It sounds like we are basically on the same page, Yuval. You don’t really think letting people buy insurance across state lines is anti-federalist: You just think that some ways of doing it are. Seems reasonable.

I’m not as enthusiastic as you about voucherizing Medicaid, which, as Michael Cannon has written, “could increase the program’s tax burden, heighten the disincentives to work, exacerbate its crowd-out effects, and increase dependence.” But let’s say it is a good idea. Whether a waiver is indicated in any particular case should be a case-by-case judgment; we should not have a bias toward approving them because that the “federalist” thing to do.