The crux of his argument is that you cannot fully opt-out. Your constituents will still pay more for Medicare (if they make more than $250k), elective plastic surgery, medical devices, etc. Moreover, medicare reimbursement rates will be cut as well. In sum, if a state were to opt out, their tax burden would still increase, but they'd see no benefits.
On the other hand, the mandate would be rescinded; nobody would be forced to pay for health insurance.
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