It would be great to have truly universal coverage in every state. But Washington is heading in the opposite direction. A progressive state like New York can and should take the lead. The states have long been the “laboratories of democracy,” and the Affordable Care Act gives states new authority to set up their own health care systems that meet Federal goals. Our advocacy could help set the model for healthcare, inspiring other states and then Washington to follow. Canada's system was set up in a province first before being adopted shortly after by the rest of the country.