Article 30 ACA Anti-Commandeering Act

Section 1-1-1900. This Article may be cited as the 'ACA Anti-Commandeering Act.' Section 1-1-1905. For purposes of this article: (1) 'ACA' means the Patient Protection and Affordable Care Act, signed by President Barack Obama on March 23, 2010. (2) 'health insurance' means any policy of insurance that meets the definition provided by Section 38-1-20. (3) 'health care exchange' means an American Health Benefit Exchange established by the federal government, any state, or political subdivision of a state, as provided for in the ACA. (4) 'public body' means any department of the State, a majority of directors or their

representatives of departments within the executive branch of state government as outlined in Section 1-30-10, any state board, commission, agency, and authority, any public or governmental body or political subdivision of the State, including counties, municipalities, townships, school districts, and special purpose districts, or any organization, corporation, or agency supported in whole or in part by public funds or expending public funds, including committees, subcommittees, advisory committees, and the like of any such body by whatever name known, and includes any quasi-governmental body of the State and its political subdivisions, including, without limitation, bodies such as the South Carolina Public Service Authority and the South Carolina State Ports Authority.

Section 1-1-1910. The General Assembly finds:

(1) that significant portions of the ACA constitute an unprecedented overreach by the U.S. Congress and the federal government into areas of law and regulation that are undoubtedly involve the exercise of powers and duties that are patently reserved to the States and the people themselves under the United States Constitution; (2) particularly offensive to the rights and freedoms of the residents of this State are those portions of the ACA that require employers to provide and individuals to obtain health insurance; (3) that pursuant to and furtherance of the fundamental principle of State Sovereignty the federal government may not command our State's officers, agents, or employees to participate in the enforcement or facilitation of any federal program the General Assembly determines to be offensive to fundamental freedoms guaranteed to our State's residents; (4) that this right to be free from the commandeering hand of the federal government has been most notably recognized by the United States Supreme Court in Printz v. United States when the Court held: The Federal Government may neither issue directives requiring the States to address particular problems, nor command the States officers, or those of their political subdivisions, to administer or enforce a federal regulatory program. (5) that the State has the duty and obligation refuse to participate in the facilitation and enforcement of those provisions of the ACA that are patently offensive to the principle of State Sovereignty and so significantly infringe upon the rights and freedom of all South Carolinians; and (6) that the anti-commandeering principles recognized by the U.S. Supreme Court in Printz v. United States are predicated upon the constitutional proposition that the State has the absolute and Sovereign right to interpose and refuse to assist in the enforcement of any federal program that the General Assembly determines to be offensive to fundamental freedoms guaranteed to our

State's residents, and the prohibitions contained in this article are a full and fair exercise of the sovereign power of this State in support of and in compliance with the anti-commandeering principles recognized by the U.S. Supreme Court in Printz v. United States.

Section 1-1-1915. (A) Notwithstanding any provision of law, regulation, rule, or order to the contrary, a public official, officer, or employee of a public body, or any other person or entity during the provision of services on behalf of a public body, shall not: (1) enforce or aid in the enforcement of any federal act, law, order, rule, or regulation intended to give effect to or facilitate the enforcement of any portion of the ACA that requires an employer to provide or an individual to obtain health insurance; (2) provide material support, participation, or assistance in any form, with or to a federal agency or employee engaged in the enforcement of any federal act, law, order, rule, or regulation intended to give effect to or facilitate the enforcement of any portion of the ACA that requires an employer to provide or an individual to obtain health insurance ; (3) utilize any assets, state funds or funds authorized or allocated by the State to any public body, on or after July 1, 2013, in whole or in part, to engage in any activity that aids in the enforcement of any federal act, law, order, rule, or regulation intended to give effect to or facilitate the enforcement of any portion of the ACA that requires an employer to provide or an individual to obtain health insurance; (4) participate in the establishment of a health care exchange by the State or a political subdivision, assist in the enrollment of any person in any health care exchange, or provide any other material support, participation, or assistance, with or to a federal agency or employee, or any other person acting on behalf of, in conjunction with, or in support of, any health care

