A number of states are taking advantage of flexibility written into the Affordable Care Act to experiment with different ways to purchase, deliver, and pay for health care.

Vermont, for example, is considering a single-payer program in which all state residents would enroll in a state-run health insurance program.  Maryland and Massachusetts are setting health care spending targets and penalizing providers that exceed those targets.

Medicaid has inspired a number of state experiments as well.  Wisconsin seeks to enable higher-earning Medicaid recipients to leave Medicaid, taking with them tax credits that will enable them to purchase affordable health insurance in the private marketplace.  Arkansas, Iowa, and Ohio are having new Medicaid recipients purchase private insurance using federal Medicaid dollars, with Pennsylvania and Utah now seeking permission to do the same.

Read more about states as a laboratory for health care innovation, and find a map with the latest information on where states stand on Medicaid expansion, in this Wall Street Journal article.