The president is sure to spotlight the successful passage of health reform tonight in his State of the Union address. But behind the scenes, reform is under attack, and not just from the Congressional Republicans’ repeal and replace movement.

States have already moved to nullify a lynch pin of the law as unconstitutional. Twenty-two states have joined lawsuits against the reform bill’s insurance mandate, which says every individual must have health insurance or pay a fine that increases over time. The fine starts at $95, or 1% of your annual household income in 2014, and then rises to $695, or 2.5% of your yearly household income in 2016.

Six states have passed legislation and two have passed a state constitutional amendment asserting that the federal government cannot tell their citizens they must have health insurance or pay a fine, reports indicate.

Vermont is moving to get a waiver out of health reform to enact a state single-payer system, And Democrat Sen. Ron Wyden of Oregon, along with Republican Sen. Scott Brown of Massachusetts, is moving to push forward enactment of a clause in health-care law to 2014 from 2017, which would let states get a waiver to opt out of the individual mandate if they meet certain benchmarks.

Even the IRS’s Taxpayer Advocate, Nina Olson, says the health-reform mandate is a problem. Olson noted in a speech that “the fine isn’t based on just your personal net income."

The fine “is based on a concept of 'household income.' This may differ from the income reported on the taxpayer's return, because it is a composite of all of the income reported by members of a taxpayer's household -- information that may not be readily accessible to the IRS,” Olson says.

That means more bureaucracy. The IRS will need more training in privacy requirements, in order to avoid a drop in tax compliance, Olson said, as taxpayers may feel they need to protect their confidential household income information for everyone who lives under the same roof. The Congressional Budget Office estimates the government will raise $69 billion over ten years from this fine -- $17 billion from individuals, $52 billion from companies

The Health and Human Services Department has granted to date 222 waivers to the health- reform law, including to 34 unions, and companies like Jack in the Box and AMF Bowling Worldwide, arguing they are necessary to ease transition. (See Dec. 8, 2010 EMac’s Bottom Line, “More Unions and Companies Win Health-Reform Exemptions,” http://www.foxbusiness.com/markets/2010/12/08/unions-companies-win-health-reform-exemptions/#).

The waivers raised a slew of questions, including whether it was fair that other businesses and entities must follow the health-reform rules while their competitors who got waivers do not. Health reform did not spell out who should get these waivers -- government officials are making these decisions.

The waivers had to do with mini-med plans, low-quality plans which cover part-time and low-wage workers. McDonald’s (NYSE:MCD) threatened to drop its mini-med plans, covering 30,000 workers, if it did not receive an exemption.

Health reform phases out by 2014 the annual limits that cap the dollar amount some plans annually pay for health care, as in the case of mini-med plans, which often provide coverage for as little as just $2,000 a year. These plans "are the only option for many Americans who can't afford coverage on the individual market," a White House blog notes. 

Furthermore, the White House blog adds that "estimates from employers and insurers indicated that complying with the new [reform] rules could cause mini-med premiums to rise by more than 200%, force employers to drop coverage, and send many Americans to purchase insurance on the individual insurance market, where they would get an even worse deal than what they have today."

The Employee Benefit Research Institute [EBRI], a top insurance research group, says health reform may become a worse deal versus what workers get today. EBRI says that employers have told it that “they are likely to pass along any health benefit cost increases to workers — and, mostly, workers are expecting such cost increases.” EBRI also found a “majority of both employers and workers indicate they are not very knowledgeable about the new law.” Here are EBRI’s findings:

*More than 40% of employers say they are likely to pass along cost increases to workers.

*About half of workers expect their health benefit costs to go up, either directly or indirectly because of reform. 

*Employers are more likely to pass along cost increases than cost decreases. While 41% were likely to pass along cost increases, only 30 % were likely to pass along any cost decreases that were directly or indirectly related to health reform.

*31 % of workers with private insurance expect their health care coverage to decline and 34% expect their benefits to be unchanged.

*However, very few employers have decided to drop health care coverage: Less than 1% have conducted an analysis and decided to drop coverage, and less than 1 % have decided to drop coverage without conducting an analysis, according to the report.