How should New Hampshire handle national health care reform?

In March 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, a federal statute that, along with the Health Care and Education Reconciliation Act of 2010, marks Congress's chief health care reform legislation. For the particulars of this act from the White House perspective, see: http://www.whitehouse.gov/healthreform.

Among other things, PPACA (termed "ObamaCare," initially by critics but later more universally used as shorthand for the federal health care reform) increases insurance coverage of pre-existing medical conditions, expands access to insurance to more than 30 million Americans, and increases projected national medical spending despite lowering projected Medicare spending under previous law, according to the Congressional Budget Office.

PPACA passed the Senate on Christmas Eve Day of 2009, by a vote of 60–39. All Democrats and two Independents voted for the bill, which passed the House of Representatives the following March by a vote of 219–212. In that vote, 34 Democrats and all 178 Republicans opposed the bill.

Almost immediately, more than half of all states, as well as numerous organizations, hospitals and individuals, began filing lawsuits in federal court challenging the constitutionality to the law. Most of the litigation centers on the law's requirement that citizens purchase health insurance -- the so-called individual mandate -- that the federal government considers crucial to making the plan work.

According to the National Republican Trust PAC-funded blog MultiStateLawsuit.com: "The Constitution limits federal power by granting Congress authority in certain defined areas, such as the regulation of interstate and foreign commerce. Those powers not specifically vested in the federal government by the Constitution or, as stated in the 10th Amendment, prohibited by it to the States, are reserved to the states respectively, or to the people.”

In March 2011, the New Hampshire House of Representatives passed a Republican-backed HB 89 "requiring the (state) attorney general to join the lawsuit challenging the Patient Protection and Affordable Care Act." The Senate set HB 89 aside to ask the state Supreme Court justices to consider whether the bill was constitutional.

State Attorney General Michael Delaney has declined to join the other 26 states' attorneys general in the lawsuit (filed in Florida on their behalf), and says any efforts by the Legislature to compel him to do so would violate the separation of powers provisions in the state and federal constitutions.

According to a report in the Nashua Telegraph, "In a lengthy brief, Delaney said making him join the suit would render inoperative the independence of the attorney general.

"'House Bill 89 violates the separation of powers because it does not allow for the attorney general to exercise his independent, professional judgment as an attorney,' Delaney wrote."

The NH Supreme Court agreed with Delaney, writing: “HB 89 would usurp this essential power because it would divest the executive branch entirely of its authority to decide whether to initiate a particular, civil action on the part of the state.”

Republican House Majority Leader D.J. Bettencourt decried the court's ruling, saying in a statement: “HB 89 is not about usurping the powers of the executive branch, but rather it is about protecting the people of New Hampshire against ObamaCare, unfunded mandates and the tremendous costs associated with a program that our taxpayers will have to pay for out of their own pockets.”

Subsequently, the Senate introduced SB 148, which hammers at the "individual mandate" part of PPACA, but does not order the state attorney general to join any federal lawsuit. That bill became law in July 2011 without Gov. John Lynch's signature.

The key provision of SB 148 reads: "No resident of this state, regardless of whether he or she has or is eligible for health insurance coverage under any policy or program provided by or through his or her employer, or a plan sponsored by the state or the federal government, shall be required to obtain or maintain a policy of individual insurance coverage except as required by a court or the department of health and human services where an individual is named a party in a judicial or administrative proceeding. No provision of this title shall render a resident of this state liable for any penalty, assessment, fee, or fine as a result of his or her failure to procure or obtain health insurance coverage."

The legislature is considering several bills in 2012 that would further undermine PPACA.  Among those bills is HB 1297, which would prohibit New Hampshire from creating the federally mandated health care exchange.  HB 1297 passed in the House March 8, 2012.

As of October 2011, the constitutionality of PPACA had been upheld by three out of four federal appellate courts, with the fourth declaring the law's individual mandate alone as unconstitutional, but staying the decision pending an appeal by the Obama administration. The Supreme Court scheduled more than five hours to hear arguments on the matter in March 2012.  The Supreme Court will issue their opinion later in 2012.

Are the foregoing legislative efforts sufficient protection of the financial sovereignty of the New Hampshire citizen, or should the state attorney general join the suit against the federal Patient Protection and Affordable Care Act?