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Archive Report:  2009-2010 State Legislation and Actions Challenging Certain Health Reforms

Updated: March 14, 2011

by: Richard Cauchi, Program Director, NCSL Health Program


During 2009 and 2010, while the U.S. Congress debated and then enacted the Affordable Care Act, a growing number of state legislatures - ultimately 40 states - considered a variety of bills, proposed costitutional amendments and binding and non-binding resolutions, intended to oppose, opt-out or challenge selected elements of federal and state health reform. 
 

2009-2010 Summary of State Legislation Challenging Health Reform

When the final vote was cast and bills were signed or rejected, the tally was;

  • Seven enacted state statutes
  • Two states had constitutional amendments approved by legislatures and voters.
  • Five states adopted non-binding or advisory resolutions or memorials
  • 30 states rejected or failed to pass proposed binding measures.
 

Staet Legislation challenging health reforms in 2009-2010


































New Laws:  Seven states have signed or enacted statutes in 2010, based on final actions as of January 2011:

  • A Virginia law passed both Senate and House, was amended by the Governor and both branches of the legislature and became law as Chapter 106 on March 10, becoming the first such statute in the nation.*  
  • Idaho enacted a similar statute, signed as Chapter 46 on March 17. 
  • A Utah statute, signed March 22, prohibits any state agency from implementing health reform unless state agencies recommend action or the legislature passes a provision.
  • A Georgia statute addition was substituted during a conference committee and passed by Senate and House on the last day; it was signed into law by the governor on June 2. 
  • Louisiana enacted a statute, declaring that residents "shall be free from governmental intrusion in choosing or declining to choose" health coverage; signed July 2.
  • Arizona enacted a separate statute, similar to their constitutional ballot question for November 2010. (Explained below) 
 

Statute by Ballot Question approved in Missouri

Missouri's Legislature passed a proposed statute, but required that it be put to voters for approval or disapproval on their primary election day, Tuesday August 3, 2010. It was approved by a 71.1 percent yes vote. 
 
Constitutional Ballot Questions passed in two states:
  • Arizona's resolution of June 2009 was the first constitutional ballot question measure to have passed the legislative process; it was approved by voters on November 2, 2010. (Also see statute, listed above).

  • Oklahoma's constitutional amendment ballot question was approved by the Senate and House in May 2010; it was approved by voters on the November 2, 2010 ballot.

Missouri-proposition-c-health-care-Voters in Aug 2010

 

Question Rejected by Voters
  • Colorado: Although the legislature rejected a resolution on the topic, a citizen initiative proposed constitutional amendment was placed on the November 2, 2010 ballot; it was rejected .
Question Rejected by Court:
  • Florida's legislature was the second state to approve a constitutional amendment ballot question, on 4/22/10, for a decision by voters on Nov. 2, 2010. However, in late July a Florida District court ruled the question wording as inappropriate; on August 31 their State Supreme Court agreed that the question must be removed from the ballot.  

Non-binding measures:

South Dakota passed a resolution opposing "government take-over" of health care. South Carolina adopted a resolution opposing health mandates and directing the attorney general to challenge such provisions in federal health reform. A Michigan Senate resolution urging removal of financial obligations passed in January 2010.  Idaho called for adding a U.S. Constitutional Amendment to provide that Congress shall make no law requiring citizens of the United States to enroll in, participate in or secure health care insurance or to penalize any citizen who declines to purchase or participate in any health care insurance. Florida's  non-binding Senate resolution urges the U.S. Congress to amend Medicaid law in order to "reestablish a fair and prudent federal-state partnership" that allows each state "the freedom to craft a Medicaid program that meets the needs of its residents" without mandatory expansion and enables states to provide cost-effective health care services to low-income residents. Oklahoma SJR 64 was a non-binding resolution authorizing legislative leaders to “employ legal counsel to file a lawsuit to prevent the provisions” of  federal health care from taking effect.

Measures That "Did Not Pass:" 

For the 2009-2010 legislative sessions, 30 states have failed to pass or have rejected bills and resolutions (29 states in 2010, one in 2009)
For 2010 sessions, the states are: Alabama, Alaska, Arkansas, California, Colorado, Delaware, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Washington, West Virginia, Wisconsin and Wyoming. A 2009 North Dakota constitutional proposal did not pass by the end of their session. If additional special sessions, reintroductions or reconsideration motions are filed, they will be added to this report. 

 

The Arizona Constitutional Amendment- Used as an example in aboiut 30 other states in 2009-2011  [Excerpt]

"To preserve the freedom of all residents of the state to provide for their own health care… A law or rule shall not compel, directly or indirectly, any person, employer or health care provider to participate in any health care system …  A person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for paying directly for lawful health care services..."
    [see full text in Appendix 1]

Arizona voters are scheduled to cast ballots on this constitutional amendment in November 2010. 

According to The New York Times, "Conservatives and libertarians, mostly, have been advancing the theory lately that the individual mandate, in which the government would compel everyone to buy insurance or pay a penalty, is unconstitutional." (NY Times, 9/26/09)   A current Massachusetts law, passed in 2006, includes an individual mandate, although it was written to be consistent with both state and federal constitutions.  To the extent that congressional proposals provide for state opt-out or opt-in features, these proposals to restrict "reform" could well become more widely discussed. 

Arizona resolution passed 2009
Arizona plans constitutional amendment on health reform. Photo copyright Joshua Lott for The New York Times, 2009. Fair Use.

NCSL Spring Forum
April 9, 2010 - Richard Cauchi -
PowerPoint PresentationAdobe PDF logo

Table 1: Filed Bills and Resolutions for 2009-2010

Table 1 indicates 1) Activity and status for measures filed;
2) the percentage of affirmative votes in the legislature required for approval;
3) the earliest date that a proposed constitutional amendment can appear on the statewide ballot. Timing and parliamentary steps vary among states. 

 

State Activity/Legislation Required for passage
 Alabama

HB 42 by Rep. Bentley; HB 47 by Rep. Gipson; HB 498 by Rep. Galliher; SB 233 by Sen. Beason. 
Would propose a constitutional amendment to prohibit any person, employer, or health care provider from being compelled to participate in any health care system.
(HB 42 prefiled 11/5/09 for 2010 session; sent to Health Committee 1/12/10; did not pass by end of session 4/22/10
(SB 233 filed 1/13/10; Passed Senate, sent to House 4/1/10; did not pass by end of session 4/22/10

60% both legislative chambers
+
2010 ballot vote
 Alaska

HJR 35 by Rep. Kelly filed for 2010 session
Would propose a state constitutional amendment prohibiting passage of laws that interfere with direct payments for health care services and the right to purchase health care insurance from a privately owned company, and that compel a person to participate in a health care system.
(Filed 1/19/10; favorable House committee reports 3/12/10; failed passage 22y-18n 4/15/10)

2/3rds both  legislative chambers
+
2010 ballot vote

HR 14 by Rep. Chenault
Would urge the United States Congress to oppose federal health care reform bills.
(Filed 2/17; re-referred to House Comm. 3/19/10; did not pass by end of session)

Non-binding
resolution; majority vote

 Arizona
 (2009)
 

 

 


 

 Arizona
 (2010)

Resolution HCR 2014 of 2009 by Rep. Barto
Refers to the November 2010 ballot a proposed amendment to the State Constitution "which provides that no law or rule shall compel any person or employer to participate in any health care system, a person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for doing so, a health care provider may provide directly purchased lawful health care services; prohibits the terms or conditions of a health care system from imposing certain mandates or limitations."   [full text in Appendix 1 below]
(Filed 1/16/09; passed House 6/11/09; passed Senate 6/22/09;  passed by voters, 55.4% Yes to 44.7% No, on Nov. 2, 2010 ballot.)  Also see2008 ballot question history, below.

50% both legislative chambers
(Passed)

2010 ballot vote

SB 1001  
Added by state statute the "public policy that every person in this state... may choose or decline to choose any mode of securing lawful health care services without penalty or threat of penalty.”   Also protects “any right of contract related to the provision of lawful health care services to any person or group".  “A public official or an employee or agent of this state or any political subdivision of this state shall not act to impose, collect, enforce or effectuate any penalty in this state that violates the public policy prescribed in this section.”
(Substituted by committee; Signed into law by governor as Chapter 1, 4/1/2010.)

