States that have refused to implement the Obama health law have already blocked $80 billion of its new deficit spending. If more states follow suit, they can block the other $1.6 trillion and force Congress to repeal the law.
The law relies on states to implement two of its most essential pieces: health-insurance "exchanges" and a vast expansion of Medicaid. Exchanges are government agencies through which the law channels $800 billion to private health-insurance companies.
The Medicaid expansion adds another $900 billion to the federal debt, with private insurers again taking a slice. States are under no obligation either to implement either. Responsible state officials will say no to both.
It is a myth that creating an exchange gives states more control over their insurance markets. Yes, the law directs the federal government to create one in states that do not. But every exchange must be approved by federal bureaucrats, empowering them to impose whatever oppressive rules on "state-run" exchanges they would impose through a federal exchange.
A critical mass of states could literally force Congress to repeal the Obama health law.
In contrast, by refusing to create an exchange states can block the law's debt-financed subsidies to private insurance companies and avoid new taxes on their employers and consumers.
The law imposes a $2,000 per-worker tax on employers, but only in states that create an exchange. (If Virginia creates one, there will be a giant sucking sound as employers flee to Louisiana, Texas, South Carolina and Florida, which have said they will not.) States creating exchanges will have to increase taxes another $10 million to $100 million per year to cover their operating costs.
The Supreme Court further empowered states when it overturned the law's Medicaid mandate. That mandate required states to expand their Medicaid rolls dramatically on pain of losing all federal Medicaid funds, which comprise 12 percent of state revenues. Twenty-six states challenged that mandate as unconstitutionally coercive.