This is the Cato Daily podcast for Thursday, January 11th, 2018.

I'm Caleb Brown.

The Trump administration plans to allow states to impose work requirements on some recipients of Medicaid.

It's something many states have requested for years.

Ray Hetterman of the Buckeye Institute speaking with me at the Cato Institute's

State Health Policy Summit last week described what that might mean.

Give me a sense of the lay of the land with respect to Medicaid and

states attempts to innovate within Medicaid at the end of 2016.

Sure, so you know states were able to make requests of the federal government through a waiver process called a section 1115 and this is a demonstration

waiver where states could make some changes to their Medicaid program with permission

of the federal government and so in the end of 2016 at the Obama administration we had HHS that had a very firm view of how Medicaid should be structured and didn't want very little innovation for states. And so under the Obama administration

states who want to innovate on their Medicaid program could innovate by

offering to cover more people, offer to cover more services, and so there were

limited in the impact

of the way they could structure their Medicaid reforms.

For example, Ohio had a Medicaid waiver

where we wanted to use cost sharing.

We wanted to create HS's and some work requirements in an attempt to try

to make Medicaid more like the private market.

And unfortunately, you know, the Obama administration rejected the Ohio Medicaid waiver and really at

that point there's nothing states could do other than ask mother may eye to the

federal government. So with respect to the the structure and the text of Obamacare, the Affordable Care Act spells out the

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