HB 2443 by Rep. Burges
Would add by state statute the Health Care Freedom of Choice Act requiring Arizona to exercise its option to decline the public health care plan if authorized by the federal government.
(Filed and sent to committees 1/26/10; did not pass by end of session)

Proposed statute:
majority both
legislative chambers

 Arkansas

ISP 2009-204 by Rep. Glidewell (Interim Study Proposal for 2010 Fiscal Session)
Would add a state statute to "ensure freedom of choice in health care" for state residents; "to prevent involuntary enrollments in health care insurance programs" and providing that an "individual or an employer may make direct payment for lawful health care services and shall not be required to pay penalties or fines" for making direct payment for health services.
(Filed 12/17/09 for 2010 session; 2010 regular session ended without action on any language)

Proposed statute:
majority both
legislative chambers

 California

SCA 29 by Sen. Strickland
Would propose a state constitutional amendment prohibiting the effectiveness or enforcement of a state or federal program that (1) requires individuals to obtain health care coverage, (2) requires health care service plans or health insurers to guarantee issue contracts and policies to all applicants, (3) requires employers to either provide health care coverage to their employees or pay a fee or tax to the state or the federal government in lieu thereof, (4) allows an entity created, operated, or subsidized by the government to compete with health care service plans and health insurers in the private sector, or (5) creates a single-payer health care system, unless the program is approved by the electorate by ballot measure.
(Filed 2/19/10; did not pass Senate Comm. 3y-6n, 5/5/10)

2/3rds  both legislative chambers
+
2010 ballot vote
 Colorado

HJR 10-1009 by Rep Acree
Resolution stating the intent of the General Assembly, to "Reserve the opportunity and ability of the State of Colorado and its citizens, under the state's and the people's Tenth Amendment rights, to opt out of any obligations due or participation required in any new federal health care legislation.
(Filed  2/5/10; Judiciary Comm. did not pass -postponed indefinitely 3/11/10)

50% both legislative chambers
 
Ballot Amendment 63
A separate citizen initiative petition was circulated in summer 2010 and certified by the Secretary of State to appear on the November 2, 2010 ballot. 

It stated: “(1) All persons shall have the right to health care choice, no statute, regulation, resolution, or policy adopted or enforced by the state of Colorado, its departments and agencies, independently or at the instance of the United States shall: (a) require any person directly or indirectly to participate in any public or private health insurance plan, health coverage plan, health benefit plan, or similar plan; or (b) deny, restrict, or penalize the right or ability of any person to make or receive direct payments for lawful health care services.”
(News articles:  Ballot amendment 63 "Two sides of the debate"  >  Vote "YES - Stand up to D.C."  versus  Vote "NO - It won't hold down health costs"

No legislative role; requires 2010 ballot vote
 Delaware
 (2010)

HB 353 by Rep. Hudson
Would add a state statute providing the following:
"The people of Delaware have the right to enter into private contracts with health care providers for health care services and to purchase private health care coverage. The United States Congress may not require any person to participate in any health care system or plan, nor may it impose a penalty, fine, tax, surcharge, or fee of any type for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan. Only the State of Delaware has the legal authority to regulate private health care insurance, systems, plans, and services for the people of Delaware within its borders."
(Filed 3/30/10; held in House Administration Comm.; did not pass by end of regular session 6/30/10; may be considered in special session)

HCR 28 by Rep. Hudson
A non-binding resolution, stating opposition to the passed federal health reform;  maintaining that the federal government does not have the authority to impose a federal healthcare program and urges the U.S. Congress to pursue less costly and more viable alternatives to reduce the cost of healthcare and increase its availability. Also states that "should the 111th Congress decide to enact a federal healthcare entitlement, it would urge Delaware’s Congressional delegation to advocate for a provision that would require states to choose to “opt-in” to the program.
(Filed and sent to committee 3/18/10; no action; held in committee; did not pass by end of regular session 6/30/10; may be considered in special session)

State statute; 50% majority vote

 

 

 

Non-binding resolution;
50% majority vote

 Florida

HJR 37 (Joint Resolutions filed for 2010) by Rep. Plakon; 39 co-sponsors; 
SJR 72 by Sen Baker.
Joint resolutions propose a State Constitutional amendment to prohibit laws or rules from compelling any person, employer, or health care provider to participate in any health care system; permits person or employer to purchase lawful health care services directly from health care provider, and permits health care providers to accept direct payment from a person or employer for lawful health care services.
(HJR 37 prefiled 7/27/2009 for 2010 session; substituted; passed House; passed Senate; enrolled; 4/22/10; was directed to appear on the November 2, 2010 state ballot for voter approval or disapproval)  This ballot question, Amendment 9, was ordered removed from the ballot by the Florida District Court in late July; on August 31 the Florida State Supreme Court agreed and orderd that the question wording was inappropriate and must be removed from the ballot [text of court ruling,  No. SC10-1527]  [Article by AP, 9/1/10] 
(SJR 72 prefiled 10/5/09; favorable comm. report 3/4/10 substituted by HJR 37 above)
NOTE: SB 10 separately calls for a United States Constitutional Convention to address various matters related to a balanced Federal Budget, including health care expenditure requirements.
(Passed Senate and House; enrolled and signed, 5/5/10)

60% both legislative chambers
+
2010 ballot vote

 Georgia
 

 

 

 

 

 

 
 

 

 Georgia

2010 resolutions: HR 1086 by Rep. Calvin Hill; HR 1107 by Rep. Mills;
SR 794 by Sen. Hill; SR 795 by Sen. Harp.
Would propose an amendment to the Constitution so as to provide that no law or rule or regulation shall compel any person, employer, or health care provider to participate in any health care system and to authorize persons and employers to pay directly for lawful health care services without penalties or fines; would provide for submission of the amendment for ratification or rejection.
SR 795 would provide that residents would not be subject to penalties or fine for not having health insurance.
(Prefiled 11/23/09 for 2010 session;  HR 1086 favorable report 3/11/10; did not pass House 3rd Reading 111y-61n-3nv, 3/18/10; motion to reconsider vote  granted 110y-58n-6nv, 3/24/10)  2/3rd affirmative vote required; did not pass by end of session 4/29/10)
SR 795 favorable report by Senate Judiciary 2/2/10; did not pass by end of session 4/29/10)SR 794 did not pass Senate 3rd reading 31y-19n, 3/18/10)

2/3rds  both legislative chambers
+
2010 ballot vote

 

SB 317 by Sen. Hill          
Would  establish by statute that "no law or rule or regulation shall compel any person, employer, or health care provider to participate in any health care system;" to authorize persons and employers to pay directly for lawful health care services without penalties or fines.
(SB 317 filed 1/25/10; favorable Comm. report 2/10/10; passed Senate  31y-16n; did not pass by end of session 4/29/10))

SB 411 with amendment 37-1032S by Sen. Hill
Wellness discounts bill; amended, inserting similar language from SB 317 by Sen. Judson Hill. 
Establishes by statute that "no law or rule or regulation shall compel any person, employer, or health care provider to participate in any health care system;" to authorize persons and employers to pay directly for lawful health care services without penalties or fines.  The intent is that state residents would not be forced to comply with the mandates in the federal health care reform law.
(House amendment, added and passed 4/27/10; 4/29/10 (AM21-3736)  passed Senate 4/29/10; signed into law by governor 6/2/10 [Bill history]

SR 829 and SR 830 by Sen. Hill.   (Substituted and approved by conference committee;
Resolutions would direct the Attorney General to "initiate a formal investigation into the constitutionality of the special exemption set forth in the United States Senate's version of this national health care legislation and explore the availability of all other legal challenges.
(Filed 1/15/10; Senate 2nd reading 2/11/10; did not pass by end of session 4/29/10)

Statute:
majority both
legislative chambers


 

 

 

 

 
 

Resolutions; majority vote

 Idaho

HB 391 by State Affairs Comm.
Amend and add to existing law to establish the Idaho Health Freedom Act, stating in part, "that every person within the state of Idaho is and shall be free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty."  "No public official, employee, or agent of the state of Idaho or any of its political subdivisions, shall act to impose, collect, enforce, or effectuate any penalty..."
(Filed 1/19/10; passed House 52y-8n, 2/9/10; amended; passed Senate 24y-10n & enrolled, 3/12/10; signed into law by governor as Session Law Chapter 46, 3/17/10)

Statute:
majority both
legislative chambers

SJM 106 by State Affairs Committee
Non-binding memorial stating findings of the Legislature urging Congress to take action to amend the United States Constitution to provide that "Congress shall make no law requiring citizens of the United States to enroll in, participate in or secure health care insurance or to penalize any citizen who declines to purchase or participate in any health care insurance program."
(Filed  3/26/10; passed Senate and House 3/29/10)

Memorial to Congress
 Illinois
 (2010)

H 6842 by Rep. Mitchell
Would  provide by statute that no resident of the State, regardless of whether he has or is eligible for health insurance coverage  shall be required to obtain or maintain individual insurance except as required by a court or a State agency
(Filed and sent to committee 3/26/10; pending; held in Rules Comm. as of 1/3/2011)

Statute:
majority both
legislative chambers

HR 1074 by Rep. Bellock
Would request that the IL Commission on Government Forecasting and Accountability examine the provisions of the federal health care reform law to determine the fiscal impact of the provisions on the budget of the State.
(Filed and sent to Rules Committee, 3/26/10; placed on calendar  4/28; held in Rules Comm. as of 1/3/2011)

Non-binding
 resolutions

HR 1075 by Rep. Bellock
Would urge the IL Attorney General to take steps necessary to file a suit challenging the constitutionality of the federal Patient Protection Affordable Care Act.
(Filed and sent to Rules Committee, 3/26/10; pending; held in Rules Comm. as of 1/3/2011))

 Indiana 
 (2009)
 

 

  

  

 Indiana 
 (2010)

SJR 65 by Sen. Waltz; SJR 91 by Sen. Waltz; SJR 111 by Sen. Waltz (Advisory resolutions for 2009) 
SJR 91: Resolved, "That the Indiana General Assembly must ensure that all residents of Indiana may enter into  private contracts with health care providers for health care services and may purchase private coverage for health care services. That the Indiana General Assembly should not require an individual to participate in a health care system or plan or impose on an individual a penalty or fine of any type for choosing to obtain or decline coverage for health care services or participating in a particular health care system or plan."

