Washington had its turn to remake the health care system when President Barack Obama signed the Affordable Care Act seven years ago, and again this year when the effort by President Donald Trump and the GOP Congress to repeal and replace the law collapsed. Now, it may be up to the states to finish the job.

Large premium increases and diminishing choice among insurers are a real problem in some states Obamacare markets. Alaska and Minnesota, which suffered among the biggest premium increases this year, are at the forefront in trying to find solutions.

And the Affordable Care Act itself can help them obtain federal funding for those new ideas.

Our market got skewered last summer, Minnesota Gov. Mark Dayton (D) said in an interview Friday. I dont know how political leaders in other states handle that, but in Minnesota, I think we pretty much Republicans and Democrats agreed we needed to respond.

On Monday, Minnesota became the second state, after Alaska , to establish a special fund that reimburses health insurers hit with extraordinarily high costs because of a small number of very sick policyholders. Alaska set up its two-year, $55 million reinsurance program using state funding in 2016. The happy result: What was expected to be an average 42 percent rate hike for Alaskas individual insurance market this year turned into a 7 percent increase.

Minnesota is hoping to replicate that success with a $542 million program to backstop insurance company expenses. Because of looming rate hikes, the North Star State had already provided relief to people who buy their health insurance plans directly from insurers or use the states exchange, MNSure , in the form of rebates financed with $326 million in state money.