> Some parts of the ACA could be implemented in state law, some would be either illegal or impractical at the state level.

That's my poor understanding of U.S. Federal vs State government that fails me here: what exactly would be illegal, what would be impractical? If a state ACA is challenged in court, couldn't they use the supreme courts rulings of Obamacare as a strong defense?

Other comments here mentions that Massachusetts already had it (and I assume would likely keep it even after Obamacare is repealed), Couldn't California copy the Massachusetts implementation?

> California already provides state-run send healthcare beyond the requirements of the federal programs it participates in.

But I assume those state-run programs aren't providing as strong of a coverage as Obamacare was? Now would seem a good time to update it to match Obamacare?

> That's my poor understanding of U.S. Federal vs State government that fails me here: what exactly would be illegal,

Mandating coverage, which is basically a requirement of affordable universal healthcare.

"What happens if I don't pay the fee?

The IRS will hold back the amount of the fee from any future tax refunds. There are no liens, levies, or criminal penalties for failing to pay the fee."

https://www.healthcare.gov/fees/fee-for-not-being-covered/

Massachusetts did this in the program that Obamacare was modeled after, so clearly that's not (currently) illegal at the state level.

The fee structure is different (just a missed deduction on the state taxes, not a separate monthly charge), but it still works.

I'm not saying it can't be done; I'm saying its a pain in the ass due to the political climate in the US. Apologies that wasn't clear.

States have granted themselves their own taxing authority, and have autonomy in doing so.

You wouldn't just copy and paste "IRS" into the state law that a state might decide to create. You would use the state's taxing authority.

Yes, state sanctions don't generally sting as much.

But each state would have to independently decide, with its own constituents, if it could economically offer subsidized health care for all of its residents.

Many states already have some form of parallel subsidized/free health care system for certain segments of the population. Like their school teachers and their children as an example.

Anyway, hope that helps.

Some states don't tax income, like my state of Florida. They don't much care about universal healthcare, because most of their residents are already on a sort of universal healthcare if you're the right age: Medicare. I'm unsure if there's a political will to enact taxes in this state to pay for healthcare when there's only a sales tax in existence (for citizens).

States have autonomy in creating any kind of sanction they want, as long as it is constitutional, but more practically as long as no judge finds that it is unconstitutional.

I think this presents an unnecessarily complicated view of things. The simple answer here is that California absolutely could develop its own healthcare system.