This may be true in an alternate universe but not in the USA which we inhabit. Do not delude yourself, Republican-dominated states will not adopt state-run single payer healthcare, period.

way when there neighbors enjoy single payer, low cost, medical insurance and care? I live in Missouri, not the most liberal of states, but less than 10 miles from me is Illinois, and if they passed single payer, the entire St. Louis Area will be well aware of the benefits, and we represent almost half the electorate in the state. A lot of residents from both states crisscross the border everyday, and frankly, if Illinois passed such a bill(which is possible), I'm packing my bags and moving those 10 miles. If I have to travel a little farther to work to avoid having to pay the atrocious plans they offer(don't pay for shit, and expensive premiums), then I will.

If the Republicans in my current state are obstinate in their opposition to single payer, how long can they dominate the state legislature? Not long, I gather, so they would be forced to either allow single payer, or get voted out of office. The biggest obstacle is still the southern part of the state, being full of ignorant jackasses, but hopefully the metro areas can counterbalance their influence.

ACA got the ball rolling. Once the government required the individual states to comply or come up with a system of their own, a crack opened for a state like Vermont or so on to entertain a single-payer system. States that want to come up with a system of their own but are still within the parameters set down by ACA as far as increasing coverage can apply for a waiver. Whether or not the White House grants the waiver depends upon who controls it. If you have a right-winger in the White House, probably not.

No state has trouble keeping its citizens or attracting people, esp if there is a thriving business community (jobs and larger tax base).

Probably a generation or two after everyone else, though.

I'd be willing to bet my ass on it.

Ditto the ass-betting.

I heard Anya Rader Wallach, Chair of the Green Mountain Care Board which is tasked with designing and overseeing Vermont's coming health care plan and she said that without the ACA, it's doubtful if it can be achieved. You can't, on a state level, simply expand Medicaid.