After the Supreme Court ruled in 2012 that states could choose whether to accept Obamacare's Medicaid expansion, many red states opted to reject it—at great cost to uninsured patients and the financially stressed hospitals that care for them. Now, some of those states are reconsidering their decision, but want to expand Medicaid on their own, conservative terms.

Last week, Politico reported that in "nearly a dozen Republican-dominated states, either the governor or conservative legislators are seeking to add work requirements to Obamacare Medicaid expansion."

Arkansas Governor Asa Hutchinson told reporter Sarah Wheaton that Medicaid "is supposed to be an incentive and encouragement for people to work versus an incentive for people to just receive the government benefit and not be part of a working culture of Arkansas," while Governor Gary Herbert of Utah described his position this way:

I wanted to be able to say, ‘If you want the taxpayers to fund your health care, then you need to go out and be involved in a work program, no ifs, ands or buts.’ I’ve been accused by the Obama administration: ‘Well, you’re trying to turn this health care program into a work program.’ And I’ve said, ‘You’re right.’

Demanding a work requirement is a more radical view than simply opposing the Affordable Care Act. Restricting health insurance to those who are working or seeking work is inconsistent with not just the ACA but also with any other universal health insurance scheme, because universal plans cover everyone. This includes plans from Republican health care analysts who propose alternatives to Obamacare that also provide universal coverage.