Iowa’s experience with Obamacare’s Medicaid expansion has been turbulent. In 2014, state officials agreed to expand Medicaid, despite the fact that the Obama administration denied virtually all of their requests for flexibility.

Iowa’s expansion was loosely modeled after Arkansas’ Obamacare expansion. Under Iowa’s “Marketplace Choice” waiver, able-bodied adults above the poverty line would receive Medicaid benefits through Obamacare exchange plans.