Medicaid expansion under the Affordable Care Act gained momentum in the first half of the year,
with Montana and Louisiana bringing the number of expansion states to 31. Other Republican-led states, including Oklahoma, South Dakota, Utah and Wyoming also seemed to be moving in that direction.
But most observers believe the election of Donald Trump, who has promised to repeal the ACA, mean those efforts are dead. After the election, South Dakota Republican Gov. Dennis Daugaard met with Vice President-elect Mike Pence and withdrew his proposal.
Leaders of states that already have expanded, including California and Michigan, have urged GOP leaders to let them keep their expansion programs.
Meanwhile, Arizona, Kentucky and Ohio sought permission from the Obama administration to add conservative, patient-responsibility features for their newly eligible Medicaid populations.
Those ideas will gain new currency in the next administration.
To lead the CMS, Trump selected Seema Verma, a consultant who helped Indiana develop a Medicaid expansion model infused with such features, such as a requirement that beneficiaries contribute to a health savings account.