Opt Out Federalism
If the Affordable Care Act isn't as stable as it could be, every state will want the power to modify the plan so it'll work better for them. Some will take advantage of that power by adding an individual mandate. Some will try out various conservative theories of how best to structure the bill. Some, like Vermont, will try to push towards single payer. And those that do nothing will act as a control group to a grand health-care policy experiment -- though not, I think, to the benefit of their residents. [. . .] the practical effect will be of making the legislation very similar to the federalist ideas I mentioned earlier in the week.
There is political merit in this approach. Consider this from The Hill:
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