Here is Ann Coulter on the scam that is “opt-out”:
The most important fact about the “opt out” scheme allegedly allowing states to decline government health insurance is that a state can’t “opt out” of paying for it. All 50 states will pay for it. A state legislature can only opt out of allowing its own citizens to receive the benefits of a federal program they’re paying for.
It’s like a movie theater offering a “money back guarantee” and then explaining, you don’t get your money back, but you don’t have to stay and watch the movie if you don’t like it. That’s not what most people are thinking when they hear the words “opt out.” The term more likely to come to mind is “scam.”