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The Trump administration still has big plans for putting restrictions on Medicaid.

Congress failed to repeal Obmacare and its Medicaid expansion or institute federal spending caps for the whole program. But the Centers for Medicare and Medicaid Services will still have broad authority to reshape the low-income insurance program, which covers 70 million Americans, in Trump’s image.

CMS Administrator Seema Verma laid out her vision in a speech today to the National Association of Medicaid Directors. One line stuck out above the rest.

“CMS believes that meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being, and health of Americans,” Verma said.

The message was clear, I think: State-proposed work requirements for Medicaid would be approved by this administration.

Verma accused the Obama administration and the Democratic Congress that expanded Medicaid to childless adults in Obamacare (a provision that has covered 12 million of the poorest Americans) of perverting the purpose of the program, which she said is to protect the most vulnerable people.

Putting able-bodied adults on Medicaid, she said, “doesn’t make sense.”

Others take serious issue with that reading. Medicaid expansion was, after all, a policy explicitly approved by Congress.

Sara Rosenbaum, a health policy professor at George Washington University, told me a few months ago that the Trump administration was signaling it was preparing “to deny or nullify an entire act of Congress by claiming that it’s contrary to the act of Congress.”

“It’s really mind-blowing,” she said then.

But this is a philosophical debate. Verma holds the strings right now, and states are preparing to take advantage of this new freedom that the Trump administration wants to provide.

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