1. States Blocking Reform Families USA – Health Action January 30, 2010 Lisa Codispoti National Womens Law Center lcodispoti@nwlc.org

2. Substance: What are they trying to block Individual, Employer Mandates –Compulsory purchase –Freedom of choice Public Option Medicaid Expansion

3. Substance: What arguments are they using? Unconstitutional –Commerce Clause –Tax & Spend –Tenth Amendment Unfunded Mandate –Medicaid –Insurance Rules/new structure

4. Vehicles State Constitutional Amendments Resolutions State laws/bills Ballot Measures

5. Whos Involved? ALEC (model legislation) Conservative think tanks: –Heritage Foundation –Cato Institute –American Enterprise Institute –Federalist Society Conservative commentators Tea Party supporters Tenthers

6. ALEC: American Legislative Exchange Council Started 30 years ago by conservative legislators and activists including Senators Jesse Helms and John Buckley, conservative funder Paul Weyrich, then IL. State Rep. Henry Hyde, Member of Pres Reagans Task Force on Federalism Task Forces- with heavy private sector participation; draft model legislation Health & Human Services Task Force- Private Sector Executive Committee Members: –Jeff Beul, Johnson & Johnson, –Joan Gardner, Blue Cross/Blue Shield –Kristin Parde, PhRMA Source: www.alec.org

7. Good News & Bad News Good news: many legal scholars believe that constitutional, other state legal challenges to health reform will not prevail Bad news: we may win these battles- but they are part of a larger strategic war

8. Good news: While Congress can not force states to act, they can incentivize –Federal funding: Medicaid, highway funds, etc. –Fall-back provisions in the health reform bills Considerable State flexibility in Senate bill

9. Bad news: Message/Politics Sows additional seeds of doubt re: overall health reform Injects federal debate into state arena State officials involved now: Governors, AGs, Insurance Commissioners, State Legislators Ballot measures: used to mobilize their base for electoral purposes Forces us to take our fight to defend to states- Optics of a federal/state stand off

10. Political Strategy Excerpts from AEI presentation as part of NCSL webinar, 12/2/09: Force exposure of coercion on less defensible terrain Weaken individual/employer mandate Unravel rest of interconnected provisions Not challenge everything head on Engage, rally local citizens vs. made in Washington A long slog to 2014

11. For more info, and to track these state legislative efforts, see: www.ncsl.org/default.aspx?tabid=18906 Lisa Codispoti Senior Counsel National Womens Law Center lcodispoti@nwlc.orglcodispoti@nwlc.org; 202-588-5180