Obamacare Proves the Virtues of Federalism

As a federal program, Obamacare could never accommodate the many Americans who want a different approach.


No issue in recent years has polarized Americans as much as Obamacare. It produced a party-line vote in Congress, a near-fatal court battle, a revolt by states that refused to run exchanges or expand Medicaid, dozens of House votes to repeal it and, now, a bungled launch that could be its undoing. It's a barroom brawl that never ends.

Barack Obama's health care plan hit nerves that are still radiating pain among many people. But being a federal program, it couldn't accommodate the many Americans who want a different approach. It's a zero-sum game. One side has to win, and the other has to lose.

It didn't have to be that way. Why is same-sex marriage, which was once politically preposterous, faring so much better than health care reform? Why has liberalization of marijuana laws happened without provoking threats of secession? One simple reason: Those changes have taken place at the state level—and only in states that chose them.

They're the product of an ingenious but often unappreciated ingredient of our system of government: federalism. In a nation with 317 million people spanning a continent, there are great differences in culture, politics, religion and barbecue. What allows us to be united states rather than warring ones is that on many things, we can agree to disagree.

Just because Vermont and New Hampshire are the Mary-Kate and Ashley of states doesn't mean they want the same things. One has a state income tax, and one never will. The people of Maryland wouldn't want to live under the laws that suit Mississippians, and vice versa. Decentralization allows peaceful coexistence.

State prerogatives have long been a cause of conservatives, but some liberals have come to prize them as well. Oregon successfully fought off a federal court challenge to its law allowing doctors to prescribe medicines for patients who want to end their lives. If legalization of marijuana had to win the approval of Congress, Coloradans would still be waiting for it.

Federalism is equally suited to the right and the left. Gun-rights advocates can have their way in Texas, while gun-control supporters can prevail in California. Laws allowing the carrying of concealed handguns gained attention when Florida passed one in 1987, which soon spread. But some states, like New York, exercise considerable discretion over who gets a permit.

Supporters of gun control often complain that permissive policies in some states undermine tough ones elsewhere. But the Law Center to Prevent Gun Violence contends that "states need to adopt strong gun laws because gun laws really do matter. Many of the states with the strongest gun laws also have the lowest gun death rates nationwide."

Most of the effects of a state's laws are felt by its residents. If they don't like those consequences, they have the power to bring about a change in the law. And if they can't get it changed, they have the option of moving to a state whose laws they like better.

On policies made in Washington, those same people have far less say—and they can't escape. The combination can breed intense resentment. One reason abortion has been a live wire for so long is that the 1973 Supreme Court ruling in Roe v. Wade imposed the same basic rules on every state. More latitude would have defused much of the emotion.

Even in immigration policy, where the feds necessarily take the lead role, there is room for diversity. Some states grant in-state tuition at public universities to young people brought here illegally by their parents, and some states deny it. Some give driver's licenses to undocumented foreigners, and some don't. Those here illegally can make their choices accordingly.

Health insurance reform might have taken a similar route. Massachusetts, in fact, enacted a plan on which Obamacare was modeled. The fact that no other state adopted it should have been a clue it wasn't ready for Broadway.

Had several other states successfully implemented similar plans, they would have dispelled doubts and provided useful real-world data on how to make this option work. At some point, its performance might have overcome enough doubts to evoke broad bipartisan support for a national version.

The federalism model doesn't satisfy ambitious reformers who are certain there is only one good way to address an injustice. But that's not a bug. That's a feature.