You wouldn't just copy and paste "IRS" into the state law that a state might decide to create. You would use the state's taxing authority.
Yes, state sanctions don't generally sting as much.
But each state would have to independently decide, with its own constituents, if it could economically offer subsidized health care for all of its residents.
Many states already have some form of parallel subsidized/free health care system for certain segments of the population. Like their school teachers and their children as an example.
Anyway, hope that helps.