A truly workable health care reform would be modeled on the bipartisan and highly successful welfare reform of the 1990s, which took ideas from the states . not just Washington . and gave them considerable flexibility to operate their own programs.
Jon Chait notes that states already have great flexibility under the Affordable Care Act. There is every reason to believe that states will get even greater flexibility in the years ahead.
Some of this flexibility is good. Yet a block grant framework of the sort embodied by the 1996 welfare reform is a terrible model for health reform. It offers Republican governors some short-term political benefit. In the long-run, it imposes huge risks on the states, and is unlikely to save states money.