(SR 65 - filed 4/7/09 - did not pass by end of session; SR 91 - filed 4/27/09 - did not pass by end of session; SR 111 - filed 4/28/09 - did not pass by end of session; Indiana does not carry over bills or resolutions to 2010)

Non-binding
 resolutions

SJR 14 by Sen. Krause, HJR 6 by Rep. Noe; HJR 8 by Rep. Turner; also non binding resolution SCR 10
Would propose a state constitutional amendment stating, "A person, an employer, or a health care provider shall not be compelled, directly or indirectly, to participate in any health care system.   A person or an employer may pay directly for lawful health care services and shall not be subject to penalties or fines for paying directly for lawful health care services.  A health care provider may receive direct payment for health care services from a person or an employer and shall not be subject to penalties or fines for accepting direct payment from a person or an employer."
SCR10 - nonbinding resolution passed Senate 2/1/10; did not pass House Committee)
(Filed 1/11/10; did not pass by end of regular session deadline 3/3/10)

50% both legislative chambers
+
2012  ballot vote

 Iowa

HJR 2007 by Rep. Upmeyer
Would propose a state constitutional amendment prohibiting passage of laws that interfere with direct payments for health care services and the right to purchase health care insurance from a privately owned company, and that compel a person to participate in a health care system.
(Filed 1/26/10; did not pass  by end of session 4/12/10)

50% both legislative chambers
+
2012 ballot vote

HF 2117 by Rep. Sorensen;  HF 2214 by Rep. Upmeyer; S 2139 by Sen. Zaun
Would  establish by statute that the people of Iowa have the right to enter into contracts with health care providers for health care services and to purchase private health care coverage.  In addition, the general assembly cannot require any person to participate in any health care system or plan, or impose any type of penalty or fine on any person for choosing to obtain or declining to obtain health care coverage or for participating or declining to participate in any particular health care system or plan.
(Filed 1/26/10; HF 2214 motion to expedite failed 44y-53n, 2/12/10; did not pass  by end of session 4/12/10)

Proposed statute:
majority both
legislative chambers

 Kansas

HCR 5032 by Rep. Landwehr; SCR 1626 by Sen. Pilcher-Cook
Would propose a state constitutional amendment providing that 1) "A law or rule shall not compel, directly or indirectly, any person, employer or health care provider to participate in any health care system or purchase health insurance.  ‘‘2) A person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for paying directly for lawful health care services."
(Filed & sent to committees 2/2/10, 2/17/10: HCR 5032 did not pass House 74y-47n by required 2/3rds vote, 3/24/10;  SCR 1626 withdrawn from and returned to Judiciary committee, 2/17/10)

2/3rds both legislative chambers
+
2010 ballot vote

 Kentucky

HB 307 by Rep Moore
Would prohibit by statute any other law "from requiring any individual to participate in any health care system or plan, or to impose a penalty or fine regarding participation; permit an individual or an employer to pay directly for health care services and a health care provider to accept direct payment without penalties or fines.  Also would prohibit the state executive branch from "participating in or complying with any federal law, regulation, or policy that would compromise the freedom of choice in the health care."
(Filed 1/21/10; sent to Banking & Insurance Comm. 1/26/10; discharge from committee petition filed 3/24/10; did not pass by end of session 4/15/10)

Proposed statute:
majority both
legislative chambers

 Louisiana







 

 

 


 Louisiana

HB 1474 by Rep. Talbot
Prohibits by state statute any state resident from being required to purchase health insurance coverage; provides that it is a declared public policy of the state that every person within the state is and shall be free from governmental intrusion in choosing or declining to choose any mode of security health insurance coverage without a penalty or threat of penalty.
(filed 5/6/10; signed into law by governor  as Act 952, 7/2/10)

SB 26 by Sen. Crowe
Would prohibit by statute any other law requiring a "person,  employer, health care provider to participate" in a health system or insurance system; also would prohibit compelling participation in any health care system or health insurance plan.  Would establish a misdemeanor offense and penalty ($500 or five day in prison) for any state or local official who "attempts to coerce any individual to purchase health insurance."
(Filed and sent to Sen. Health and Welfare 3/5/10; did not pass by end of session) 5A

Proposed statute:
majority both
legislative chambers

HB 94 by Rep. Talbot
Would propose a state constitutional amendment to prohibit laws or rules that would compel "any person, employer, or health care provider to participate in any health care system"; would allow the direct payment of health care services; also such persons, employers or providers would "not be required to pay penalties or fines" for buying or selling health services.
(Prefiled 3/4/10; House ordered to 3rd reading; did not pass by end of session)

2/3rds both legislative chambers
+
2010 ballot vote

  Maryland

HB 603 by Rep. Shenk; SB 397 by Sen. Pipkin
Would propose a state constitutional amendment limiting the regulation of health care in the state; prohibiting a law from compelling residents to participate in any health care system; prohibiting residents from being required to pay penalties or fines for not participating in health insurance; specifying that the purchase or sale of specified health insurance may not be prohibited by law; authorizing residents to pay directly or accept direct payment for specified health care services.
(Filed 1/29/10; HB 603 unfavorable report, did not pass Health & Govt. Op. Committee, 3/26/10)  (SB 397 did not pass Comm. 3/29/10)

60% both legislative chambers
+
2010 ballot vote

HB 1563 by Rep. Dwyer
Would provide by statute any other law requiring a "person, employer, health care provider to participate" in a health system or insurance system;, a person has the right to choose to participate in a private health insurance system or plan; establishes that, notwithstanding specified provisions of law and subject to a specified exception, a person has the right to pay for lawful medical services without interference and a penalty, tax, fee, or fine may not be imposed on a person who declines to contract for health insurance coverage.
(Filed and sent to committee 3/21/10; did not pass by end of session 4/20/10)

Proposed statute:
majority both
legislative chambers

  Michigan

SJR K of 2009 by Sen. Kuipers; HJR CC by Rep. Calley;  HJR Z of 2009 by Rep. Amash
Would propose a state constitutional amendment "to affirm the right to independent health care." Includes a statement that "a person or employer shall not be required to pay penalties or fines for paying directly for lawful health care services.
(Filed 8/1/9/09, 8/29/09 and 9/9/09; pending in Committee on Health Policy; no floor vote in 2009;  carried over to 2010)  SJR K  2nd Reading and committee substituted; failed to pass 3rd Reading; reconsidered 3/16/10; no further actions as of 5/21/10)

2/3 both legislative chambers
+
2010 ballot vote

  Minnesota         

HF 171 by Rep. Emmer, S 325 by Sen. Koch, S 1282 by Sen. Hann 
Would propose an amendment to the Minnesota Constitution stating that "no law shall be passed that restricts a person's freedom of choice of private health care systems or private health plans of any type. No law shall interfere with a person's or entity's right to pay directly for lawful medical services, nor shall any law impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or health plan."
(Filed 1/22/09, 3/9/09; did not pass committee by end of 2009 session; did not pass committees by end of 2010 session 5/17/10)

Executive Order 10-12: In an action unrelated to the legislature "Governor Pawlenty signed an Executive Order "Directing State Agencies to Decline All Discretionary Participation" in Federal health reform – 8/31/2010.

