Earlier this month, the Trump administration shot down a plan from Idaho to sell health insurance that doesn’t comply with Affordable Care Act (ACA) regulations.

“If a state fails to substantially enforce the law, the Centers for Medicare & Medicaid Services (CMS) has a responsibility to enforce these provisions on behalf of the State,” wrote CMS Administrator Seema Verma in her rejection letter.

Three weeks later, another state — Iowa — is on the verge of making a similar move.

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More Democrats than ever have signed on to a proposal that would shift every U.S. resident onto Medicare, but a large proportion remain uncertain about heading into a completely government-run system as an immediate sequel to Obamacare.

The Medicare for All Act that has been introduced would move everyone in the U.S. onto Medicare, even if they have private healthcare coverage. It is backed by Sen. Bernie Sanders, I-Vt., and an unprecedented 16 Democratic senators. Among them are possible 2020 presidential hopefuls Sens. Cory Booker, D-N.J., Kamala Harris, D-Calif., Elizabeth Warren, D-Mass., and Kirsten Gillibrand, D-N.Y. Most Democratic lawmakers in the House have co-sponsored a similar bill.

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