In the US, along with federal government, state governments and counties also contribute financially towards healthcare of their people.
Counties are not sure whether their healthcare costs will really go down considerably because it will all depend upon how residents transit to the private insurance or State Medi-Cal program. The fear is that anywhere between 3 million and 4 million people will not get themselves insured even it has been made mandatory. At least half of these people are staying in the US illegally and they cannot take benefit of the federal insurance program or Medi-Cal. As per the federal law, these people also need to be treated at the county expense (Gardner).
The whole arrangement is a political decentralization between the state and counties while providing healthcare services to its citizens. There is no doubt that counties can provide medical services to its residents much more effectively as a local body while federal and state governments funding them appropriately; in a way, this is a most pragmatic arrangement by public administration departments as a whole fulfilling the principle of Fiscal Federalism in the country.