To me, all the detailed problems and arguments back and forth about the details of the so-called “ACA” is, like much of the activities of the federal government, a study in trying to do the wrong thing the right way.
Obamacare is unconstitutional and should be repealed as such. The Commerce Clause of the Constitution was in no way intended to give the federal government this kind of power, power our Founders never contemplated. Health insurance is none to the federal government’s business. Neither is health care.
And because the Supreme Court and federal government will almost certainly not repeal Obamacare, the states should reject ACA as an unconstitutional federal act.