Obamacare envisioned a major role for the state governments, often trying to force them to do what they didn’t want to do and harming their citizens in the process. An Obamacare replacement plan will also require considerable implementation at the state level—although this facet of reform has received almost no attention in Congress or in the press coverage of the repeal and replace effort. The difference: Assuming the American Health Care Act (the Ryan bill) is appropriately amended, the additional reforms envisioned here will liberate the states. If they enact these reforms successfully: