Obamacare: The Road to Repeal Starts in the States. by Michael F. Cannon

States that have refused to implement the Obama health law have already blocked $80 billion of its new deficit spending. If more states follow suit, they can block the other $1.6 trillion and force Congress to repeal the law.

The law relies on states to implement two of its most essential pieces: health-insurance "exchanges" and a vast expansion of Medicaid. Exchanges are government agencies through which the law channels $800 billion to private health-insurance companies.
The Medicaid expansion adds another $900 billion to the federal debt, with private insurers again taking a slice. States are under no obligation either to implement either. Responsible state officials will say no to both.
It is a myth that creating an exchange gives states more control over their insurance markets. Yes, the law directs the federal government to create one in states that do not. But every exchange must be approved by federal bureaucrats, empowering them to impose whatever oppressive rules on "state-run" exchanges they would impose through a federal exchange.