Illustration by Walter Green
Illustration by Walter Green

After the U.S. Supreme Court review this week of the federal health-care law, state and local governments might think twice before carrying it out.

The 26 states that brought the suit against the Affordable Care Act were unhappy about some fundamental parts of the law to begin with. A few states have even refused to take money tied to its implementation.

But so far Orange County, California, appears to be the only county government brave enough to express its opposition by refusing funds made available under the law.

Earlier this month, its board of supervisors voted to reject a $40,000 grant to the county’s health-care agency for a workplace-wellness program because the funding was tied to Obamacare. Last June, the same board, which oversees the county’s $5.5 billion annual budget, voted against a grant that would have provided $10 million over five years for health programs, including anti-obesity and anti-smoking efforts.

If the Supreme Court votes to strike down the law, or key provisions of it, state and local governments might incur expenses because federal dollars would no longer be available to finance the programs they approved. Maybe that prospect will encourage other local and state governments to follow Orange County’s lead.

States Take Lead

Michael Tanner, a senior fellow at the Cato Institute, which is on the front lines in fighting the federal health-care law, pointed to the movement on the state level to block Obamacare. “Florida, Wisconsin and Kansas have not only refused to take money but returned money previous governors accepted from Obamacare,” he said, “but this is the first I’ve heard of it on the county level.”

Orange County, which has more than 3 million people, remains one of the most conservative counties in the country and the “last conservative bastion in California,” as described by John Heubusch, executive director of the Ronald Reagan Presidential Foundation. All five members of the elected county board are registered Republicans; even so, the vote on the health grants was split 3-2.

The states’ efforts against Obamacare have drawn all the attention, probably because of the focus on the state-run health-care exchanges outlined in the law. “Saying ‘no’ to a state exchange is absolutely critical to the success” of suits against the law, said Diane Cohen, a senior attorney at the Goldwater Institute, while speaking to lawmakers at a meeting of the American Legislative Exchange Council last year.

Georgia, for example, has not authorized the creation of a health exchange while the Supreme Court considers the law, but as the state’s insurance commissioner said to the New York Times, “Whether the mandate is struck down or not, Georgia is under the edict to establish an exchange.”

The architects of Orange County’s action expressed their frustration in a different way.

In an e-mail, the board of supervisors chairman, John Moorlach, explained his rationale for voting to reject the funds: “How do I, in good conscience, take money from a government that is structurally bankrupt? How do I, also in good conscience, take money from a program that I believe is destined to fail? Socialized medicine will fail, and will fail miserably. When do grant and funding recipients collectively stand up and say, ‘Don’t make us complicit in your poor fiscal management!’”

Brazen Stance

That’s a pretty brazen stance for a local elected official. Even if the supervisors continue to turn down federal funds, on a practical level county residents will still be paying for the program and subsidizing health care elsewhere.

Tanner of the Cato Institute said he doesn’t know if their principled stance really impedes Obamacare, but “it’s important in another way.” When the case against the new health-care law was making its way through the lower courts, the federal government and states were moving ahead with carrying it out. The assumption was that it was “harder for the court to reject something that has already been implemented.”

But, he said, this was not the case. “The fact that they were moving forward with it worked against their legal case,” because some states balked at enforcing the law.

The more states and localities that reject the money, the more support for the case against the law. Conversely, taking the grants makes the case for Obamacare stronger. Accepting the money “should not have a legal impact, but it does,” Tanner said.

Shawn Nelson, the vice chairman of the board of supervisors who voted to reject the grant funding, said that elected officials elsewhere should follow suit.

“Clearly, if everybody would step up to the table and not take money, it would make a huge difference,” he said.

(Brian Calle is a columnist for the Orange County Register and a senior fellow at the Pacific Research Institute. The opinions expressed are his own.)

Read more opinion online from Bloomberg View.

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To contact the writer of this article: Brian Calle in Orange County, California, at bcalle@ocregister.com.

To contact the editor responsible for this article: Katy Roberts at kroberts29@bloomberg.net.