exchange offering health insurance to employers or residents of this State in order to facilitate any portion of the ACA that requires an employer to provide or an individual to obtain health insurance; (5) apply for, seek, or receive any public or private grant, allocation, donation, or funds of any kind to be used to support the enrollment of any person in any health care exchange; and (6) apply for or utilize any assets, state funds or funds authorized or allocated by the State to any public body, on or after July 1, 2013, in whole or in part, to engage in any activity that aids in the enforcement of any federal act, law, order, rule, or regulation intended to give effect to or facilitate the enforcement of any other portion of the ACA, other than: (i) those portions of the ACA that set forth standards, regulations or other requirements that must be discharged by the South Carolina Department of Health and Human Services in connection with providing Medicaid services to those who qualify for such services under the state standards, which do not and shall not include those who would qualify under the Medicaid population expansion authorized by the ACA, that are currently in place; and (ii) those portions of the ACA that recognize the authority of the South Carolina Department of Insurance with respect to insurance products sold in South Carolina on the federally facilitated exchange to the maximum extent possible by law. (B) A violation of this section is considered sufficient cause to remove or terminate, as provided by law, a state officer, official, or employee, or to terminate any contract or other agreement with any person or entity providing services to a public body. (C) The Attorney General shall bring an action in any court of competent jurisdiction to enjoin any action by a public official, officer, or employee of a public body, or any other person or entity during the provision of services on behalf of a public body that violates the provision of

this section. As part of any proceeding brought pursuant to this section, the Attorney General may seek and the court may impose a civil fine of up to one thousand dollars for each occurrence on any person the court determines to have knowingly violated the provisions of this section.

Section 1-1-1920. Notwithstanding any other provision of law, the state shall not establish, facilitate, implement or participate in the expansion of the Medicaid program pursuant to the ACA or any related subsequent enactment.

Section 1-1-1920. The Governor shall coordinate annually with the Attorney General, the Director of the Department of Health and Human Services, the Commissioner of the Department of Insurance, and the Director of the Department of Social Services in order to make recommendations to the General Assembly of additional portions of the ACA or subsequent related enactments or regulations that should be included in the prohibitions provided by Section 1-1-1915 in order to fully support the findings in Section 1-1-1910. The recommendations must be submitted to the respective Chairmen of the House and Senate Judiciary Committees by November 1st of each year.

Section 1-1-1925. (A) The ACA provides numerous grants to the States for the implementation thereof, including: 1311 (42 U.S.C. 18031) Grants to the States for Affordable Choices of Health Benefit Plans; 1102 (42 U.S.C. 18002) Grants to the States for Reinsurance for Early Retirees; 1101 (42 U.S.C. 18001) Grants to the States under Pre-Existing Condition Insurance Plan; 2793 (42 U.S.C. 300gg-93) Grants to the States to Enable Them (or Exchanges) to Establish, Expand or Provide Support for: 1. Offices of health insurance consumer assistance, 2.

