State Private-Market Health Insurance Reform: Lessons on Health Insurance Exchanges, Progress, and Next Steps

Perhaps the most powerful obstacle to state-based health care innovation is a federal government seeking to impose a single national system through regulations and mandates. There is an enormous reservoir of expertise, experience, and field-tested reform among the states, and we should take advantage of that by placing states at the center of health care reform efforts so that they can use approaches that best reflect their own needs and challenges. America’s Founders created a system in which the federal government may exercise only delegated powers that James Madison described as “few and defined.” The rest belong to the states or to the people. Not only does federalism protect liberty by limiting government, but it allows states to try different things, to test different solutions, to use different approaches.

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