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July 01, 2014 5:20 PM Line in the Sand on Medicaid “Experimentation?”

By Ed Kilgore

Since the original decisions by states to accept or reject the Affordable Care Act’s Medicaid expansion, there’s been a twilight struggle in which states (all but Arkansas being states under GOP management) have been negotiating with HHS to secure expansion money for concessions on “state flexibility,” typically meaning acceptance of various conservative “reforms” in the underlying Medicaid program.

The latest such deal involved Indiana, where Gov. Mike Pence took the risk of going along with a Medicaid expansion in exchange for continuation of a waiver-based Medicaid “experiment” utilizing Health Savings Accounts, a favorite conservative health policy pet rock.

But according to a report from Wonkblog’s Jason Millman, the Obama administration may be drawing a line in the sand against an accomodation with Oklahoma, which is fighting expansion but wants permanent extension of a waiver-based state “experiment.”

It’s not totally clear how it’s all going to turn out, but it’s good to know all the cards aren’t being held by Republican governors and legislators who want Obamacare money while attacking Obamacare as the Great Satan of domestic policy.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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