In light of the Supreme Court’s ruling upholding the Affordable Care Act, many claim that the choice of states’ ability to opt out of Medicaid expansion requirements without losing all Medicaid funding was a big victory for federalism. That may be true, but federalism is still seriously in jeopardy.

As the theory goes, states can differentiate themselves on the basis of taxes, spending and regulation, or even social policies that give Americans more leeway in deciding the rules under which they want to live. If you don’t like the level of taxes or the policies in your state, you can vote with your feet and move to another jurisdiction. In theory, this competition for residents helps keep lawmakers in check, giving them an incentive to keep taxes and other intrusions modest.