Wall Street Journal, July 18, 2018
Stephanie Armour

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[...] Across the country, the details vary but the story is the same. The Trump administration has been rolling back sections of the Obama-era health law piece by piece. And states are filling the void, either to buttress or countermand changes from Washington.

The result is that the country is increasingly returning to a pre-ACA landscape, where the coverage you get, especially for people without employer-provided insurance, is largely determined by where you live.

This is likely to be the driving dynamic of U.S. health care for years to come, as Republicans chip away at the ACA in the aftermath of a failed attempt to repeal it outright, spurring GOP-led states to do the same, while Democrats battle to preserve it in places where they can.

The outcome is consistent with President Donald Trump’s goal to dismantle a one-size-fits-all approach of the ACA and leave decisions about many health-policy issues to the states. Many Republicans say that is a better approach because states have specific challenges better handled locally, and can also be a laboratory for new ideas.

The growing divergence between states may be even more pronounced than it was before the ACA, also called Obamacare, passed in 2010. Many states have adopted broader consumer protections than before the health law. Others have taken new steps to curb the law’s provisions, such as adding work requirements to Medicaid. [...]

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