawsuit seeking to block the implementation of federal reform.

States Moving Forward on Implementation, Not Nullification

At the same time the right wing is focused on grandstanding and political gamesmanship, legislators and officials in all 50 states are moving forward with the hard work of planning the effective implementation of the Patient Protection and Affordable Care Act at the state level. Many of these efforts began well before the passing and signing of federal reform, and will accelerate in the coming weeks and months as responsible leaders in the states focus on delivering quality, affordable healthcare to their constituents. (For more on implementation, see State Implementation of Federal Reform: Resources.)

Here are just a few of the efforts publicly announced, although others are moving forward in states across the country (updated 5/24/10):

States Moving Forward on Implementation

  • In California, Assembly bill 1595 and Senate bill 890 establish the intent of the Legislature to enact legislation that would implement federal health care reform.
  • In Illinois, SB 3047 creates a bipartisan Health Care Justice Implementation Task Force whose primary goal is to monitor the implementation of the federal health care reforms and make recommendations for state implementation.
  • An Iowa bill, Senate File 2356, received Senate approval by a bipartisan vote. This health care reform bill sets the groundwork for how potential federal health care funding may be used to benefit Iowans. It includes an insurance exchange and it also expands the state's unofficial public option program for adults below 200% FPL.
  • A Joint Select Committee to study Maine's role in the implementation of federal health care reform has passed both the House and Senate and does not require the Governors’ signature.
  • In Nebraska, LR 372 would set up a committee to study the potential effect of national health care reform proposals on Nebraska and analyze policy options for responding to and implementing health care reform measures.
  • The Texas House established a House Select Committee on Federal Legislation, with a specific emphasis on implementing health care reform efforts.
  • Two 2010 bills in Minnesota, HF3709 and SF3296, make conforming and other changes related to federal health care reform; provide funding for health care subsidies; establish accountable care organizations and a publicly administered health plan, expand eligibility for medical assistance, and establish the Minnesota Health Insurance Exchange.
  • In Maryland, Gov. O'Malley appointed a commission to make recommendations about the implementation of federal health care reform, which he predicted would save his state $1 billion.
  • In Rhode Island, S2552, the Rhode Island Health Reform Act of 2010, would provide for a state-sponsored system of universal health care, including the establishment of a quasi-public non-profit organization through which all public and private purchases of insurance or health care services will be transacted for all Rhode Island employers and individuals.
  • In Wisconsin, Gov. Doyle created an Office of Health Care Reform to prepare for the sweeping changes from health care reform that effect in 2014, from creating a state-based insurance exchange to communicating to the public to explain the changes to the state's health care system.
  • Gov. Gregoire in Washington signed an executive order declaring the formation of a Health Care Cabinet directed to guide implementation of reform. The group will consist of the state Health Care Authority administrator, the state Health Department secretary, the Department of Social and Health Services secretary, as well as the governor's executive policy director and state budget director.
  • New Mexico is preparing to implement federal reforms (including its own innovative high risk insurance pool and a state insurance exchange) through the passage of SJM 1, which establishes a Health Care Reform Working Group.
  • In Vermont, the Senate passed S88 by a landslide bipartisan vote of 28-2, a bill which would enhance federal reforms by establishing the goal of universal access to health care through the design of multiple possible plans, at least one of which must include a public option.
  • In Colorado, Gov. Ritter signed an executive order to create a board of advisers on health care policy that will oversee the implementation of federal reforms, including setting up a state insurance exchange.
  • In New Jersey, the Health Insurance Exchange Act, SB 1288, establishes the New Jersey Health Insurance Exchange as an independent public entity, in but not of the Department of Banking and Insurance, with certain authority to facilitate the availability and choice of health benefits plans offered to employees of small employers that employ between two and 50 employees, and other eligible persons not employed by small employers.
  • In Oregon, the state legislature laid the groundwork to implement federal reform in 2009 with the passage of HB 2009, which created the Oregon Health Authority, a state agency which is overseeing the interaction between state and federal health reform.
  • In Connecticut, the state legislature in 2009 passed SustiNet, which created a board of directors now charged with making recommendations on the implementation of federal reform.
  • In Michigan, Gov. Granholm signed Executive Order No. 2010-4 which created a council to oversee and develop recommendations for the implementation of the Patient Protection and Affordable Care Act.
  • The state legislature in Montana prepared for the implementation of federal health care reform in 2009 with the passage of SJR 35, a resolution that created a legislative committee which is now studying opportunities and requirements for state action under federal reform.
  • In Louisiana, HB303 would "provides for compliance with federal law" for expanded coverage by the Louisiana Health Plan.
  • In Mississippi, SB 2554 created the Mississippi Health Insurance Exchange Study Committee to make recommendations on the implementation of federal reform. It was signed into law by Gov. Barbour on April 14, 2010.
  • In Pennsylvania, legislation to create a Health Insurance Reform Implementation Authority (HB 2462) has been introduced with bipartisan support. In addition, Gov. Rendell issued an Executive Order to immediately create two committees that will oversee the implementation of health care reform, including one specifically focused on designing the state's high-risk pool.
  • In addition, 29 states (Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, West Virginia, and Wisconsin) have decided to establish the temporary high-risk insurance pools provided for in the Patient Protection and Affordable Care Act to help people with pre-existing and chronic health conditions who cannot find affordable health insurance.

The insurance industry-backed ALEC and their allies on the right aregrossly exaggerating their success at obstruction at the state level. In fact, legislators of good faith and good conscience across the country are focused on making sure costs are kept down and coverage is expanded for their constituents by rejecting nullification and focusing instead on implementation of the Patient Protection and Affordable Care Act.

(Additional Sources: - State Legislation Challenging Certain Health Reforms, 2010; PBS NewsHour - States Challenge Health Care Reform)