If you thought that state level politicians were completely corrupt and
ruthless, and did not care about the people at all, and 50% of healthcare
spending came from the federal Government (and it does), you might expect the state
politicians to regulate in a way that would increase the income of
the health workers in their states.
Now I do not think state level
politicians were very corrupt and ruthless, but it is interesting that they seem to regulate healthcare in a way looks like was designed to exactly that.