Greg Sargent is reporting that at least one of the 26 states that successfully challenged the government over the individual mandate is now using Judge Roger Vinson’s decision as an excuse to stop implementing reform:

“Judge Vinson declared the health care law void and stated in his decision that a declaratory judgment is the functional equivalent of an injunction. This means that, for Wisconsin, the federal health care law is dead — unless and until it is revived by an appellate court. Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law. What that means in a practical sense is a discussion I’ll have in confidence with Governor Walker, as the State’s counsel.”

As Sargent points out, it’s unclear what this practically means. After all, the 26 states have already received money from the law and, despite what their respective politicians say on the T.V., they’re busy implementing the measure. Politico’s Sarah Kliff notes:

In Texas, a conservative state legislator is pursuing legislation that would authorize the state to build infrastructure for a health insurance exchange. In Kansas, the Republican insurance commissioner is waiting to see whether her state will win a competitive grant from the federal Department of Health & Human Services, despite newly-elected Gov. Sam Brownback’s strong opposition to the health overhaul. And in Iowa, where Gov. Terry Branstad is party to the Florida lawsuit, the Iowa State Legislature is finalizing recommendations for how to best implement the law in their state. [...]

All told, each of the 26 states that are party to the federal lawsuit in Florida against health reform have received some level of funding to implement provisions of the Affordable Care Act. Observers on both sides of the aisle expect implementation to move forward largely despite Monday’s ruling.

I suspect that state lawmakers who refuse to implement the law will face the same conundrum as conservatives who firmly avoided establishing state-based high risk insurance pools or are now refusing to consider building the exchanges: they will cede the implementation of all of these elements to the federal government. That is, by refusing to implement the measure themselves, Republicans are inviting the federal government to step in, thus bringing about the very kind of federal intrusion that seek to avoid.

This afternoon, building off of the momentum of Judge Roger Vinson’s ruling against the health care law, Senate Minority Leader Mitch McConnell (R-KY) announced that he would file an amendment to the Federal Aviation Administration reauthorization bill that would force the body to vote to repeal the entire Affordable Care Act. The House of Representatives successfully passed a similar measure after just seven hours of debate and now McConnell is also hoping to undo the entire health law without holding hearings or discussing the consequences of the measure.

In fact, the strategy directly undermines the GOP’s criticism of the process Democrats took to pass the law in the first place. Recall that Republicans accused Harry Reid of ramming through the bill, despite numerous hours of committee mark-up and debate, and now they’re clamoring to do that which they so vociferously condemned:

- “Senate Republicans are going to insist that there be an actual bill, that there be a CBO score so we know what it costs, that it be available on the Internet for a minimum of 72 hours so the American people can react to it…Senate Republicans are going to insist that this be a real Senate debate, a multi-week debate that gives everyone on both sides an opportunity to freely amend this measure and the American people an opportunity to fully understand what’s in it.” [McConnell, 10/14/2009]

- “There is no justification for this blind rush — except a political one, and that’s not good enough for the American people. And there’s no justification for forcing the Senate to vote on a bill none of us has seen. ” [McConnell, 12/17/2009]

- “I think we ought to at least have as much time for the other 99 senators and all of the American people to take a look at this bill as Majority Leader Reid has had.” [ McConnell, 11/15/2009]

While all 47 Republicans support repeal, McConnell’s bill is expected to fail without attracting Democratic support. Some moderate Democrats who voted for the law in 2010 have expressed reservations about certain provisions (including the individual mandate and the 1099 requirement) but have not come out against reform as a whole. Sen. Chuck Schumer (D-NY) also told reporters that “a budget point of order lies against” the measure, since it “breaks the budget by a trillion dollars” without making up for the loss in revenue. Republicans will need 60 votes to overcome the point of order.

Sen. Debbie Stabenow (D-MI), who will likely face a tough re-election battle, will also offer an amendment to eliminate a provision that requires businesses to report purchases over $600 on a 1099 tax form.

Reid has previously pledged not to bring repeal for a vote, but allowed the GOP to vote on the measure “because they did not filibuster the motion to proceed for the FAA bill,” The Hill’s Alexander Bolton reports.

