At the federal level, health care legislation appears to be stalled. Republicans can’t agree on what they want to do while Democrats also don’t agree — and even if they did, they have no power to enact anything. Several state governments, however, have been trying their hand at significant health policy innovation.

In Nevada, both chambers of the state legislature recently passed a bill that would allow any resident to buy into the state’s Medicaid program. Termed the Nevada Care Plan, the measure’s original author, Democratic Assemblyman Mike Sprinkle, intends for his bill to sidestep the GOP’s efforts at the federal level to roll back Medicaid.

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“Imagine a Medicaid expansion that could provide coverage to all Nevadans. One that would give every Nevadan an opportunity to purchase a plan with Medicaid-like benefits on the insurance market,” Sprinkle wrote in a May 30 editorial promoting his measure. “An expansion that would create more options for patients in counties where they currently only have one option for health insurance — putting control back in patients’ hands.”

Under the Nevada Care Plan, anyone, including people receiving federal subsidies for health care, could purchase a Medicaid insurance plan. Such plans would be included in the state’s health care exchange website, competing with private companies’ offerings.

It’s an interesting proposal and one likely to prove influential, even if the state’s Republican governor, Brian Sandoval, decides not to sign it.

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However, despite his “R” label, there is some possibility that Sandoval may actually approve the bill. As New York Magazine's Ed Kilgore notes, the governor has been one of a few Republicans who has strongly supported the Medicaid expansion of Obamacare. And according to the Reno Gazette-Journal, Sandoval strongly opposes the American Health Care Act that recently passed out of the U.S. House of Representatives.

But Nevada isn’t the only state trying to take a different approach to expand health insurance coverage. Earlier this month, California’s state senate approved a preliminary measure that would provide health insurance to all residents at an estimated $400 billion tab.

The bill did not include any provisions on how to pay for the cost, however, and it was strongly opposed by California Republicans.

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“We don’t have the money to pay for it,” state senator Tom Berryhill told the Los Angeles Times. “If we cut every single program and expense from the state budget and redirected that money to this bill, SB 562, we wouldn’t even cover half of the $400-billion price tag.”

Conservatives are raising similar doubts about a New York proposal which proponents have said would cost little more since a move to universal health care would eliminate tens of millions of dollars in profit-skimming from multiple companies trying to get their cut from the money the state already spends on medical care.

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“We are a large state. To the extent that there are benefits from economies of scale, we have that,” Richard Gottfried, the bill’s primary sponsor in the state assembly told Salon last month.

“We are also a state that has a tremendous concentration of wealth. While there are certainly a lot of poor people in New York, there are also a lot of wealthy people. So our ability to fund a program with a lighter burden on working people is partly because of the substantial number of upper-income New Yorkers.”

The Empire State has also attracted attention for a policy announced by Governor Andrew Cuomo which would prohibit health care providers who withdraw from the local health care exchange markets from receiving Medicaid monies from New York.

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But cost concerns are ultimately what doomed an earlier effort in Vermont to provide health insurance to all state residents.

And while observers will be watching what happens in California and New York, it may be Nevada's Medicaid expansion which proves most influential since it is likely to have lower costs while also greatly expanding access to health care.