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While in principle that makes sense, I think in reality it wouldn’t work.

First, rural counties are not prepared to run their own immigration systems. That kind of work is centralized for several good reasons.

Second, they’d still have to compete with richer counties, who would also love to reduce their health care costs. The price overall might drop a bit, but ultimately I think more urbanized counties would tend to win out over rural counties in such a system.



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