I suspect we'll end up with a patchwork: From activist private organizations / charities. To state gov'ts in blue states. To just private industry (given how solar is now the least expensive energy source). To just private citizens who would prefer to work for less money on something valuable than squeeze a tiny bit more profit as a corporate cog.

Ideally the Federal gov't gets back into play, but we shouldn't plan for that future. It's a nice to have, but its a single point of failure. Especially if the Supreme Court doesn't believe in the independence of agencies anymore.

As an example, the American Academy of Pediatrics now has their own vaccine schedule, which they didn't have before. Nobody in their right mind trusts the CDC / FDA on this right now.