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A growing number of Republican state leaders, not content to wait as Congress struggles to repeal the Affordable Care Act and overhaul Medicaid, are mobilizing in an effort to reshape how health care is delivered in their states. Encouraged by a Trump administration that appears receptive to such moves, more than a half-dozen states are seeking federal permission to impose coverage restrictions on many Medicaid beneficiaries, including drug testing and lifetime enrollment caps, some of which would be unprecedented. (Armour, Levitz and Hackman, 2/23)

Congressional Republicans struggling over how to repeal Obamacare are stuck on a key problem: what to do with the millions of people in 31 states covered under the dramatic expansion of Medicaid the law enabled. So they have privately turned to a handful of governors to help resolve the issue -- including Wisconsin's Scott Walker and Ohio's John Kasich, according to several sources involved in the talks. The hope, according to congressional sources, is to let the governors cut a deal on an issue that directly impacts their states and let the White House and Republican leaders endorse the plan that eventually emerges. (Raju, 2/23)

The governors are especially worried about what will happen to Medicaid, the health care program primarily for low income Americans. Even conservative Kansas Gov. Sam Brownback, whose state did not agree to the federal Medicaid expansion, said people who already received coverage should not lose it. Brownback said “Obamacare repeal and replace is going to be the top discussion” at the governors meetings. “The governors are going to be at the tip of the spear on that. You’ve got to do it in such a way that you are repealing but you’re not kicking people off,” he said. (Cockerham, Wise and Hotakainen, 2/24)

Ohio Gov. John Kasich is among a small group of governors being called upon by congressional Republicans to help craft a solution to the Medicaid expansion conundrum amid the repeal and replacement of Obamacare. ... Kasich arrived in Washington D.C. today following a trip to Germany and the United Kingdom and is expected to meet with the other governors, the source said. Kasich worked the phones while overseas, talking to other governors and their staffs on crafting a health-care replacement plan. The governor is scheduled to meet with Trump on Friday. (Ludlow, 2/24)

Governors are descending on Washington this weekend as Republicans wrestle with the future of ObamaCare's expansion of Medicaid. GOP lawmakers say they are looking to governors for advice on what to do about the program, which is one of the toughest issues Republicans face as they look to repeal and replace the healthcare law. Many of the lawmakers representing states that accepted the Medicaid expansion are looking to keep it. But they are at odds with conservatives and Republicans from states that rejected the expansion; they are pushing full repeal. (Sullivan, 2/24)

Most governors realize that the GOP's Medicaid restructuring plan, recently outlined by House Republican leaders, would mean significantly less federal funding over time, even though states would get more flexibility in how to spend those dollars. It “will result in the single largest transfer of risk ever from the federal government to the states,” Arizona's Republican Gov. Doug Ducey recently wrote to House leaders. (Meyer, 2/23)

A bipartisan association of mayors from across the United States outlined on Thursday its demands for a Republican alternative to the 2010 health care law. Mayors of several major cities also cautioned that repealing the law without an adequate replacement could have significant consequences for local economies. Among the main areas of the law the U.S. Conference of Mayors wants to see maintained are provisions that GOP lawmakers in Congress also support, such as the ban on insurers denying coverage based on pre-existing health conditions and allowing young adults to stay on their parents' plans until the age of 26. But one key area where the group differs from some congressional Republicans is what to do regarding the law’s Medicaid expansion. (Williams, 2/23)

A key element of the Republicans’ plan for replacing Obamacare is transforming the costly Medicaid program into a series of block grants to the states. The idea is to save the federal government billions of dollars in the coming years while giving state officials more flexibility to set eligibility requirements and spending levels to provide health care services to the nation’s poor and disabled. But there is one serious catch: While the extensive use of block grants has proven over the years to be a great financial boon for Congress and the federal government in attempting to rein in spending, it has been a bad deal for the states and hundreds of millions of Americans dependent on federal assistance. (Pianin, 2/23)