A lot of thought went into the Affordable Care Act. Why "reinvent the wheel"? Revise and adjust to find the balance where it's functionality improves. Surely Social Security, Medicare and Medicaid have had to be tweaked over the years. Bottom line it should be a Federal program in order to "level the playing field"; devolving it to the states inevitably results in inequities between the states - as we've already seen between states that have resisted and those that have embraced the ACA.