This afternoon, Sens. Lindsey Graham (R-SC) and John Barrasso (R-WY) are introducing a bill that reinforces the notion that Republicans aren’t very interested in finding alternatives to expanding coverage or lowering health care costs. This particular measure would allow states to “opt out” of the individual mandate, Medicaid expansion, and what Graham refers to as the “business mandate” — a misnomer for a provision that requires large companies to pay a fee if their workers receive government subsidies from the new exchanges.

Here is how Graham describes the legislation on his website:

GRAHAM: If you don’t buy the health care you pay a fine and a lot of people are going to end up getting into government-run systems. But the real problem for South Carolina, is the expansion of Medicaid….So my bill, along with Sen. Barrasso from Wyoming, a physician, is to allow states — if they choose to — to opt out. Remember when Governor-elect Nikki Haley asked President Obama if they could opt out and he said, maybe they could, well, that’s never going to happen. …What I want to do is give every sate the ability to opt out if they choose and take this fight from Washington, down to the state level….before it drives businesses out of the health care business….opting out is a form of repeal and replacing.

Watch it:

I’m not sure why Graham thinks that individuals who forgo the mandate would “end up getting into government-run systems” since the fine is just that — it doesn’t automatically transfer you into Medicaid or some other form of government-sponsored insurance. It simply leaves you uninsured and on the hook for any unanticipated health care spending.

And as for Graham’s overall bill, it’s unnecessarily redundant. Under Section 1332 of the Affordable Care Act, South Carolina can opt out of the individual mandate if it can find an alternative way to expand coverage and lower health care costs. It’s also free to leave the Medicaid program and forgo the millions it receives from the federal government to cover its poorest residents. Of course, Graham’s measure is slightly different — rather than trying to improve the existing individual mandate opt out provision by working with Sens. Wyden and Brown (who are trying to allow states to leave earlier), he wants South Carolina to abandon the mandate without developing any alternative for expanding coverage. Graham doesn’t even pretend to offer any solutions.

In other words, this senator, who receives taxpayer-subsidized health insurance, is openly proposing a measure that would take away coverage from millions of South Carolinians and offer no affordable means for finding insurance. This is the state of GOP health policy in 2011.

Mitt Romney appeared on ABC’s Good Morning America today and offered no apology for the Massachusetts health reform plan he signed as governor, even after a district judge in Florida challenged the constitutionality of the individual health mandate. “I’m not apologizing for it, I’m indicating that we went in one direction and there are other possible directions. I’d like to see states pursue their own ideas, see which ideas work best,” Romney said, arguing that a state can force citizens to purchase insurance, but the federal government cannot:

ROMNEY: I think it is a very bad piece of legislation. I think the President should have been more attuned to what we did in our own state, which is we allowed each state to create a solution to the uninsured in the way that the states thought best, that’s the way the Constitution intended it. We are a federalist system. We don’t need the federal government imposing a one-size-fits all plan on the entire nation.

Watch it:

To be clear, Romney didn’t “allow each state” to do anything. As Governor, he enacted a mandate-centric reform in Massachusetts that’s very similar to the federal health care law.

The Affordable Care Act permits states to opt out of the individual mandate if they think they can do a better job of expanding access and lowering health care cost. Section 1332 specifically says that states can obtain an innovation waiver from the mandate and some of the law’s other requirements.

Romney is now keen on distinguishing his state’s mandate from federal reform, but in October of 2009, he urged Democrats to use the Massachusetts law as a model to expand coverage:

ROMNEY: We have found that we can get everybody insured without breaking the bank and without a public option…Massachusetts is a model for getting everybody insured in a way that doesn’t break the bank, doesn’t put the government in the driver’s seat and allows people to own their own insurance policies and not to have to worry about losing coverage. That’s what Massachusetts did.”

At that point, the former Massachusetts governor was busy attacking the public option and didn’t give too much thought to distancing himself from the mandate, which some national Republicans still supported. He berated Democrats for not using Massachusetts as a model. They did, and now he’s pretending that they didn’t.