Hey Speaker, this is why people are asking if this bill is unconstitutional.
In addition, the bill would preempt state and local laws that conflict with or are in addition to new federal standards established by the bill. Those preemptions would limit the application of state and local laws, but CBO estimates that they would not impose significant costs.
As conditions of federal assistance (and thus not mandates as defined in UMRA), the bill also would require state and local governments to offer health insurance to their employees and would require “maintenance of effort” payments associated with high-risk pools. New requirements in the Medicaid program also would result in an increase in state spending.
page 9 of the CBO estimate
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