50% both legislative chambers
+
2010 ballot vote

  Mississippi

HCR 17 by Rep. Monsour; SCR 562 by Sen. Nunnelee
Resolution, would propose a constitutional amendment to prohibit laws compelling any person, employer or health care provider to participate in any health care plan. Would  provide that a "person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for paying directly."
(Filed; sent to Committee on Constitution 1/7/10; HCR 17 and SCR 562 died in committee 2/2/10)

2/3 both legislative chambers
+
2010 ballot vote

  Missouri

HJR 48 by Rep. Davis; HJR 50 by Rep. Ervin; HJR 57 by Rep. Jones Ti;
SJR 25 by Sen. Cunningham;
Joint resolutions, would propose a constitutional amendment which would prohibit compelling a person to participate in any health care system. "Upon voter approval, this proposed constitutional amendment prohibits any person, employer, or health care provider from being compelled to participate in any health care system. Individuals and employers may pay directly for lawful health care services, and health care providers can accept payment for health care services from individuals or employers without being subject to fines or penalties. The purchase or sale of health insurance in private health care systems cannot be prohibited by law or rule.  Committee substitute added definitions
(Prefiled 1/6/10 for 2010 session; HJR 48 House resolutions combined & passed House 109y-46n, 3/16/10; pending in Senate 5/12/10)
( SJR 25 substituted; favorable comm. report 3/16/10); session adjourned 5/25/10 without further action) 

50% both legislative chambers
+
2010 ballot vote

HB 1764 by Sen. Cunningham  [final full text]
Proposed state insurance statute amendment to prohibit "any person, employer, or health care provider from being compelled to participate in any health care system. Individuals and employers may pay directly for lawful health care services, and health care providers can accept payment for health care services from individuals or employers without being subject to fines or penalties.
The summary for voters reads, "Shall the Missouri Statutes be amended to:  Deny the government authority to penalize citizens for refusing to purchase private health insurance or infringe upon the right to offer or accept direct payment for lawful healthcare services?"
(Senate substituted language prohibiting "compelling" participation in health insurance. Passed Senate 26y-8n, 5/4/10; passed House 5/11/10, 5/11/10; approved on August 3, 2010 primary election ballot by voters, 71.1% yes)  Vote Results Here
> Legislative News release5/11/10.
>
With Prop C, Missouri voters will be first in nation to weigh in on health-care reform. Includes NCSL material.  - St. Louis Beacon - July 28, 2010

State Statute placed on voter ballot for approval in August 2010.

  Nebraska

LR 289CA by Sen. McCoy
Proposed constitutional amendment stating "no law shall be passed that: (1) Restricts a person’s freedom of choice of private health care systems or private health plans of any type; (2) Interferes with a person’s or an entity’s right to  pay directly for lawful medical services; or (3) Imposes a penalty or fine of any type for choosing to obtain or decline health care coverage."
(Filed 1/13/10; postponed indefinitely; did not pass by end of session 4/14/10)

60% both legislative chambers
+
2010 ballot vote

  New Hampshire

CACR 30 of 2010 by Rep. Renzullo
Would propose a state constitutional amendment to establish a right stating, "People may enter into private contracts with health care providers for health care services and to purchase health care coverage." Also would prohibit the state legislature from requiring health insurance or imposing any fine or penalty for not having coverage.
(Filed 1/6/10; did not pass as "inexpedient to legislate" 2/3/10)

60% both legislative chambers
+
2010 ballot vote with 2/3rds popular vote

Also see Financing category below

  --
   New Jersey

ACR 109 by Assemblymember Mchose; SCR 81 by Sen. Doherty
Would propose a state constitutional amendment to prohibit state or federal law or regulation from compelling a person to obtain, provide, or participate in health care coverage.
(New Jersey 's constitution requires a three-fifths vote in each chamber at one session [2010], or majority vote in each chamber for two successive sessions [for 2012])
(ACR 109: Filed 2/25/10; held in in commerce committee as of 1/3/2011)    
(SCR 81: Filed 2/25/10; held in health and human services committee as of 1/3/2011)

Both legislative chambers
+
ballot vote
(see note)

   New Mexico
   (2009)

 

 

 

   New Mexico
   (2010)

SJR 1 of 2009 by Sen. Sharer/ HJR 10 of 2009 by Rep. Gardner
Proposed constitutional amendment stating, "No law shall be enacted that: A. restricts a person's freedom of choice of a private health care system or plan; B. interferes with a person's right to pay directly for lawful medical services; or C. imposes a penalty or fine of any type on a person for choosing to obtain or to decline health care coverage or for participation in a particular health care system or plan."  
(SJR 1 filed 1/21/09; HJR 10 filed 1/28/09; failed to pass by end of session; no carryover)

50% both legislative chambers
+
2010 ballot vote

HJR 5 by Rep. Gardner; SJR 2 by Sen. Sharer
Proposed constitutional amendment stating, "No law shall be enacted that: A. restricts a person's freedom of choice of a private health care system or plan; B. interferes with a person's right to pay directly for lawful medical services; or C. imposes a penalty or fine of any type on a person for choosing to obtain or to decline health care coverage or for participation in a particular health care system or plan."  
(Filed 1/20/10; failed to pass by end of regular session 2/10)

  North Carolina

HJR 1674 by Rep. Stam; SJR 1134 by Sen. Clary
Proposed Joint Resolution Authorizing the 2009 General Assembly to Consider a  Bill To Be Entitled An Act To Protect The Freedom to Choose Health Care And Health Insurance.
(Filed 5/17/10; Did not pass by end of 2010 session)

Proposed bill, majority vote required

SB 1157 by Sen. Forrester
Proposed constitutional amendment stating, "A law or rule shall not compel, directly or indirectly, any person, employer, or health care provider to participate in any health care system. (b) A person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for paying directly for lawful  health care services."
(Filed 5/17/10; Did not pass by end of 2010 session)

50% both legislative chambers
+
2010 ballot vote

  North Dakota

HCR 3010 by Rep. Kasper (Joint Resolution), a proposed 2010 constitutional amendment based on Arizona language.
Would propose an amendment to the State Constitution; relates to freedom of choice in health care; prohibits laws that restrict an individual's choice of private health care systems or private plans, interfere with a person's right to pay for lawful medical services, or impose a penalty or fine for choosing to obtain or decline health care coverage or for participation in any health care system or plan."
(Filed 1/14/09, failed to pass House 3/4/09 by end of 2009 session; no regular session in 2010)

50% both legislative chambers
+
future year ballot
vote

  Ohio

SJR 2 of 2009 by Sen. Coughlin; SJR 7 by Sen. Grendell; HJR 3 by Rep. Maag
Joint resolutions for a proposed constitutional amendment to state, " The people of Ohio have the right to enter into contracts with health care providers ... and to purchase private health care coverage" Would prohibit state laws requiring coverage or imposing fines. For "obtaining or declining" coverage.
(SJR 2 filed 2/24/09; held in Senate committee; did not pass by end of session1/4/11)
(SJR 7 filed 9/29/09; held in Senate Insurance &  Commerce Comm. as of 1/3/2011)
(HJR 3 filed  8/26/09; sent to Insurance Comm. 9/15/09; carried over to 2010; held in comm. as of 1/3/2011)

60% both legislative chambers
+
2010 ballot vote

HB 489; SB 244
Would prohibit requiring an individual to obtain or maintain a policy of health insurance. 
(Filed 4/14/10; pending;' held in original comm. as of 1/3/2011)

Proposed statute:
majority both
legislative chambers

  Oklahoma

SJR 59 - Binding Joint Resolution for a separate 2010 constitutional amendment ballot question establishing as state policy that, "A law or rule shall not compel, directly or indirectly, any person, employer or health care provider, to participate in any health care system;  A person or employer ... shall not be required to pay penalties or fines for paying directly for lawful health care services..."
Conference Comm. report; approved by Senate by 30y-13n, 5/5/10; approved by House  by 88y-9n and sent to Secretary of State 5/26/10; passed by voters on the November 2, 2010 ballot as Question #756)

HJR 1054 by Rep. Ritze; SJR 56 ; SJR 59 by Sen. Newberry
Joint resolution for a proposed constitutional amendment stating, "A law or rule shall not compel, directly or indirectly, any person, employer or health care provider to participate in any health care system; and A person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines" for lack of insurance.
    HJR 1054 was amended  by conference committee: it would enact a statute instead of a constitutional amendment. Also directs the state Attorney General to file a lawsuit against the federal government to prevent legislation regarding federal health insurance;
(HJR 1054 filed 12/22/09; passed House 77y-10n, 3/11/10;  enacting clause stricken, which nullified effect of the resolution; passed Senate 36y-11n, 3/23/10 ; Statute version favorable conference committee report, 4/19/10; approved by House 4/28/10; approved by Senate 4/29/10; vetoed by governor; veto overridden by House 5/18/10; veto override  did not pass in Senate, 5/21/10)

