Those of you who have been following the saga of state resistance to the Affordable Care Act’s Medicaid expansion probably know there are two basic bend-the-rules exceptions the administration has accepted in order to pull states over the line: Arkansas’ expand-but-privatize approach (which recently survived a near-death experience in the Arkansas legislature, at least for the next year), and Iowa’s expand-with-“personal-responsibility” approach (allowing more copays and deductibles, and more coercive “healthy choice” programs, than are allowed in traditional Medicaid).

It sounds like Utah is on the brink of cutting a deal with HHS that combines the Arkansas and Iowa approaches, per this report from WaPo’s Jason Millman:

Utah Gov. Gary Herbert is looking for a way to join the Medicaid expansion, and that could have national implications….

Herbert has broadly sketched out what his plan would look like. He’s asking the feds for a three-year block grant to cover about 110,000 low-income people with private insurance. He’s also seeking cost-sharing and work requirements that could be tough sticking points with CMS.

There’s no guarantee, of course, that the Utah legislation will go along with this deal if HHS approves it, but at this point Herbert is driving the policy train.

Progressives could look at such developments as paving the way for more Republican-governed states to expand Medicaid, which is a good thing, or as concessions that threaten the safety-net features (and “single payer” structure) of Medicaid, which is a bad thing. “Traditional” Medicaid has, of course, been changed significantly by waivers in the past; use of private health insurance for Medicaid beneficiaries was relatively common even before the passage of ACA.

But I tell you what: if, God forbid, I were a Republican governor, I’d come up with a package of every conservative pet rock reform I could think of that was applicable for Medicaid, put it into a waiver package, and tell my conservative friends that I was going to try to get Barack Obama to pay for turning Medicaid inside out. However it turned out, I’d be a political winner with the Right.

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Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.