The state steps in when other agencies cannot or will not....that said, most of $$ and hence, work should be at the lowest level-ie, county, state......
Obama/Romneycare would work better at state level, provider we had a sound economy/monetary system and the power/money mainly in state, as originally intended to be.
"national healthcare" works much better in smaller, more homogenous states (Denmark, Malta, Costa Rica for example)
same with food, other things.....
no sound monetary/economy, everyone suffers, eps charities and Churches.....my mother works as volunteer for CPO (Catholic Parish Outreach) and they are suffering badly......same w/Prots,etc.....all around a lot of growing poverty.
People that had good paying jobs, within a few months, reduced to food stamps,etc......abused women, homeless (most poverty caused by medical costs/bills)
Rerum Novarum Quad-Anno and other pre 1958 encyclicals all note the roll of state and its far different then the nromal left/right arguements.....