One ramification of the U.S. federalist system for medical malpractice reform is:

Group of answer choices

A. Congress must ultimately approve any state legislation.

B. Individual states must apply for 1155 waivers from the Department of Health and Human Services.

C. State courts are precluded from ruling on state constitutional matters.

D. Political battles concerning legal reforms must be fought out in 50+ separate state jurisdictions.

E. No ramifications