Would expanding Medicaid in Alabama bankrupt the already cash-strapped state budget and further sink our country into unsustainable levels of national debt? “When you expand Medicaid, the administrative costs and the cost of expansion will eventually swamp the state,” warned U.S. Rep. Gary Palmer (R-AL). “It has in other states. Illinois is about to go bankrupt.” States that expanded Medicaid have signed up more than twice as many “able-bodied adults” than expected and per-person costs have exceeded original estimates by a whopping 76%, according to a 2018 report by the Foundation for Government Accountability. This led to cost overruns of 157%, the report showed, with Medicaid now accounting for one of every three state budget dollars.

Tennessee is charging ahead to become the first state in the nation to ask the Trump administration for Medicaid funding in a lump sum—a radical overhaul of the entitlement program that critics warn could force major cutbacks in healthcoverage for low-income people. State Republican lawmakers last week, emboldened by the Trump administration’s promise to provide states with more flexibility to run their Medicaid programs, approved legislation requiring Tennessee to submit a Medicaid block grant plan to the federal government within six months. The legislation now goes to Republican Gov. Bill Lee, who will sign the bill, a spokesperson said.

Kansas’ new law allowing the sale of health plans that can turn away people with pre-existing medical conditions has heightened concerns that more states may move to allow leaner, cheaper plans that don’t comply with ACA rules. So far, three states have passed laws allowing their Farm Bureaus to bypass ACA rules and sell health plans that are free from any state insurance regulation. Kansas became the latest last week. The state’s Democratic governor let the bill become law without her signature in the hope of winning GOP support for a bill to expand Medicaid to low-income adults, though that remains uncertain.

One feature of the political moment is that ideas that first appeared on the left (tariffs) are gaining support on the populist right. The latest example is a GOP plan in Florida to import prescription drugs from Canada, which is impractical, unsafe and unlikely to reduce prices at the pharmacy.

The Florida Legislature has been moving on a plan pushed by Republican Governor Ron DeSantis that directs the state health agency to set up a prescription drug importation program. Other states like Colorado are pondering similar schemes, and Vermont is well along in setting one up.

Tennessee would dramatically overhaul how it provides health care to its lower-income and disabled residents under a proposal the House advanced Thursday.

The bill cleared the GOP-dominated chamber on party lines, with 68 Republicans in favor and 21 Democrats against.

It’s a proposal considered one of the top policy debates of the sessions, yet many in the minority party were visibly upset after being cut off from the debate and forced to cast a vote before all members had a chance to speak.

Republican Idaho Gov. Brad Little has signed a bill that adds work requirements and other sideboards to Idaho’s Medicaid expansion. Voters approved the expansion—giving Medicaid health insurance to all low-income adults in Idaho—with a 61% vote in November. Instead of funding the expansion or repealing it, the Idaho Legislature took up bills to change it. Lawmakers passed the latest version of their sideboards legislation on Friday, after weeks of intense deliberation. The governor received it Monday.

Alaska Gov. Mike Dunleavy told President Donald Trump that the state is open to the idea of receiving Medicaid funding through fixed amounts annually. The block grant approach could allow the state more flexibility in how it spends Medicaid funding, Dunleavy spokesman Matt Shuckerow told Alaska Public Media. The Republican governor wrote to the president last month that Seema Verma, the administrator of the Centers for Medicare and Medicaid, had urged the state to become the first receive the federal funding this way. He noted that Alaska is eager to do it.

The Trump administration today approved Utah’s request for a scaled-back Medicaid expansion with a work requirement just days after a federal judge blocked similar rules from taking effect in Kentucky and Arkansas.

The approval also lets Utah cap program enrollment if the state runs out of money and marks the first phase of a plan to replace a Medicaid expansion voters approved last November with a scaled-down program covering roughly 60,000 fewer people.

Under a plan announced Monday, the newly eligible for Medicaid in Nebraska will have different benefits and requirements than others on Medicaid. To get full coverage, they would have to work, care for a family member, volunteer, look for work, or attend college or an apprenticeship. Matthew Van Patton, the state Medicaid director, said the newly eligible would be offered two levels of coverage, basic and prime. He said basic coverage would be modeled after a Blue Cross Blue Shield small group insurance plan, rather than traditional Medicaid coverage.

When the Idaho Senate came to order on Monday morning, it seemed that the work requirements many Idaho Republicans wanted to tack on to voter-approved Medicaid expansion might be dead in the water.

After all, a federal judge last week struck down such work requirements in Arkansas and Kentucky.

But the Republicans pressed on, undeterred. Senators on Monday introduced a series of amendments to an existing bill. Unlike the work requirements that have been discussed in Idaho and other states, failure to comply wouldn’t mean losing Medicaid. People still would have coverage. They would just have a co-pay imposed on them — such as $5 to $30 for a doctor’s appointment — until they complied. Some people would be exempt, such as parents, caregivers and those filing for disability.