SCR 64 by Sen. President Pro Tempore Coffee and House Speaker Benge
Non-binding resolution authorizing legislative leaders to “employ legal counsel to file a lawsuit against the United States Congress, the President of the United States of America, and the Secretary of the United States Department of Health and Human Services to prevent the provisions” of  federal health care from taking effect.
(Adoped by Senate by 29y-17n; adopted by House by 63y-19n; certified as passed)

(SJR 59 Conference Comm. report for a separate 2010 constitutional amendment ballot question approved by Senate by 30y-13n, 5/5/10; approved by House  by 88y-9n and sent to Secretary of State 5/26/10; passed by voters on the November 2, 2010 ballot as Question #756)

Oklahoma article:  Question 756: Voters will have health care 'opt out' amendment in November - 9/8/2010

50% both legislative chambers
+
2010 ballot vote

 

- - - - - - - - -

HJR 1054
majority both
legislative chambers

SJR 58 by Sen. Coffee
Petitions the federal government to opt-out of certain mandates; and for certain waivers and block grants.
(Filed 2/1/10; passed Senate 35y-11n, 2/22/10; did not pass by end of session 5/28/10)

SJR 64
Directs the Attorney General to file a lawsuit against the federal government to prevent legislation regarding federal health insurance; directs distribution.
(Filed 2/1/10; passed Senate 29y-16n, 2/24/10; did not pass by end of session 5/28/10)

Non-binding
 resolutions

   Pennsylvania

HB 2053 by Rep. Baker 
Proposed statute "providing for the rights of individuals to purchase private health care insurance and prohibiting certain governmental action." States, "The people shall have the right to enter into private contracts with health care providers for health care services and to purchase private health care coverage. The legislature may not require any individual to participate in any health care system or plan, nor may it impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan."
(Filed and sent to Insurance Committee, 10/21/09; no floor vote in 2009;  carried over; did not pass by end of 2010 session)

Proposed statute:
majority both
legislative chambers
 

   Rhode Island

S 2544 and S 2747 by Sen. Blais
Would provide that no law would restrict a person's ability to contract with, pay for, and/or otherwise select a private health care system or private plan of that person's choosing; would take effect upon passage.
(Filed and sent to committee 2/11/10; committee "held for further study"; did not pass  by end of 2010 session 4 /28/10)

Proposed statute:
majority both
legislative chambers

  South Carolina

HJR 4181 by Rep. Scott; HJR 4240 by Rep. Duncan; HJR 4602 by Rep. Viers; SJR 980 by Sen. Bright; SJR 1010 by Sen. Rose.
Resolution for a proposed constitutional amendment, "prohibiting any law, regulation, or rule to compel an individual, employer, or health care provider to participate in a health care system, by allowing individuals and employers to pay directly for lawful health care services without penalties or fines for these direct payments, by providing that the purchase or sale of health insurance in private health care systems must not be prohibited by law, regulation, or rule."
The resolution title states, "... to preempt any federal  law or rule that restricts a person's choice of private health care providers or the right to pay for medical services."
(HJR 4181 filed for 2010 session; sent to Committee on Labor, Commerce and Industry, 11/17/09; held/pending 5/31/10; session adjourned without further action 6/3/10; state wide session to be held 6/15/10) 
(SJR 980 and SJR 1010 filed; sent to Senate Judiciary Committee 1/12/10; favorable report 3/30/10; session adjourned without further action 6/3/10; state wide session to be held 6/15/10) 


SB 987 by Sen Rose. 
By statute would provide that citizens “have right to enter into private contracts with health care providers for health care services and to purchase private health care coverage. The General Assembly may not require a person to participate in any health care system or plan and may not impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan.”
(Favorable Senate Judiciary Committee report 3/31/10; held/pending 5/31/10; session adjourned without further action 6/3/10; state wide session to be held 6/15/10) 

50% both legislative chambers
+
2012 ballot vote

 

 

 

 

 Proposed statute: 
majority both legislative chambers

SCR 424 by Sen. Bright
Senate concurrent resolution referencing state sovereignty under 9th and 10th Amendments. Resolves "that it is the policy of the State" that "no law shall interfere with the right of a person to be treated by or receive services from a health care provider of that person's choice; no law shall restrict a person's freedom of choice of private health care systems or private health care plans of any type; no law shall interfere with a person's or an entity's right to pay directly for lawful medical services; and no law shall impose a tax, penalty, or fine, of any type, for choosing a health care provider."  
    States that "the Attorney General will challenge constitutionality of any provision adopted by U.S. Congress" that violates these policies; also "no state agency, agent, department, instrumentality, or subdivision shall cooperate or participate in any way with any mandate passed by U.S. Congress"  if a court challenge is filed.
(Adopted by Senate and House with amendments, 3/9/10)

resolution; majority vote; no signature needed

  South Dakota

HJR 1001 by Rep. Jensen
Resolution for a proposed constitutional amendment, stating "The Legislature may not enact a law that restricts an individual's freedom of choice of private health care systems or private plans of any type; a law that interferes with a person's right to pay directly for lawful medical services; or a law that imposes a penalty or fine of any type for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan."

(Filed 1/28/10; sent to committees 2/10/10; did not pass committee "deferred " past end of session, 2/18/10)

50% both legislative chambers
+
2010 ballot vote

SCR 1 by Sen. Brown
Would oppose "the government takeover of health care as currently proposed by Congress" and encouraging preservation of states' rights regarding health care regulation, urging "not to adopt either measure or institute new federal review, oversight, or preemption of state health insurance laws."
(Filed 1/28/10; passed Senate 22y-10n, 2/1/10; passed House 44y-24n, 2/3/10)

 Non-binding resolution

  Tennessee

SB 2490 by Sen. Black; SB 2560 by Sen. Black; SB 3498 by Sen. Beavers;  HB 2622 by Rep. Lynn; HB 2654; HB 3433 by Rep. Bell
Would amend state law by adding a "Tennessee Freedom of Choice in Health Care Act.”
(SB 2560, HB 2622 assigned to committees, 2/22/10, 3/17/10; ; did not pass by end of session 6/10))
SB 3498 passed Senate engrossed, 29Y-1n, 2/22/10; did not pass House by end of session 6/10)

Proposed statute: 
majority both legislative chambers

HJR 0745 by Rep. Lynn
Resolution for a proposed constitutional amendment, stating  -  Prohibits laws or rules that would compel any person, employer, or health care provider to participate in any health care system.
(Filed 1/21/10; sent to committees, 2/22/10; held; did not pass House by end of session 6/10)

50% both legislative chambers
+
2012 ballot vote

SJR 897 by Sen. Ramsey
Would request that the TN Attorney General join other States in contesting the implementation of the federal health care legislation that was signed into law on March 23, 2010.
(Filed 3/25; adopted in Senate 21y-8n, 4/12/10; ; did not pass House by end of session 6/10)

Non-binding resolution

  Utah 

H 67 for 2010 session by Rep. Wimmer
Amends statute provisions related to the state's strategic plan for health system reform to respond to federal reform efforts; prohibits a state agency or department from implementing any provision of the federal health care reform without reporting to the Legislature: 1) the the specific federal statute or regulation that compels the state to adopt the particular provision; 2) consequences to the state if the state refuses to adopt the particular federal provision; and 3) impact to the citizens of the state if reform efforts are implemented or not implemented.

[Section deleted from final law:] 4) would require any agency of the state not to implement any part of federal health care reform passed by the US Congress after March 1, 2010, unless the department or agency reports to the Legislature and the Legislature passes legislation "specifically authorizing the state's compliance or participation in, federal health care reform."
(Passed House amended , 53y-20n, 2/11/10; passed Senate 22y-7n; signed into law by governor  3/23/10)     News articles 4, 7

Statute: 
majority both legislative chambers

 

HCR 8 by Rep. Clark
Urges Congress to refuse to pass any health care legislation that contains certain provisions, urges Congress to pass health care legislation with specific provisions, and urges Congress, should it pass health reform legislation that further restricts states, to grandfather certain state laws, regulations, and practices.
(Filed 1/25/10; signed into law by governor, 3/22/10)

HJR 11 by Rep. Morley
Urges the United States Congress to refrain from passing certain federal health insurance reforms.
(Filed 1/25/10; Passed House 51y-21n, 2/8/10; passed Senate 18y-8n, 2/18/10)

Non-binding resolution

  Virginia

 

 

 

 

 

HJ 7 by Del. Marshall
Resolution for a proposed constitutional amendment, to protect "an individual's right and power to participate or to decline to participate in a health care system or plan;  prohibiting any law that will infringe on an individual's right to pay for lawful medical services and  prohibiting the adoption of any law that imposes a penalty, tax, or fine upon an individual who declines to enter into a contract for health care coverage or to participate in a health care system or plan.
(Filed for 2010 and sent to committee 12/9/09; did not pass)  [Also see bills below]

