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.

Arkansas Gov. Asa Hutchinson is asking the Trump administration to appeal a federal judge’s decision to strike down the state’s Medicaid work requirements. “I remain fully committed to the work requirement and we are in this for the long haul because we believe it is the right policy,” Hutchinson, a Republican, said in a press conference Thursday. Hutchinson said that he thought the judge’s ruling was wrong, and that he had just gotten off the phone with members of the Trump administration, who remained committed to the program.

A federal judge on Wednesday threw out Medicaid work requirements in two states. In twin rulings, Judge James E. Boasberg of the Federal District Court for the District of Columbia rejected for a second time Kentucky’s attempt to require recipients to work or volunteer as a condition of coverage and blocked a similar rule in Arkansas. Seema Verma, who is in charge of the Medicaid program, said “We will continue to defend our efforts to give states greater flexibility to help low income Americans rise out of poverty.” The ruling will be appealed.

States. They’re just as perplexed as the rest of us over the ever-rising cost of health care premiums.

Now some states — including Montana, North Carolina and Oregon — are moving to control costs of state employee health plans. Their strategy: Use Medicare reimbursement rates to recalibrate how they pay hospitals. If the gamble pays off, more private-sector employers could start doing the same thing.

“Government workers will get it first, then everyone else will see the savings and demand it,” says Glenn Melnick, a hospital finance expert and professor at the University of Southern California. “This is the camel’s nose. It will just grow and grow.”

A House panel on Wednesday sent the latest Medicaid expansion bill in the Idaho Legislature on to the House floor, but without a recommendation to pass it.

The bill — from Nampa Republican Rep. John Vander Woude — includes controversial provisions, such as a work requirement. It also requires people who are just above the poverty line to buy private health insurance plans from Idaho’s insurance exchange.