The House of Representatives vote to repeal the Patient Protection and Affordable Care Act inevitably raises the question “how do opponents propose to replace it?”

Governors of the seven states who have signed Health Care Compact legislation have already answered that question.

The Health Care Compact returns authority over health care to the states. States would be free to choose different solutions that best suit them. Massachusetts could require residents and businesses to purchase private insurance, while Vermont could opt for a single-payer program, and Texas could choose a market-based system.

Returning health care spending and policy details to the states solves the larger problem that has bedeviled the system. Our health care problems cannot be solved as long as decisions about them are made by politicians and bureaucrats at the federal level in Washington, D.C.

We must fix the governance problem of “who decides” before we can fix the policy problem of “what is decided.”...