Federal promises, state solutions
For decades, healthcare has been treated as a national crisis in need of a national solution. Federal intervention, however, has only made care more expensive and less responsive to patients. The Affordable Care Act (ACA) succeeded in improving access for the sick, but its title became something of a farce as premiums and out-of-pocket costs soared for millions of families.
As with so many issues today, the latest content at American Habits reminds us that real healthcare innovation is happening far from Washington. Even the One Big Beautiful Bill reinforces this trend, giving states greater freedom to manage Medicaid as Rev. Ben Johnson notes in his contribution.
In an interview with Matt Dean of The American Experiment, his knowledge and experience as a state legislator and majority leader shows that real progress comes not from federal decrees but from states strengthening Medicaid integrity and redesigning overall care to prioritize the experience for patients. We also touched on some of the reasons why Minnesota is traditionally known for its strong healthcare culture.
I reached out to Tennessee State Rep. Bryan Terry, chair of the House Health Committee, because I knew he’d humanize how lawmakers deal with a contentious policy issue. A physician shaped by experiences during the Oklahoma City bombing in 1996 and years of medical service, Rep. Terry says that real reform starts with compassion, state-level innovation, and a focus on the “glimmers” of hope that strengthen communities even amid national division.
Where Terry highlights the compassion and community at the heart of good policy, Ge Bai shows how misaligned federal incentives undermine those very goals.
States have no reason to wait on Washington, as Josh Archambault argues in outlining a slate of smart, targeted reforms, from price transparency to expanded telehealth, that can result in lower costs and better access.
Haley Holik reminds us with a bracing look at the fiscal and human consequences of Medicaid expansion, warning that adding more able-bodied adults to the rolls drains resources from the truly needy and destabilizes state budgets.
Together, their analyses highlight a simple truth: meaningful progress comes when states confront the real drivers of healthcare costs rather than the broken promises of federal overreach.
I spoke with Avik Roy, a longtime authority on market-based reforms. Roy’s interview is a tour de force analysis of how American healthcare went off course and he offers plenty of his own thoughts toward affordability and real competition. We dig into many topics, but I found his explanation on his long commitment to healthcare, given that it’s such a heavy driver of our debt, both compelling and clarifying about why serious reform can’t wait.
Naomi Lopez shows how states can lead the next era of healthcare innovation by setting the rules of the road for AI, ensuring patient-centered technology can thrive without federal bottlenecks. Her work points to a future in which states, not Washington, shape how advanced tools improve care, streamline bureaucracy, and expand access to communities too often left behind.
This healthcare issue is a reminder that meaningful reform grows from the ground up, not the top down. When states are free to solve problems their own way, innovation flourishes and patients benefit.
