With the enactment of the Patient Protection and Affordable Care Act, the national health policy debate has entered a new phase. Washington has embarked on an effort to exercise control over the entire health care sector of the economy, which now accounts for one out of every six dollars in American wallets. Washingtons agenda is to transfer both private and state health policy decision-making to the federal government, particularly the U.S. Department of Health and Human Services (HHS). In the wake of the enactment of this massive federal health care legislation, and over the next several years of its implementation, the debate on the future of this huge and growing sector of the American economy will continue and likely intensify. Ideally, individual states will continue to play a vital role, either in blocking, changing, or improving upon whatever Washington does or in seizing the initiative if Washington falters in trying to reform health care.