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Indiana, which has a conservative Republican governor and Legislature, is pioneering an experiment that requires low-income patients to contribute monthly to a special health account. ... Charging poor people small premiums or fees for care — long favored by conservatives who contend that "skin in the game" engages patients in their health — has historically produced mixed results. But at a time when Obamacare remains deeply unpopular among Republicans, the idea is attracting new interest as GOP governors seek ways to put a conservative stamp on expanding coverage. Indiana's experiment may provide a glimpse at where the health law is headed in some parts of the country. (Levey, 7/4)

About 1 million low-income Ohio residents could be required to pay a new monthly cost for Medicaid health coverage or potentially lose it under a Republican provision in the state budget, officials estimate. The idea, which will require federal approval, was part of the $71.2 billion, two-year spending blueprint that Republican Gov. John Kasich signed Tuesday. (Sanner, 6/2)

Despite a key win in the Supreme Court and pressure from liberal activists, North Carolina's legislative leaders said this past week that they have no plans to expand the state's Medicaid rolls through President Barack Obama's 2010 health care law. Demonstrators who have routinely come to the Legislative Building to protest Republican policies arrived again this past week on the coattails of a Supreme Court decision to uphold subsidies for individuals who purchased insurance on federal exchanges. They demanded Republican Gov. Pat McCrory and General Assembly leaders either accept federal funding to expand Medicaid enrollment through the Affordable Care Act, or come up with their own plan to close the insurance gap. (Moritz, 7/4)

It has been five years since the Affordable Care Act (ACA) became law, and new data and numerous real-life stories are beginning to reveal how close or how far the ACA has come toward meeting its objective in Washington state. One challenge has been expanding the reach of insurance to more people. Today, more than 91 percent of the state’s population has coverage — the highest rate in decades, according to state officials. But coverage alone isn’t a measure of success. Equally important is whether people can afford their insurance and medical bills and whether they can get access to care that makes them healthier. (Stiffler, 7/4)

When nursing becomes painful or difficult in the days after giving birth, women can turn to certified lactation consultants for advice and relief. But some Illinois women say that when they tried to get their insurers to pay for the service, their claims were repeatedly denied. The Affordable Care Act identifies breast-feeding benefits as a preventive service like contraception and lung cancer screening, which the law requires insurers to cover at no cost to policyholders. Recently a nonprofit that advocates for breast-feeding mothers sent a letter to the Illinois Department of Insurance requesting that insurers be forced to pay for the services of certified lactation consultants. (Venteicher, 7/3)