States fail at implementing MFA---political and economic failures.
Eric Brown 20, Professor of Law and director of the Center for Law, Health & Society at Georgia State University College of Law. She got her BA from Dartmouth and MPH from Johns Hopkins University; and Elizabeth McCuskey, Professor in Boston University’s School of Public Health and School of Law. Prior to her academic career, she practiced law with Drinker, Biddle, & Reath LLP. McCuskey earned her J.D. from the University of Pennsylvania Carey Law School, 2020, “FEDERALISM, ERISA, AND STATE SINGLE-PAYER HEALTH CARE,” University of Pennsylvania Law Review, Vol. 168, No. 389, p. 444 //RK
In health care, there are numerous political, economic, and historical reasons to prefer federal reforms. Politically, state “health reform” cuts both ways—some states aim for universal coverage and patient protections, others pass health laws restricting access, perpetuating discrimination, and responding to inaccurate assumptions.283 Though federal legislation is not inherently prone to protecting access, federal baseline protections can guard against discrimination and codify evidence-based solutions, counteracting local prejudices.284 Economically, federal reforms enjoy the advantages of economies of scale and deficit spending, as well as cost-control power in interstate markets.285 Historically, the decades before the ACA witnessed the widespread failure of state regulation to rein in costs and expand access to care, with the exception of Massachusetts’s bold universal coverage experiment and a handful of other state reforms.286 The ACA then built comprehensive federal reforms on the results of Massachusetts’s experiment.287 The decade since the ACA’s enactment has also witnessed some of federalism’s pitfalls, as a shift in the federal Executive has undermined the ACA’s core protections and encouraged states to pursue variations that contradict the purposes of federal laws, while receiving funding provided by those laws.288