As a practical matter, all a state can refuse to do is to set up a state run health care exchange, or set up one with substantially different rules from those mandated by federal law, in either case the federal government is empowered to set up a federally run exchange. There is nothing such states can do to prevent the establishment of the federally run exchange or to prevent individuals from participating in it if they wish, so this kind of symbolic resistance will likely have the effect of:
1) *Increasing* federal participation in health-care funding and rule-making.
2) Reducing the cost control effectiveness in states which set up simultaneous state and federal exchange systems as a split membership will reduce bargaining power of each.
IMO one thing doesn’t get enough attention in most discussions here is that while “Health Care Reform” is politically unpopular, some individual provisions of the bill - including some of the most politically and economically significant - poll at 70% or higher popularity, so it’s unrealistic to suppose that we are ever going to return to the system as it existed prior to passage of the bill - that ship has sailed.
Can you cite the article and section that enumerates that particular power?
IMO one thing doesn’t get enough attention in most discussions here is that while “Health Care Reform” is politically unpopular, some individual provisions of the bill - including some of the most politically and economically significant - poll at 70% or higher popularity...
I've heard this mentioned a number of times but all it does is spotlight the Framers intent and the primary purpose of our Constitution. Our Founders were bright enough to know that at some point the unwashed could be sold a bill of goods by feral government pimps in exchange for votes. One of the primary functions of our Constitution was to restrain the federal government enough to assure that didn't happen.