States that originally rejected the Affordable Care Act's expansion of Medicaid now are offering alternatives, such as contracting with private insurers to provide expanded coverage. Ohio is negotiating with the federal government on a plan. Missouri state Rep. Jay Barnes, a Republican, introduced a market-based Medicaid plan that includes private insurers and covers fewer people than the ACA's expansion. If the White House wants to reduce the cost of care, he said, it will have to take conservative ideas into account.

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