Can States Ban Obamacare?

When the Affordable Care Act (ACA), or Obamacare, was first enacted, many states (and other groups) attempted to fight the law, or at least specific provisions. Several states attempted to ban Obamacare within their borders, but being a federal law, this proved impossible.

This didn’t stop some states from doing all they could to sabotage and undermine the program. For example, several states refused to use federal funding to create state health exchanges (through which residents could apply for, purchase, and manage health insurance plans). Some states also refused to supplement Medicaid programs with additional state funds.

Legal complaints against Obamacare were largely unsuccessful, and the Supreme Court ultimately upheld the law by a ruling of 5-4. Despite that, there have been dozens of attempts to repeal the ACA in the house and senate since it went into effect. President Obama blocked these attempts with his veto power (or the threat of veto).

Now there is a new president and a new administration in the White House, and President Trump and the republican-led Congress have vowed to repeal and replace Obamacare. What does this mean for states? Can they ban Obamacare now?

Repeal
At this point, the ACA is a federal law, which means it can only be banned if the Congress and the president all agree to repeal it, which they plan to do. This only involves individual states insomuch as members of Congress will vote on behalf of their states, hopefully taking the wants and needs of their constituents into account.

If the ACA is repealed and replaced, states will no longer be beholden to Obamacare – they will have to follow whatever law is enacted to replace the ACA. Insurance companies, healthcare providers, and U.S. citizens will have to do the same.

Executive Order
The president has the power to issue executive orders, but may not use this power to overturn existing laws, like the ACA. However, executive orders can be used to undermine the authority of Obamacare and make the law ineffective.

This has already started. President Trump has signed an executive order directing federal agencies to begin granting waivers, exemptions, and delays for any of the measures included in Obamacare that would impose costs on states or on individuals.

Many people and entities were upset about the individual mandate (that requires every citizen to carry minimum coverage or pay penalties). This executive order could allow federal agencies to give provisions to individuals without healthcare or waive penalties associated with failure to meet mandatory minimums, for example, although this has not been expressly stated.

The executive order has also called for a halt on new regulations that would extend the reach of Obamacare, and grants states greater latitude to control health care programs. The language of the executive order is not very clear about what these directives mean or how they should be implemented in a practical sense.

So, can states ban Obamacare? The answer is no – the federal law cannot be banned outright at the state level. However, it seems as though states are gaining greater ability to challenge and undermine the law should they so choose.