Health insurance captivates us like few other issues because it affects us personally and distinctively. In more recent times it has come to reflect our political disposition regarding individual and collective responsibility. While the Affordable Care Act (ACA) repeal and replacement presently hangs on a legislative precipice, the philosophical dimensions of this debate concerning the role of the individual and the state should merit greater attention. Instead, the ACA’s destiny now appears to rest on the resolution of Medicaid and the division between federal and state governments.