Republicans in more than a dozen states opposed to President Barack Obama's push for health care overhaul have mounted state-driven efforts to block federal intervention in health care, with some early success.
The push-back centers in some areas on fact — Obama's stated determination that all Americans should be required to get health care coverage, for example. Other resistance, though, is based on unfounded notions of what has been proposed — fears, for example, that the nation would adopt a single-payer system in which the government would take over health care, something Obama specifically disavowed on Wednesday.
Even if state lawmakers succeed, doubts remain over whether their proposals would take effect if a federal overhaul were passed. Experts say federal law likely would trump such state changes.
"My sense is that if they pass a comprehensive reform bill, it would probably pre-empt what the state is doing," said Paul Bender, a professor at Arizona State University's law school and an expert in constitutional law.
In any case, supporters aren't letting up.
"It became very clear that the direction for what they call health care reform at the federal level was putting at risk our health care freedoms, and we need to move quickly to make sure citizens are protected," said Republican state Rep. Nancy Barto, sponsor of a measure in Arizona.
Lawmakers in eight states, only half of which are controlled entirely by Republicans, have filed proposals this year to ask voters to amend state constitutions to prohibit what they bill as restrictions on a person's freedom to choose a private health care plan, mandatory participation in any given plan and penalties for declining coverage. Similar measures were considered in two other states, though they wouldn't have been decided by voters. And lawmakers in three other states say they plan to file similar ballot proposals in the coming months.
Last week, Minnesota Gov. Tim Pawlenty, a potential 2012 GOP presidential candidate, said that federal health care proposals will step on states' rights and there needs to be a discussion about whether aspects of it are constitutional.
"The larger issue and the more important issue is for state policymakers to remind the federal government that there is a proper role for states, there is a proper role for the federal government and we should be mindful of those boundaries," he said.
As far as ballot initiatives, Arizona is the only state so far to put the proposal on the 2010 ballot.
The Arizona measure began to take root more than three years ago, when Republicans still controlled Congress and a health care overhaul was far from imminent.
Supporters say they weren't trying to cure all weaknesses in the health care system and instead were attempting to keep it from getting worse. They say consumers shouldn't be forced to accept restrictions that could come in a government-run health insurance option.
Opponents say the state measures amount to a defense of a failed and inequitable health care system.
"The idea that they want to put in our constitution a roadblock to coverage is silly," said Democratic state Sen. Dan Gelber of Florida. "We have to find ways to cover more people."
The idea of state-guaranteed protections for health care has gained the most traction in Arizona. A similar proposal that was put on the ballot through a signature campaign was rejected last November, failing by less than a half percent.
Eric Novack, an orthopedic surgeon in metro Phoenix and limited-government proponent who led last year's campaign, said he started to shape the concept in spring 2006. He said the measure was rooted in his belief that if the failing health care system didn't protect the rights of patients, it would sacrifice their rights in the name of reform. He doubts Obama's claim that Americans who already have health insurance will be able to keep their current coverage. "It's such a sweeping statement, it can't possibly be true," Novack said.
Democratic state Rep. Kyrsten Sinema of Arizona said the single-payer option that worries the proposal's supporters won't become a reality and scoffed at the notion that Arizona was in danger of becoming a home for socialized medicine.
"Arizona? Really? We are the most libertarian state in the country," said Sinema, who believes any state changes will be made moot by a federal overhaul.
Health care proposals in other states have had less traction. A measure was voted down in the Republican-controlled legislatures in North Dakota and Wyoming, and no action has yet been taken on measures in Michigan and Minnesota. The proposal never made it out of its first committee before the Democratic-controlled New Mexico Legislature ended its last session.
A version of it was introduced in Ohio last month, and Florida lawmakers will consider it when they reconvene next spring.
Similar proposals were filed in two other states, neither of which gave voters the last word. Indiana's Senate forwarded to Washington a nonbinding message urging protections of individual health care freedoms. A binding proposal in West Virginia didn't clear its statehouse before its session concluded.
Lawmakers in Kansas, Louisiana and Georgia said they plan to file similar ballot proposals in the future.
Republican state Sen. Judson Hill, sponsor of a proposal drafted in Georgia, said the measure is the "best way to protect Georgians from the Democrat-led Congress' attempt to socialize health care through their public option health care mandate."
Passage won't be easy in Georgia, where a constitutional amendment needs two-thirds support from the Legislature and approval by a majority of the state's voters. That's a tall order, given that Democrats still hold enough seats in both chambers to block constitutional amendments.
"I am against a federal take-over of our health care industry," said Republican state Rep. Kirk Talbot, who plans to file a similar proposal in Louisiana. "I fear that the federal government is about to mandate unfunded and expensive Medicaid obligations."
Associated Press writers Greg Bluestein in Atlanta and Melinda Deslatte in Baton Rouge, La., contributed to this report.