50% both legislative chambers
+
2012 ballot vote

SB 283 by Sen. Quayle;  SB 311 by Sen. Martin; SB 417 by Sen. Holtzman Vogel, HB 10 by Del. Marshall.
Amends state law by adding a section, "Health insurance coverage not required. No resident of this Commonwealth, regardless of whether he has or is eligible for health insurance coverage under any policy or program provided by or through his employer, or a plan sponsored by the Commonwealth or the federal government, shall be required to obtain or maintain a policy of individual insurance coverage.  No provision of this title shall render a resident of this Commonwealth liable for any penalty, assessment, fee, or fine as a result of his failure to procure or obtain health insurance coverage."  It does not apply to Medicaid and CHIP coverage.
(Filed for 2010 session 1/13/10; SB  283, SB 311 and SB 417  passed Senate 23y-17n, 2/1/10; passed House 67y-29n, 2/12/10; sent to governor; amended and repassed  Senate 3/4/10; repassed House ; became law as  Virginia Chapter 106 of 2010, 3/10/10.
* Under Virginia law, the Governor exercised his option to return the bill to the legislature with a formal recommended amendment.  Both branches of the legislature voted to accept the Governor's recommendation, at which point the bills became law without requiring the Governor's signature.
[news articles: VA
2/10/2010; Boston Globe 3/8/2010

Statute: 
majority both legislative chambers

  Washington

HB 2669 by Rep. Hinkle; SB 6535 by Sen. Holmquist
Would amend state law by adding a provision that the state "shall not directly or indirectly compel any person, employer, or health care provider to participate in any health care system." and that " A person or employer may pay directly for lawful health care services and shall not be required to pay any penalty, fine, or other sanction for paying directly for lawful health care services.
(Filed  & sent to Health & Wellness Comm. 1/12/2010; did not pass by end of regular session; reintroduced in 1st Special Session 3/15/10); final day 4/13/10)

Proposed statute: 
majority both legislative chambers

SJR 8220 by Sen. Stevens
A proposed 2010 Constitutional amendment to provide that no law or rule may compel any person, employer, or health care provider to participate in any health care system; defines health care system as any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for, or payment for, health care services or health care data or information for its participants.
(Filed  & sent to Health & Wellness Comm. 1/12/2010; did not pass by end of regular session; reintroduced in 1st Special Session 3/15/10)

2/3rds  both legislative chambers
+
2010 ballot vote

  West Virginia
  (2009)

 

 
 

  West Virginia
  (2010)

H 3002 by Rep. J. Miller
The "Health Care Freedom Act" states, "The people have the right to enter into private contracts with health care providers for health care services and to purchase private health care coverage. The Legislature may not require any person to participate in any health care system or plan, nor may it impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan."
(Filed 3/9/09; failed to pass by end of session; cannot carry over to 2010)

Proposed statute: 
majority both legislative chambers
(Did not pass)

HJR 103 by Rep. J. Miller
A proposed 2010 Constitutional amendment prohibiting compulsory purchases in healthcare and providing choice and in payment for health services.
(Filed 2/5/10; motion to discharge postponed 2/25/10; did not pass committee by deadline -end of session. 3/19/10)

2/3rds Vote in both legislative chambers
+
2010 ballot vote

  Wisconsin

SJR 62 by Sen. Leibham;  AJR 138
A proposed 2012 Constitutional amendment; would establish the "right of the people to contract privately for health care services and health care coverage, and prohibiting requiring a person to obtain or maintain" health coverage.

(Filed 2/22/10; did not pass committee by 2010 session deadline 4/28/10)

50% both legislative chambers
+
2012 ballot vote

  Wyoming
  (2009)

 

 

  Wyoming
  (2010)

 

 

 

   "

SJR 3, by Sen. Pres. Hines
A proposed 2010 Constitutional amendment based on Arizona language, "that protects individuals, employers and health care providers from having to participate in any health care system."  Provides for "freedom of choice in health care; prohibits laws interfering with freedom of choice in health care" 
(Filed 1/20/09; died in Senate committee 3/3/09; no carryover)

2/3 both legislative chambers
+
2010 ballot vote

SJ 1 by Sen. Pres. Hines; HJ 12 by Rep. Lubnau
Resolution for a proposed 2010 constitutional amendment for “Health freedom of choice,” stating, “the federal government shall not interfere with an individual’s health care decisions.” Also would call for “prohibiting any penalty, fine or tax imposed because of a decision to participate in or decline health insurance, or to pay directly or receive payment directly for health care services.”
(Filed 1/26/10; did not pass introduction 18y-12n, 2/9/10; HJ 12  did not pass introduction 38y-19n, 2/10/2010)  [news article]

SB 49 by Sen. Jennings
Resolution would direct the attorney general to investigate the state and federal constitutional effects of federal health care or health insurance reform legislation; requiring a report within 60 days of any future federal enactment; providing for the attorney general to seek legal remedies.
(Filed 2/3/10; did not pass introduction requirement, 18y-12n, 2/9/10) 

2/3 both legislative chambers
+
2010 ballot vote


 
Proposed statute; 2/3 required for consideration in budget session

Table 2: States Opposing Health Reform Financing and Unfunded Mandates

State

Activity/Legislation

Required for Passage 

Arizona

HCM 2002 ; SCM 1001
Relates to Medicaid; urges Congress to ensure that any federal health care reform legislation has a minimal fiscal impact on the states.
(Filed 1/15/10; favorable report 3/17/10; did not pass by end of session)

Non-binding
 resolutions

Florida

S4b  Non-binding Senate resolution urges the U.S. Congress to amend Medicaid law in order to "reestablish a fair and prudent federal-state partnership" that allows each state "the freedom to craft a Medicaid program that meets the needs of its residents" without mandatory expansion and enables states to provide cost-effective health care services to low-income residents
(Passed Senate; passed House 11/16/10 Adopted)

 
Illinois

HR 1074 by Rep. Bellock
Would request that the IL Commission on Government Forecasting and Accountability examine the provisions of the federal health care reform law to determine the fiscal impact of the provisions on the state budget, with a report due July 1, 2010 for use wit the FY1011 budget.
(Filed and sent to Rules Committee, 3/26/10; held in comm. as of 9/7/10)

Non-binding
 resolutions

Iowa

SB 2097
Would affirm the intent of the General Assembly to exercise those powers reserved to the states; includes but not limited to providing state-based regulation of the health insurance market; provides aggressive oversight of this market; enforces consumer protection and a local, responsive presence for consumers.
(Filed; sent to Senate Committee on Judiciary 1/27/10; did not pass by end of session 4/10)

 
Michigan

SR 106 by Sen. George
Memorializes the President, the Congress, and the Secretary of HHS to remove provisions from the final version of the federal health care reform legislation that would increase financial obligations for states, whether through expanded Medicaid requirements or other mandates.
(Filed; Adopted by Senate 1/16/10)

Non-binding
 resolutions

New Hampshire

SB 417 by Sen. Bradley
Would amend state law to prohibit the expansion of the Medicaid program if Congress passes a national health insurance plan unless the expansion is approved by the NH Legislature or is paid for by the federal government.
(Filed and sent to Senate Finance Committee 1/6/10; did not pass; voted as "inexpedient to legislate" , 14y-10n, 3/3/10)

Proposed statute: 
majority both legislative chambers

Sources: NCSL research; State legislative web sites; StateNet for selected features.  Powered in part by
 

 

News and Articles, 2009-2010

2011 News and Articles  

 APPENDIX 1 - The Arizona Approved Constitutional Amendment

Engrossed (Full Text) 
State of Arizona, House of Representatives -- Forty-ninth Legislature, First Regular Session,  2009

HOUSE CONCURRENT RESOLUTION 2014

A CONCURRENT RESOLUTION
PROPOSING AN AMENDMENT TO THE CONSTITUTION OF ARIZONA; AMENDING ARTICLE XXVII, BY ADDING SECTION 2, CONSTITUTION OF ARIZONA; RELATING TO HEALTH CARE SERVICES.

    Be it resolved by the House of Representatives of the State of Arizona, the Senate concurring:

    1. Article XXVII, Constitution of Arizona, is proposed to be amended by adding section 2 as follows if approved by the voters and on proclamation of the Governor: 
     2. Health care; definitions

     section 2. A. To preserve the freedom of Arizonans to provide for their health care:

     1. A law or rule shall not compel, directly or indirectly, any person, employer or health care provider to participate in any health care system. 
     2. A person or employer may pay directly for lawful health care services and shall not be required to pay penalties or fines for paying directly for lawful health care services. A health care provider may accept direct payment for lawful health care services and shall not be required to pay penalties or fines for accepting direct payment from a person or employer for lawful health care services. 

     B. Subject to reasonable and necessary rules that do not substantially limit a person's options, the purchase or sale of health insurance in private health care systems shall not be prohibited by law or rule. 

