States take aim at health reform law from several fronts


Opposition to federal health reform approved by Congress and President Obama in March 2010 continues to find legal recognition in the states.

Opposition to federal health reform approved by Congress and President Obama in March 2010 continues to find legal recognition in the states. Indeed, more than 40 states have taken varied actions to challenge the Patient Protection and Affordable Care Act.

In 30 states, legislation called for constitutional amendments. The amendments typically call for the prohibition of an individual mandate to carry health insurance and are submitted to voters for approval. Arizona (6/09), Florida (4/10), and Oklahoma (5/10) approved such measures. In Colorado, a citizen’s initiative, Amendment 63, made its way to the November ballot. (In Florida, the proposed amendment was knocked off the ballot after the State Supreme Court deemed its language overtly political.)

Federal constitutional amendment

Idaho called for an amendment to the U.S. Constitution forbidding any law to require health care insurance. This was adopted by both Senate and House on March 29, 2010.

State law

At least 16 states proposed bills to amend the law, not the state constitution. These measures, successful in Virginia, Georgia, Idaho, Louisiana, Missouri, and Utah, essentially state that no person should be required to carry health insurance. (In the case of Missouri, a law proposed by the legislature was submitted to voters and approved during its Aug. 3 primary election.)

Executive and judicial branch legal action

Attorneys general and/or governors in more than 20 states have taken actions to challenge the federal government’s constitutional authority to mandate certain elements of the health care reform law (see list below). Legal experts express varying opinions on the validity of this approach given the notion of federal supremacy over states’ authority. However, the federal government twice failed on separate motions to dismiss two lawsuits. In Virginia, a hearing on the merits of Attorney General Ken Cuccinelli’s case will be held Oct. 18. Oral arguments in the multi-state lawsuit led by Florida Attorney General Bill McCollum are scheduled for Dec. 16.

States challenging the federal government’s authority to mandate aspects of health reform














North Dakota


South Carolina

South Dakota





To learn more about legislative issues in your state, please visit AACU’s Action Center today at

We also encourage you to post your comments about this topic in the “Post a Comment” box below.

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