DENVER | Congress can pass a federal health care bill and President Obama can sign it, but that doesn't mean the states plan to abide by it.
Lawmakers in 30 states are pressing for constitutional amendments to exempt individuals from the requirement to purchase health care, a pivotal piece of the legislation under debate in Congress.
In Colorado, organizers of a proposed ballot measure filed language with the state elections office Friday. They would like the state legislature to place the amendment on the ballot, but given that both houses are controlled by Democrats, that's unlikely.
"I want Colorado to become a sanctuary state for good health care," said Jon Caldara, president of the Independence Institute, who is leading the ballot effort. "People are angry, and rightfully so. If the legislature's not going to step up and do something, then we're going to have to."
Mr. Caldara's group plans to kick off its ballot campaign with a rally Tuesday outside the state Capitol. His group drafted its own language, but many states are using versions of legislation developed by the American Legislative Exchange Council.
Nineteen states have filed or pre-filed legislation using the organization's legislative language, known as the Freedom of Choice in Health Care Act, said Christie Herrera, ALEC's director of health and human services task force. Ten others have announced their intent to introduce similar bills this session.
"It's all about preserving the right of people to choose health care for themselves," said Ms. Herrera.
Opponents of the opt-out movement argue that it shows no regard for the uninsured. They also question the motives of state lawmakers, accusing them of being more interested in embarrassing the president and weakening the Democratic Party's chances in 2010 midterm elections than in true reform.
"This is a classic case of 'follow the special interests.' If you look at the people orchestrating this effort, it's exactly the same people who were behind the tea parties and who organized rallies against the stimulus and cap-and-trade," said Michael Huttner, chief executive officer of ProgressNow, a liberal advocacy group.
"These people have nothing better to do than hammer this administration and everything they do," he said. "This is just the issue that's been in the news. If it were some other issue like energy, this entire campaign would be on a completely different thing."
The Freedom of Choice act was in turn modeled after Proposition 101, the proposed 2008 Arizona constitutional amendment. Gov. Janet Napolitano, a Democrat who is now homeland security secretary, opposed the proposition, saying it would interfere with public health programs. Heavily outspent, the initiative lost by a nose: The margin of defeat was 50.2 percent to 49.8 percent.
But Proposition 101 is getting a second chance: The Republican-dominated state Legislature voted in June to place its clone, House Bill 2014, on the 2010 ballot.
Leaders of the Arizona ballot-measure campaign say they favor reform, but not the kind that forces people to purchase government-approved health care plans.
"Changes are incredibly important," said Dr. Eric Novack, an orthopedic surgeon and chairman of Arizonans for Health Care Freedom. "But at the center of those changes must forever be the rights of patients and families to remain in control of their own health and health care decisions."
House Minority Leader John A. Boehner, Ohio Republican, lent his support to the movement last week. His home state is one of those where opt-out legislation has been introduced.
"With our focus squarely on defeating a government takeover of health care, this growing rebellion in the states is yet another indication of strong grass-roots opposition to Washington Democrats' plans," Mr. Boehner said in a statement. "All the burdensome mandates, tax hikes, and new layers of red tape Democrats are devising behind closed doors would wreak havoc on the states, so it's no surprise a majority of them are already fighting back."
Democrats argue that too many of the uninsured won't get health care coverage if states are able to skirt the bill. House Democrats from Texas are worried their conservative state Legislature would opt out of setting up a state insurance exchange, which they could do under the Senate bill but not the House's.
The Senate bill "relies on states with indifferent state leadership that are unwilling or unable to administer and properly regulate a health insurance marketplace," a group of 11 Texas Democrats wrote in a letter last week to House Speaker Nancy Pelosi, California Democrat, and Majority Leader Steny H. Hoyer, Maryland Democrat.
"A number of states opposed to health reform have already expressed an interest in obstruction."
For Mr. Caldara, the effort is personal. His 5-year-old son, Chance, has Down syndrome and has undergone eight surgeries in his short life.
"I haven't the time nor the power to bring down a president. My sole concern is saving my children, here in Colorado, from Obamacare," Mr. Caldara said.
Ms. Herrera said conservatives aren't the only ones who oppose federal health care reform.
"We're seeing a lot of support, not only from our natural constituencies like the tea party, but from progressives," she said. "That's shocked me considerably."
While the House and Senate have both passed versions of federal health care reform, the differences between the two bills are significant. Lawmakers are now trying to hammer out the differences, but whether they can strike a balance that satisfies both houses remains to be seen.
"They have razor-thin margins, and with the arguments over Medicare, abortion, [special deals for wavering lawmakers], all these have a chance of blowing up the Death Star," said Ms. Herrera. "But we're not waiting for the federal government to act. Even if federal health care implodes, there's still a strong effort at the state level to enact individual mandates."
Indeed, the health care backlash began even before Mr. Obama took office. Interest in government-run health care plans surged after Massachusetts adopted a universal medical plan for state residents in 2006.
If Congress does approve health care reform, both sides agree the issue is headed for a legal showdown. State lawmakers are already invoking the 10th Amendment, which gives the states all powers not granted to the federal government, although whether they can supersede the Supremacy Clause is a question for the courts.