Iowa may be the latest Republican controlled state to expand its Medicaid program. The federal government is poised to approve a waiver that will allow Iowa to use federal funds to purchase private insurance for individuals eligible for the expansion while charging some a premium for their coverage. I’m not thrilled with the idea of requiring people who live near the poverty line to pay a premium for Medicaid. But if this is the kind shell game conservatives need to play to convince themselves that they’re remaining true to their skewed free-market principles, then fine. It’s a better option than completely denying health coverage to people for no other reason than geography. And perhaps the feds’ flexibility on the mechanics of the expansion will encourage other red states to follow suit and do the right thing for their citizens.