Health care politics With spending on Medicaid waivers now making up about a third of federal spending on the program, they’ve become a lightning rod for disputes between states and the federal government. (Photo: Shutterstock)

When Republican-led states balked at expanding Medicaid under the Affordable Care Act, President Barack Obama’s administration tossed them a carrot — allowing several to charge monthly premiums to newly eligible enrollees.

Republicans pushed for the fees to give Medicaid recipients “skin in the game” — the idea they would value their coverage more — and to make the government program resemble employer-based insurance.

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