The Affordable Care Act lives to see another day. Late last month, the Supreme Court upheld the distribution of subsidies, as well as the mandates and penalties attached to them, in the 34 states that use the law’s federal healthcare exchange.

Yet despite this decision, one thing remains painfully clear: The Affordable Care Act isn’t working for millions of Americans. No ruling from the Supreme Court can change that fact.

President Obama’s signature law, passed in Congress on a strict party-line vote in 2010, has failed to achieve the goals he set for it. He promised it would increase consumers’ health insurance choices — most Americans have fewer options today. He promised it would deliver affordable health insurance and reduce annual premiums by up to $2,500 — premiums are still rising across the country. And he promised universal coverage — an estimated 27 million Americans will still be uninsured by 2025. 


Most Americans are well aware that the law isn’t working. Outside Washington, people still oppose the Affordable Care Act by wide margins: 55 percent to 43 percent, according to a recent poll by CNN. Many have personally dealt with canceled plans, increasing premiums, higher deductibles, smaller networks and a litany of other ills caused by the law.

Yet they have no way out. After five years of the ACA, a majority of Americans are still waiting for real healthcare reform that delivers security, safety and stability.

Such a reform is still possible — but only if Congress frees the states to deliver it. Although the chances of passage are non-existent while Obama is in office, congressional Republicans owe it to the American people to offer reforms that empower states to make healthcare affordable, accessible and effective — what the country was promised with the Affordable Care Act. If they identify the right policies in the coming months, they’ll be able to take them to the American people and potentially set the stage for passage under the next president. 

But Republicans should also be cautious in what they seek to accomplish. The Affordable Care Act shows the dangers of a top-down, one-size-fits-all reform controlled by the federal bureaucracy. Instead, Congress should prioritize targeted healthcare reforms that unshackle state lawmakers from Washington’s control.

Americans already trust that their state governments will look out for their best interests far better than either the president or Congress. State lawmakers are also chafing under the ACA’s one-size-fits-all regulatory constraints, which severely limit their ability to help their own constituents. In recent weeks, over 350 state lawmakers from 33 states have urged Congress to free them from the Affordable Care Act’s byzantine regulatory system.

That’s the right path to take. States are more competent, more responsive and more flexible than Washington, D.C. State lawmakers are also better equipped than federal bureaucrats to understand — and address — their constituents’ healthcare needs. This reflects the undeniable fact that every state is different, from Connecticut to California and Alaska to Alabama.

Congress can empower state lawmakers in a number of ways. States need the freedom to substantively tailor Medicaid and the Children’s Health Insurance Program — both of which are currently one-size-fits-all programs like the ACA — to their citizens’ medical needs, not just tinker around the edges as they can now. They should be allowed to help patients with pre-existing conditions by allowing for “health status” insurance or by allowing them to re-establish high-risk pools. States should also be able to govern their own insurance markets, which for the most part are currently dictated by Washington. The list goes on. 

Even without these changes, states have a limited number of opportunities to improve healthcare for their citizens. But they won’t truly be able to enact meaningful reform until Republicans in Congress give states the freedom they haven’t had in generations.

The need for action is urgent. The Supreme Court may have temporarily protected the Affordable Care Act thanks to its ruling in Kingv. Burwell, but that doesn’t change the fact that millions of people are still suffering under Obama’s signature law. They were promised an affordable, accessible and effective healthcare system, but that will never happen so long as Washington is in control.


Nascimento is the senior policy advisor at Freedom Partners Chamber of Commerce.