Many major pieces of legislation are highly controversial, and the Affordable Care Act (ACA), also known as ObamaCare, is no exception. One of the most debated aspects about the law was whether the government could require Americans to have health insurance or pay a penalty.

The ACA states that Americans that did not apply for health insurance by March 31st, 2014 will be subject to a tax penalty when they file taxes in 2015, unless they obtain an exemption from the requirement. Each year, the tax penalty becomes more expensive. The Supreme Court ruled on June 28th, 2012 that enforcing this provision falls under the taxation powers of Congress. However, in the same ruling the Court found that states could not be required to expand their state Medicaid programs.

Can States Opt Out of ObamaCare?

The provisions of the ACA are national and apply to all states. No state can opt out of the major provisions of ObamaCare. However, many states have decided not to expand Medicaid due to state budget concerns and overall opposition to the ACA. Other states have not yet decided whether to participate. As of March 26th, 2014, 27 states had decided to expand Medicaid and five states were still debating the issue.

Some states with budgetary or other concerns about Medicaid expansion are finding creative solutions to provide coverage for lower income citizens. One example is Arkansas, which is using the federal Medicaid funding to purchase private plans for its lower income residents.

Methods of Non-Cooperation

As with any mandate, just because the federal government can require it doesn’t mean the states or citizens have to be happy about it. Some officials in states that strongly opposed the law found ways to not cooperate in aspects of the ACA that were under their control.

In 2012, Missouri voters approved a ballot initiative that barred state and local government officials from doing anything to implement the law. The state also restricted the work of navigators and limited the state enforcement of ACA provisions. State officials said they were simply reflecting the will of Missouri citizens, who strongly oppose the ACA.

The South Carolina legislature considered a bill, the Freedom of Health Care Protection Act, which would have prohibited state officials and agencies from enforcing or promoting the ACA within the state, and would have given state residents a tax refund equal to the amount of any federal penalty imposed for not carrying health insurance. The bill passed the South Carolina House but failed in the Senate. In Tennessee, a bill is under consideration that would prevent insurers from accepting ‘risk corridor’ payments, which is a type of safety net in the ACA for insurers who attract poor-risk customers.

Supporters of the ACA say that these measures keep Americans from getting health insurance they deeply need. Opponents say that the law is a fiscal disaster and intrudes on citizens’ rights, and taking a stand is necessary.

The ACA is a wide-ranging law that affects all Americans both financially and in terms of access to health coverage. The intent of the law is to make health insurance more accessible and affordable for all Americans. Opponents point to cancelled policies and higher prices to say that the law does not achieve these aims and needs to be dismantled. Supporters point to thousands of Americans who were able to afford and obtain health insurance for the first time in 2014. The debate is unlikely to end soon, and while it lasts, some states will continue to mitigate their involvement in the ACA.