     C. This section does not:

     1. Affect which health care services a health care provider or hospital is required to perform or provide. 
     2. Affect which health care services are permitted by law. 
     3. Prohibit care provided pursuant to article xviii, section 8 of this constitution or any statutes enacted by the legislature relating to worker's compensation. 
     4. Affect laws or rules in effect as of January 1, 2009. 
     5. Affect the terms or conditions of any health care system to the extent that those terms and conditions do not have the effect of punishing a person or employer for paying directly for lawful health care services or a health care provider or hospital for accepting direct payment from a person or employer for lawful health care services.

     D. For the purposes of this section:

     1. "compel" includes penalties or fines. 
     2. "direct payment or pay directly" means payment for lawful health care services without a public or private third party, not including an employer, paying for any portion of the service. 
     3. "health care system" means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants. 
     4. "lawful health care services" means any health-related service or treatment to the extent that the service or treatment is permitted or not prohibited by law or regulation that may be provided by persons or businesses otherwise permitted to offer such services . 
     5. "penalties or fines" means any civil or criminal penalty or fine, tax, salary or wage withholding or surcharge or any named fee with a similar effect established by law or rule by a government established, created or controlled agency that is used to punish or discourage the exercise of rights protected under this section.
    2. The article heading of article XXVII, Constitution of Arizona, is proposed to be changed as follows if approved by the voters and on proclamation of the Governor: 
    The article heading of article XXVII, Constitution of Arizona, is changed from "REGULATION OF PUBLIC HEALTH, SAFETY AND WELFARE" to "REGULATION OF HEALTH, SAFETY AND WELFARE". 
    3. The Secretary of State shall submit this proposition to the voters at the next general election as provided by article XXI, Constitution of Arizona.

 -----------------------

Arizona 2008 History/Action:  In 2008, Arizona Proposition 101 appeared on the ballot, referred to by proponents as the "Freedom of Choice in Health Care Act."  If it had passed, it would have added the following language to the Arizona Constitution: "Because all people should have the right to make decisions about their health care, no law shall be passed that restricts a person's freedom of choice of private health care systems or private plans of any type. No law shall interfere with a person's or entity's right to pay directly for lawful medical services, nor shall any law impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan." Proposition 101 failed to pass by a vote of 1,048,512 in favor and 1,057,199 opposed, a difference of 8,687 votes. Arizona's Proposition 101 language from 2008 has served as the basis for 2009 legislative language drafted by the American Legislative Exchange Council (ALEC).


Arizona Opinions: ALEC article: "Arizona Poised to Block Single-Payer Health Care" http://www.alec.org/am/pdf/Inside_July09.pdf
The 2009 legislative resolution was approved "along party lines." “I certainly would expect it would go to the courts as a states' rights issue,” says Bert Coleman, manager of the Arizona campaign. Coleman adds that proponents of the efforts chose to go through the legislative route rather than a much slower citizen petition (as in 2008) process in order to be part of the ongoing discussion over health reform. “We wanted to be part of the debate now,” Coleman stated to Inside Health Policy. “Will it influence the debate? I certainly hope so.”


Sources and Archives:   (2009-2010)
NCSL provides links or references to third-party articles and information as a convenience. NCSL is not responsible for the accuracy or completeness of such material.
 

[1] American Legislative Exchange Council (ALEC) as quoted in article of August 12, 2009 and NCSL interview with Christie Herrera, ALEC Health Director, August 17, 2009. 

[2] Insurance NewsNet: Legal Analysts: "Suits May Challenge Constitutionality of Individual Mandate in U.S. Health Reform," October 8, 2009.

[3] New York Times "Health Care Overhaul and Mandatory Coverage Stir State' Rights Claims," September 29, 2009

[4] CNS News.com, a subsidiary of the Media Research Center. "Nineteen States Move to Defend Individual Health Care Choice," Tuesday, October 27, 2009

[5] Inside ALEC: "Arizona Poised to Block Single-Payer Health Care." Page 11, July 2009.
ALEC web site, accessed 12/31/2010. 

[6] Marsha Shuler, The Advocate, [Baton Rouge]. [Louisiana state] legislator pushing amendment addressing health-care changes."  August 11, 2009

[7]  Deseret News, "Pushing back against feds,"   August 13, 2009

[8] Politico.com. Professor Randy Barnett and Professor Timothy Jost: "Healthcare: Is 'mandatory insurance' unconstitutional?" Sept. 18 2009:

[9]  Inside ARM. State Lawmakers Seek Legislative Solutions to Health Care Reform Mandates - September 28, 2009.

[10] News-Leader (Missouri)  Lawmakers: Overhaul a threat to freedom. November 15, 2009

[11] Denver Post. Efforts already underway in Colorado to blunt federal health care reforms.  December 30, 2009 

[12] Virginia v. Sebelius, 2010 U.S. Dist. LEXIS 77678; Filed March 23, 2010 (Aug. 2, 2010)

 

APPENDIX 2:  Number of Sessions During Which Legislative Enactment Is Required

 In the following 35 states, the legislature enacts a proposed constitutional amendment during only one session.

            Alabama                                   Louisiana                                 North Dakota
            Alaska                                      Maine                                      Ohio
            Arizona                                    Maryland                                 Oklahoma
            Arkansas                                  Michigan                                 Oregon
            California                                 Minnesota                                Rhode Island
            Colorado                                  Mississippi                               South Dakota
            Florida                                     Missouri                                   Texas
            Georgia                                    Montana                                 Utah
            Idaho                                       Nebraska                                Washington
            Illinois                                      New Hampshire                       West Virginia
            Kansas                                      New Mexico                           Wyoming
            Kentucky                                 North Carolina                        

In the following 12 states, the legislature must enact a proposed constitutional amendment during two sessions.

            Delaware **                             Nevada                                   Tennessee
            Indiana                                     New York                                Vermont
            Iowa                                         Pennsylvania                           Virginia
            Massachusetts                       South Carolina                        Wisconsin
** Delaware does not require a public vote once a proposed amendment passes two consecutive sessions by a 2/3 vote.

In the following three states, the vote total determines the number of sessions during which a proposed constitutional amendment must be enacted.

            Connecticut                             New Jersey                               Hawaii

 Source for Appendix 2: Brenda Erickson, NCSL Legislative Management memorandum, 2009.

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APPENDIX 3:   ARCHIVE OF COURT ACTIONS, 2010-2011 

2011 APPEALS COURT STEPS

District of Columbia U.S. Court of Appeals (No. 11-5047): On November 8, 2011, at the U.S. Court of Appeals for District of Columbia, a three-judge panel issued a ruling in the case (Susan Seven-Sky v. Eric Holder, Jr)  upholding the constitutionality of the federal ACA law.  In a 2-1 decision, Judge Laurence Silberman affirmed the lower court's ruling, finding that the ACA's individual mandate -- requiring that nearly all persons have health insurance -- is within Congress' powers. Judge Brett Kavanaugh's dissent disagreed with the conclusion, without taking a position on the merits of the law, stating that the case lacks standing until the law takes effect in 2014.  This was an independent lawsuit filed by the American Center for Law and Justice and dismissed by U.S. District Judge Gladys Kessle, of the District of Columbia, on February 22, 2011.  The appeal was supported by attorneys general offices in 14 states: Alabama, Florida, Indiana, Kansas, Maine, Michigan, Nebraska, North Dakota, Ohio, Pennsylvania, South Dakota, Texas, Washington and Wisconsin.

Florida v. U.S. Dep't of Health & Human Services. [court papers]  On September 28, 2011 both the plaintiffs and the Justice Department, in the Florida-based multi-state challenge to the Affordable Care Act (ACA), formally petitioned the Supreme Court to take up the case during its upcoming term (October 2011-June 2012). 
“We believe the question is appropriate for review by the Supreme Court," the Justice Department stated on Wednesday.  “Time is of the essence,” wrote Paul D. Clement, the former United States solicitor general who represents 26 states that are challenging the law.  On September 26, the Justice Department said that it had decided not to ask the full U.S. Court of Appeals for the 11th Circuit in Atlanta to conduct another review at the circuit court level, which could have slowed the court process.   
> On August 12, the Court of Appeals for the 11th Circuit in Atlanta, in State of Florida v. U.S. Dep't of Health & Human Services, ruled against the individual mandate provision in the ACA,  by 2-to-1. This case was initiated by Florida A.G. Bill McCollum and eventually joined by 26 states; their case argued that the reform law should be struck down because it relies on an unconstitutional expansion of federal power. 
> Court Filings requesting U.S. Supreme Court review: United States Justice Department petition for a writ of certiorariFlorida et al petition for a writ of certiorari | NFIB petition for a writ of certiorari 9/28/2011. [see definition]
 

Virginia: On September 8, 2011, the U.S. Court of Appeals for the Fourth Circuit in Richmond, Virginia sided with the federal health reform law on procedural grounds, dismissing or “vacating” two separate earlier District Court cases.  

