You lost me on “...with the federal government generally paying...”
“You lost me...”
The federal welfare state isn’t going away soon.
To make it go away would require at a minimum the repeal of the general income tax on the middle and working class people of the USA plus trade reform to give the welfare class sufficient job opportunities. Think of the 1834 Poor Law reform that was enabled by the English Industrial Revolution.
I hope my type of policies would be so effective and so popular that total federal health care coverage subsidies could be reduced.