“While the Republican-controlled Congress is trying to repeal the Affordable Care Act (ACA), governors on both sides of the aisle are anxiously awaiting to see what happens. In the meantime, some are trying to make their own changes to the health-care system in their state — and have the best chance of doing so in years.

“To customize their Medicaid programs, states have been able to ask the federal government for waivers for decades. The Obama administration rejected many waivers, concluding that they were unconstitutional or would drastically limit poor people’s ability to afford health insurance. For example, many states sought to make employment a requirement for Medicaid, but the Obama administration declined every such request.

“With Donald Trump in the White House and Tom Price leading the Health and Human Services (HHS) Department, conservative states will likely see their long-denied wishes come true. Both officials support giving states more flexibility than the Obama administration, and a final bill to replace the ACA would likely increase states’ power as well. So in the early days of the Trump administration, some governors enthusiastically submitted waivers.”

“If some of these proposals get the greenlight as expected, they could drastically change the structure of Medicaid in their states and have national implications.”