  • In Commonwealth of Virginia v. Kathleen Sebelius (#11-1057), the Appeals Court judges’ opinion (33 pages) ruled that Virginia did not have standing to challenge the Affordable Care Act based on their state statute (Virginia Chapter 106 of 2010) declaring opposition to an "individual mandate."  The federal law will require most Americans to obtain or purchase health insurance by 2014 or face a financial penalty. The unanimous opinion, written by Judge Diana Gribbon Motz, concluded that a state does not “acquire some special stake in the relationship between its citizens and the federal government merely by memorializing its litigation position in a statute.” (p. 28) She continued, “If we were to adopt Virginia’s standing theory, each state could become a roving constitutional watchdog of sorts.”

    In both cases, the decision was to “vacate the judgment of the district court and remand to that court, with instructions to dismiss the case for lack of subject-matter jurisdiction.”   Virginia goes back to the U.S. District Court for the Eastern District of Virginia; (Civil Action No. 3:10-cv-188,) where Judge Henry Hudson had issued a ruling on December 13, 2010, declaring the federal individual mandate unconstitutional. Virginia Attorney General Kenneth Cuccinelli announced on September 8 that he would appeal to the U.S. Supreme Court.

  • In Liberty University v. Timothy Geithner (#10-2347), the Appeals Court judges’ opinion (140 pages) ruled 2-1 that the plaintiffs also lacked standing to challenge the federal law, for a different legal reason. Judge Motz wrote that the Liberty suit could not seek to strike down the individual mandate before it took effect in 2014 because doing so would, in effect, usurp the government’s right to collect a tax.

Earlier, another federal appeals court disagreed when reviewing similar but separate legal challenges, upholding the Affordable Care Act.

  • Ohio:  On June 29, a three-judge panel of the Court of Appeals for the Sixth Circuit in Cincinnati, in Thomas More Law Center v. Barack Obama (#10-2388), ruled 2-to-1 in favor of the federal law’s requirement that most Americans must obtain health insurance, starting in 2014. Judge Jeffrey Sutton delivered the opinion for the court; the decision in part split three ways, with no majority to completely uphold the mandate under the Commerce Clause. 

Litigation Highlights, 2010-2011 Background

For two years there were two distinct state-based  federal court challenges, a third case supported by Missouri executiives, and several other private party suits with judges' rulings.  Some cases have been combined by federal appeals courts:

  1. State of Florida v. U.S. Dep't of Health & Human Services. (led by Florida A.G.; in Florida Northern District Court; Case No.3:2010-cv-0009 ) Filed March 23, 2010.  On January 31, 2011 Federal District Judge Roger Vinson declared the federal health care overhaul unconstitutional, siding with 26 states that sued to block it, saying that people can't be required to buy health insurance by 2014 or face penalties. He went a step further than a previous ruling against the law, declaring the entire thing unconstitutional if the insurance requirement does not hold up. 

    Attorneys for the administration had argued that the states did not have standing to challenge the law and that the case should be dismissed. The final step will almost certainly be the U.S. Supreme Court. Two other federal judges have already upheld the law and a federal judge in Virginia ruled the insurance mandate unconstitutional but stopped short of voiding the entire law. At issue was whether the government is reaching beyond its constitutional power to regulate interstate commerce by requiring citizens to purchase health insurance or face tax penalties. 
    >  "Fla. judge strikes down Obama health care overhaul" - Washington Post 1/31/2011
    > On March 3, Judge Vinson, in response to the February 18 Administration’s “Motion to Clarify” his decision regarding the constitutionality of the Affordable Care Act, ruled that he would not require the Administration to cease implementation of the Affordable Care Act, but does require the Administration to move forward on their appeal of his decision (finding the Act unconstitutional) within seven days.  He stated that imposing a stay on implementation would be unnecessarily disruptive and asked the Administration to request expedited consideration in either the federal appeals court or the U.S. Supreme Court. 
    > On March 10, 2011 both parties requested an expedited appeal to the U.S. Appellate Court.  See: State Response to DOJ Motion to Expedite |  FL Petition for Hearing, March 10.  The case will be heard by the U.S. Court of Appeals for the 11th Circuit on June 8, 2011. 
    > On April 8, 2011 an amicus brief was filed on behalf of a bipartisan group of 154 state legislators from 26 states, supporting the federal government's appeal.

  2. Commonwealth of Virginia v. Sebelius. (led by Virginia A.G.; initially in U.S. District Court for the Eastern District of Virginia; Civil Action No. 3:10-cv-188).  Filed March 23, 2010. Judge Henry Hudson in August 2010 declined to dismiss the suit. He issued a ruling declaring the individual mandate unconstitutional on December 13, 2010.  The appeal by the Administration was heard by the U.S. Court of Appeals for the 4th Circuit on May 10.
    > On September 8, 2011, the 4th U.S. Circuit Court of Appeals sided with the federal Health Reform Law in Virginia's healthcare reform legal challenge; the Appeals Court order was to "dismiss the case for lack of subject-matter jurisdiction."
    > Health Care Law Ruled Unconstitutional (NY Times, 12/13/2010)
    > Virginia: Reply Memo Summary Judgment, Oct. 4

  3. Thomas More Center v. Obama. (on behalf of 4 residents of S.W. Michigan; in U.S. District Court for the Eastern District of Michigan; Case No. 2:10-cv-11156-GCS-RSW) Filed March 23, 2010. On October 7, Judge George Steeh dismissed this case, stating that choosing not to obtain health insurance coverage qualified as an example of "activities that substantially affect interstate commerce." Plaintiffs appealed to the U.S. Court of Appeals for the 6th Circuit, with a hearing on June 1, 2011.
    > News article: "Justices are asked to hear challenge to health care law.  Describes the step as "The Supreme Court was asked on Wednesday to hear a challenge to the health care overhaul law, raising the possibility that the justices could rule on the matter by next summer, just months before the presidential election. Similar requests are likely to follow, and it is not clear which if any of them the court will agree to hear."  published 7/28/11 by the New York Times.

  4. Liberty University v. Geitner.  Also in Virginia, a private party suit by Liberty University was rejected in the U.S. District Court for the Western District of Virginia on November 30; the judge issued a 54-page ruling that granted the government’s request to dismiss the case. The appeal to the U.S. Court of Appeals for the 4th Circuit will be heard May 10, 2011.  [read news article]

  5. US Citizens Assoc. v. Sebelius. In another private party suit, the U.S. District Court for the Northern District of Ohio in a ruling Nov. 22 allowed part of a lawsuit challenging the constitutionality of the health reform law to move forward. Dismissing three claims brought by the U.S. Citizens Association, Judge David Dowd agreed to hear arguments that the law’s individual mandate violates the Constitution’s interstate commerce clause. The rejected claims asserted that the law violated plaintiffs’ freedom of association guaranteed by the First and Fifth Amendments, the due-process clause of the Fifth Amendment and plaintiffs’ right to privacy. “It is apparent to the undersigned that the controversy ignited by the passage of the legislation at issue in this case will eventually require a decision by the Supreme Court after the above-described litigation works its way through the various circuit courts,” Dowd wrote.

  6. Judge dismisses lawsuit claiming the ACA health care mandate violates religious freedoms.   U.S. District Judge Gladys Kessler, of the District of Columbia, on February 22, 2011 dismissed a lawsuit filed by the evangelical Christian legal group the American Center for Law and Justice on behalf of five Americans who prefer not to purchase health insurance. Three are Christians who say they rely on God to protect them. The two others have a holistic approach to medical care.   The Judge wrote that Congress "was acting within the bounds of its Commerce Clause power" when it mandated that individuals buy health insurance by 2014 or pay a penalty.  In upholding the law, Kessler said that the decision to forgo health insurance by some individuals leads to substantially higher insurance premiums for other individuals who do obtain coverage. "There is nothing extraordinary about Congress' use of its Commerce Clause power," she wrote, "to rein in the price of health insurance policies."

  7. (Kinder et al. v. Geithner et al., 1:10-cv-101) Missouri Lieutenant Governor Peter Kinder and six state residents sued U.S. officials in July 2010, claiming the law is unconstitutional because it requires people to buy health insurance. U.S. District Judge Rodney W. Sippel dismissed the case in April 2011 and Kinder appealed.  On July 18, 2011 officials from 21 other states filed a brief asking the federal appeals court in St. Louis to reinstate the lawsuit.

  8. Other -- There are a variety of other private-party filed lawsuits related to the 2010 federal health law.  [litigation list]

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