You are right, Kentucky might not implement it from the outset, maybe not for years. But a federal initiative on healthcare is not a requirement for either the implementation itself, or funds dispersal, nor is it a hard requirement for controlling the way disbursed funds are utilized.

My view on this is not motivated by a negative view on universal healthcare; I am 100% for it. I see the longterm downside of a federal program, in a country the size of the US as more likely to cause harm than good, and that greater autonomy leads to much better long term, stable equilibria, while consolidation of resources, political control and funds leads to the opposite.

I see your view as better for Kentucky today, and worse for not just Kentucky but also the other 49 states 10 years down the line.