Virginia became the first state to enact legislation to prevent its residents from being mandated to purchase health insurance or participate in any healthcare system.
The conservative American Legislative Exchange Council (ALEC) has identified 37 other states that have similar bills pending or have announced that they will introduce this legislation. At least one house of the legislatures in Idaho, Missouri, and Tennessee has passed such legislation.
These legislative initiatives are based on ALEC's model "Freedom of Choice in Healthcare Act." Under the legislation, any state attempt to require an individual to purchase health insurance - or forbid an individual from purchasing services outside of the required healthcare system - would be rendered unconstitutional. Many independent legal observers have said that such laws are themselves unconstitutional, however, as they are intended to nullify federal laws.
Nullification is an extraconstitutional procedure that was employed in the early 19th century by states in the Old Confederacy.
The Freedom of Choice in Healthcare Act has already been filed or pre-filed in 33 states: Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
Lawmakers in an additional four states - Montana, North Carolina, Rhode Island, and Utah - have publicly announced their intentions to file the legislation. A citizen-led initiative has also been announced in Colorado.