If lawmakers in Congress have a Plan B for health reform, it’s essential that they decentralize power to the states. Let states enact policies that the majority of their constituents want, not Washington. If Vermont wants to try to achieve a sustainable single-payer model again, go for it. If North Carolina wants to be first in health care freedom, even better.

To some degree, the failed House GOP health reform bill, the American Health Care Act (AHCA), did include provisions that would grant states more flexibility over the delivery of health care and the design of health insurance. States would have been able to restructure critical safety net programs like Medicaid. They could have had the opportunity to create federally funded high- risk insurance pools for patients with pre-existing conditions. Another notable provision up for debate was whether states are granted the option to keep or get rid of the Affordable Care Act’s (ACA) ten essential health benefit mandates (EHBs). This federal regulation requires every insurance company to expand coverage for various preventative care services at no direct out of pocket cost to policyholders. Services include pediatric dental, vaccinations, maternity care, and cancer screenings. EHBs are just one example of how the ACA has increased the federal government’s role over how insurance carriers are to be regulated. Historically, states have predominantly held regulatory power over insurance companies.

North Carolinians will have to wait and see whether the EHB mandate will stay. Many policyholders like that fact that health plans are more comprehensive in scope of preventative care. Patient advocate groups and special interests argue that more primary care benefit mandates reduce the incentive for patients to self-ration health care needs that otherwise end up costing the health care system more money down the line. A heavier investment in primary care is certainly needed, but there are ways in which the market has already been working to fill this gap in a more cost-effective manner – negating the need for certain health benefit mandates. Direct primary care (DPC) is just one  living example. Read more about how this innovative health care delivery model works for patients, employers, and local governments here, here, and here.