The Trump administration is readying guidance that could let states remodel their Medicaid programs to more closely resemble block grant proposals favored by Republicans during their failed effort to repeal the Affordable Care Act, according to people familiar with the discussions.

States would still have to adhere to certain requirements but could get far more leeway in how they design their programs, likely in exchange for some type of cap on federal funding, the people said. The guidance would lay out how states could satisfy federal requirements to get waivers to pursue the changes, they said.

The primary concerns with this model include:

Restricted access to existing medicines: The 14 countries that the Centers for Medicare & Medicaid Services (CMS) has proposed referencing in this IPI model, on average, have access to only 48 percent of the new drugs developed in the past eight years, and it took an average of 16 months after their initial global launch for those drugs to become available in those 14 countries. If the United States adopts the prices of those countries, American patients may very well face the same access restrictions as exist in those countries and lose access to existing treatment options.

Federal law might be hard to change in Washington, but in some cases, states are able to take advantage of flexibility built into federal law to develop new programs and approaches. This is true under federal Medicaid law and it is also true under the ACA, which is why CMS recently stepped up efforts to support state-specific strategies to improve their individual health insurance markets and to develop alternatives to Obamacare that better meet the needs of their residents.

In her first speech as speaker of the House, Nancy Pelosi made it clear that she knows that health care is key to why voters sent Democrats to Congress.

“In the past two years the American people have spoken,” Pelosi told members of Congress and their families who were gathered Thursday in the House chamber for the opening day of the session.

“Tens of thousands of public events were held, hundreds of thousands of people turned out, millions of calls were made, countless families, even sick little children — our little lobbyists, our little lobbyists — bravely came forward to tell their stories and they made a big difference,” said Pelosi, a California Democrat.

Writer and editor Robert Verbruggen presents in this National Review Magazine piece perhaps the best overview of the Obamacare battles and experience that we have seen.  And he sees a silver lining in the current legislative stalemate: Though two simple changes—Congress ending the individual mandate and President Trump expanding other options through regulatory changes—both individuals and states now have more freedom without denying Obamacare to anyone who wants it. There will be some downsides, for sure, and conservatives shouldn’t be happy that so much of the law remains in place. But maybe, just maybe, the GOP might have bungled its way into something that works.

Gov. Jay Inslee and Democratic lawmakers Tuesday announced proposed legislation for a new “public option” health care plan under Washington’s health insurance exchange. “We are proposing to the state Legislature that we have a public option that is available throughout the state of Washington so that we can increase the ability to move forward on the road to universal health care in the state of Washington,” said the governor, who is considering a run for president in 2020.

New York City Mayor Bill de Blasio (D) on Tuesday issued a bold guarantee of affordable health care for every resident, thrusting the nation’s largest city to the forefront of debates over universal health coverage and immigrant rights.

The promise is aimed at 600,000 New Yorkers who lack insurance because they can’t afford it, believe they don’t need it, or can’t get it because they are in the country illegally.

The announcement makes New York the second U.S. city to attempt to provide health care to everyone living there, coming about a dozen years after San Francisco pioneered the idea with a more limited promise. 

After dismissing for years the idea that Democrats’ health care plans would lead to a government takeover, new House Budget Committee Chairman John Yarmuth on Tuesday asked Congress’ top economist to sketch out the options for a government takeover. The Kentucky Democrat also implicitly sketched out the political game plan: enact socialized medicine before patients and taxpayers understand what they’ll be losing.

People 65 and older accounted for over one third of U.S. medical spending. Yet despite the fact that government pays for 65% of the elderly’s medical expenses, the burden of health spending (out-of-pocket expenses as a percentage of income) is much higher among the elderly than among those below age 65. You might suppose that a policymaker in 2008 would look at these data and conclude that if there is a crisis in affordability within the U.S. population, it lies among the elderly. 

The Health Care Choices Proposal would block-grant to each state its federal share of health care funding. When combined with their own health care resources, states would have the authority to determine how best to help their unique populaces obtain insurance. This private-insurance based program would give patients more choices—at multiple price points—to customize a health insurance plan that works best for their unique situation. It would empower employers, families, and individuals with expanded choices and premiums up to 32% lower.