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We could win Universal Healthcare the same way we won gay marriage and legal weed.

California and New York are leading the way.

While Trump does his worst to destroy Obamacare, California’s Senate just passed a bill to guarantee healthcare to all Californians. And that could mean healthcare for everyone.

California’s bill, along with its New York counterpart, mark the beginning of a winning strategy for healthcare for all: not wasting energy on the national level responding to Trump’s daily dumpster fires, but working strategically to set up state-level systems of healthcare for everyone.

Four states hold the key to a successful state-level push for healthcare for all: Washington, Oregon, California and New York. With about 70 million residents between them, those four states represent over 20% of the entire U.S. population; a win in those states would create a ripple effect like chucking a boulder into a tiny pond.

California is leading the way: a bill to provide healthcare to all California residents rocketed through their Senate health committee, their budget committee, and then cleared its biggest hurdle yet when the state Senate passed it last week. It now needs to pass the state Assembly before it lands on Gov. Jerry Brown’s desk.

New York isn’t far behind: their State Assembly passed a comprehensive Universal Healthcare bill earlier this month. And in the Senate, the bill has an unprecedented level of support, thanks to the Independent Democratic Conference, which usually votes with the Republicans, jumping on board for the first time.

Washington and Oregon are the final pieces of the puzzle, and both of them have bills in the pipeline and the Democratic majorities to make waves. With the entire West Coast on board, anything is possible: a regional healthcare system, for example, would keep costs down in the rural parts of the coastal states. Or we could dream even bigger and go for a bi-coastal risk pool with New York, laying out a compelling path for smaller East Coast states like Vermont or powerhouses like Massachusetts (Bernie! Liz!) to join as well.

And all of this comes at a time when blue state voters are leaning further left than ever, legalizing recreational marijuana (OR) and hiking taxes on the wealthy (CA) in the last election. Perhaps most importantly, voters have shown themselves to be willing to pay a little more in taxes in exchange for a lot more in state services, like California did last year when they voted to increase taxes on cigarettes to put more money into Medi-Cal, the state’s healthcare system for low-income Californians.

The health insurance and pharmaceutical lobbies would have us believe that Universal Healthcare is some mystical, convoluted quest that would turn the country upside down. It isn’t. And it doesn’t get any more complicated by starting at the state level, either. Universal Healthcare on a state level works just like it would on a federal level: instead of using our incomes each month to pay for our health insurance, we would use our tax dollars to cover healthcare  — in the same way we use Medicare taxes to cover Americans 65 and over.

Of course, Big Pharma’s opposition is no surprise. A win for us would be a loss for them; a state-run healthcare system would almost certainly mean finally allowing state governments to negotiate prices directly with drug corporations, as opposed to letting them set their own ridiculous prices and letting the market decide who lives and who dies. And you can bet that corporations like Mylan wouldn’t be able to get away with doubling the price of a medicine like EpiPen for no reason.

Real, meaningful reforms almost always get their start at the state level. Even Canada’s Universal Healthcare system started with an election in Saskatchewan in 1944 (yeah, that’s how behind we are). Think marriage equality or legal weed: you start the healthcare snowball in states with the most receptive and active progressive leadership. As more states follow suit, you build the momentum and the power you need for an unstoppable avalanche.

We have the model for how this could work. We have the momentum to get it done. We even have conservative commentators saying this isn’t just possible, but inevitable. We don’t need our Senators in D.C. on board, and we don’t need to run ourselves ragged trying to keep track of all the destructive crap in the Trumpcare plan: we just need to chalk up tactical victories in the states with progressive majorities, a much more feasible task. By working strategically, starting with just these four vanguard states, universal healthcare becomes a very real possibility.

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