The law is constitutional. We all pay Medicare and Medicaid taxes. The super neo-corporatists should be thrilled that private industry is getting the windfall of the requirement to purchase health care: free market forces will dictate that competition will drive prices down. And if the American people really don't like it, then the government can collect it and buy insurance for you directly.
Either way, far right conloons, you are in the system legally and constitutionally: there is no out.
It is not because it states that congress has powers to do certain things and all other powers are reserved for the states. I know you throw out the supremacy clause but it states all laws in PURSUENCE of the constitution are the supreme law of the land. That is a limitation on the federal government that confides it to what it can pass in the constitution. I know most laws are of this nature but just because a law has been passed and can be enforced does not make it superior to any state law. It is only superior in that case when their are no opposing state laws to it so it becomes the state's choice if it wants to have that law applicable within its jurisdiction.
Medicaid and that stuff is enforceable simply because there is no opposing state law. When there is those, in theory, can be nullified. I doubt most state actually want to do this.