health insurance ombudsman programs; 1281 (42 U.S.C. 300d-81) Grants to the States to promote universal access to trauma care services; 4004 (42 U.S.C. 300u-12) Grants to the States to promote awareness of health improvement across the life span; 4108 (42 U.S.C. 1396a) Grants to the States to carry out initiatives to provide incentives to Medicaid beneficiaries to reduce or prevent chronic diseases; 4201 (42 U.S.C. 300u-13) Community Transformation Grants; 4202 (42 U.S.C. 300u-14) Grants to the States to carry out 5-year pilot programs to provide public health community interventions, screenings, and clinical referrals for individuals 55 to 64 years of age; 4204 (42 U.S.C. 274b) Grants to the States for immunizations for adults; 2821 (42 U.S.C. 300hh-31) Grants to the State health departments to assist in improving surveillance for, and response to infectious diseases and other conditions of public health; 5102 (42 U.S.C. 294r) Grants to the States for Health Care Workforce Development; 5405 (42 U.S.C. 280g-12) Grants to the States for Primary Care Extension; 2031 (42 U.S.C. 1397) Grants to the States for Elder Justice; 10212 (42 U.S.C. 18202) Grants to the States for Establishment of Pregnancy Assistance Fund; 10607 (42 U.S.C. 280g15) Grants to the States for Demonstration Projects to Evaluate Alternatives to Current Medical Tort Litigation; 3505 (42 U.S.C. 300d-4) and 1281 (42 U.S.C. 300d-81) Grants to the States for Trauma Care Centers and Service Availability; 1322 (42 U.S.C. 18042) Grants (loans) to the States to Assist in Establishment of CO-Ops; 1204 (42 U.S.C. 300d-6) Grants to the States for Regionalized Systems for Emergency Care Response; 3503 at 935 (42 U.S.C. 299b-35) Grants or contracts to the States to Implement Medication Management Services in Treatment of Chronic Diseases; 2951 (42 U.S.C. 711) Grants to the States for Maternal and Child Health Services; 2952 (42 U.S.C. 712) Grants to the States for Support, Education and Research for Post Partum Depression; 3129 (42 U.S.C. 1395i-4(j)) Grants to the States for Extension of and

Revisions to Medicare Rural Hospital Flexibility Program; 3306 (42 U.S.C. 1395w-23(f)) Grants to the States for Outreach, and Assistance for Low-Income Programs, Additional Funding for State Health Insurance Programs; 3501 at 934 (42 U.S.C. 299b-34) Grants to the States for Quality Improvement, Technical Assistance and Implementation; 3502 (42 U.S.C. 256a-1) Grants to the States to Establish Community Health Teams to Support the Patient-Centered medical Home; 2405 (42 U.S.C. 3012(a)(20)(B)(iii) and 202(b)(8)) Grants to the States Expand State Aging and Disability Resource Centers; 2954 (42 U.S.C. 710) Grants to the States for Abstinence Education; 4101 (42 U.S.C. 280H-4) Grants to States and Others for the Development of School-Based Clinics; 4306 (42 U.S.C. 1320b-9a(e)(8)) Grants to the States for Childhood Obesity Demonstration Project; 5207 (42 U.S.C. 254q(a), 338H(a)) Grants to the States for National Health Service Corps; 10202 (42 U.S.C. 1396d) Grants to the States to Offer Home and Community-Based Services as a Long-Term Care Alternative to Nursing Homes; 10203 (42 U.S.C. 1396(e)) Grants to the States for CHIP Through Fiscal year 2015 and Other CHIP Related Projects; 5306 (42 U.S.C. 294e-1) Grants to the States and Others for Mental and Behavioral Health Education and Training; 3112 (42 U.S.C. 1395iii, 1898(b)(1)(A)) Revision to the Medicare Improvement Fund; 4002 (42 U.S.C. 300u-11) Grants to the States for Prevention and Public Health; 5201 (4201 U.S.C. 292s) Grants to the States from Federally-Supported Student Loan Funds; 10503 (42 U.S.C. 254b-2) Grants to the States for Community Health Centers and National Health Service Corps; 10201 (42.U.S.C. 1396) Grants to the States for Purposes of Pilot Projects for Expanding, Providing and Paying for Health Care Under Medicaid. (B) Neither the State of South Carolina nor any political subdivision thereof, including, but not limited to, counties, municipalities, nongovernmental and nonprofit organizations or special

purpose districts of the State, shall apply for or receive any grants from any Federal agency, nor perform any acts or functions, for purposes of the provisions of the ACA set forth in paragraph (A) hereinabove.

Section 1-1-1930. Renumber sections to conform. Amend title to conform.