The big picture: The Centers for Medicare & Medicaid Services, under the leadership of Administrator Seema Verma, has made clear that it wants to say "yes" to new limits on Medicaid eligibility, and has invited states to ask for those limits.

• But CMS hasn't actually said "yes" yet to some of the most significant limits states have asked for.
• In the meantime, states are left either with vague ambitions they’re not sure how to implement, or with risky plans that put their own budgets on the line.

What we're watching: State-level Republicans are waiting for CMS to resolve two related issues: how much federal funding their versions of Medicaid can receive, and the extent to which they’re able to cap enrollment in the program.

• “These issues are going to continue to be intertwined,” said Joan Alker, the executive director of Georgetown University’s Center for Children and Families.

Verma has reportedly told state officials that she wants to use her regulatory power to convert Medicaid funding into a system of block grants — which would be an enormous rightward shift and probably a big cut in total funding.

• CMS probably cannot do that on its own, experts said, but it could achieve something similar by approving caps on either enrollment or spending.

Where it stands: GOP lawmakers in a handful of states are looking to Utah, which has bet big on Verma's authority, for signals about what's possible.

• Utah voters approved the full ACA expansion last year, but the state legislature overruled them to pass a more limited version.
• By foregoing the full expansion, Utah passed up enhanced federal funding. It's still asking for that extra money — a request CMS has never previously approved.
• Utah will also ask CMS to impose a per-person cap on Medicaid spending — a steep cut that was part of congressional Republicans’ failed repeal-and-replace bill, and which may strain CMS' legal authority.
• If Utah doesn't get those two requests, its backup plan is simply to adopt the full expansion.

What's next: Utah is not the only red state leaning into Verma's agenda, but it's further out on a limb than any other.

• Idaho, like Utah, overruled its voters to pass a narrower Medicaid bill. But it preserved an option for people to buy into the ACA's expansion.
• Alaska Gov. Mike Dunleavy has said he wants to take Verma up on her offer of block grants; so have legislators in Tennessee and Georgia. But in the absence of any detail about what that means, or what CMS will approve, that's all pretty vague right now.

If CMS does move forward on any of this, it could face the same threat of lawsuits that have stymied its first big Medicaid overhaul — work requirements.

• Those rules are on ice in two states because a judge said they contravene Medicaid's statutory structure and goals. The same argument could await a partial expansion or tough spending caps.

“There’s a clear agenda here to get a handful of states to take up these waivers, which fundamentally undermine the central tenets of the Medicaid program — which [are] that it is a guarantee of coverage, and a guarantee of federal funding,” Alker said.

Go deeper: Medicaid is the ACA's workhorse

Driving the news: Sanders will introduce a new version of "Medicare for All" today that's even more ambitious than his last one — which was already more ambitious than any other health care system on Earth.

• If something like Sanders’ bill did become law, it would “leapfrog the rest of the world,” as the Kaiser Family Foundation’s Larry Levitt put it.
• It would be the most robust system in the world, and one of the most centralized — a sea change from today's largely privatized patchwork.

What it would mean for you: Sanders’ plan would move almost everyone — whether you’re on Medicare or Medicaid, or buy insurance on your own through the Affordable Care Act, or get it through your job — into a single government-run program.

• You could not keep your existing plan.
• You could keep your doctor. When the Affordable Care Act made some people switch doctors, it's because they had to switch insurance plans, and each plan has its own network of doctors and hospitals. With a single national plan, though, there are no networks.
• Coverage would be incredibly generous. Sanders' program would cover just about everything, including vision and dental, all with no premiums and no out-of-pocket costs (like copays and deductibles) — unlike today's private insurance.
• Taxes would go up. A lot. That’s the tradeoff for eliminating premiums and deductibles. Sanders has not said which taxes he would raise.
• Overall spending would be about the same as what we’re expected to spend under the status quo, according to multiple estimates. We'd just pay for it differently. Today's hodgepodge of premiums, copays and state and federal spending would all be rolled into one federal, taxpayer-funded program.

Yes, but: This is Sanders' plan as written. It would need several political miracles to pass, especially in this pure form. And even then, it would still need sustained political support to keep functioning the way Sanders intends.

The other side: The leading alternative to Sanders’ proposal, known as “Medicare for America,” would move more gradually and is not quite as robust as Sanders’ version — but would still be enormously different from what we have now.

How it works: A new public program would automatically absorb the uninsured, all newborns, and everyone on Medicare, Medicaid, and the Affordable Care Act’s exchanges.

• This version would be optional: Employers could keep offering coverage on their own, or pay to cover their workers through the public plan.
• So your plan could change if your employer opted into the new system, and that means your doctor could, too. (Reminder: employers can already change their plans today.)
• Over time, as more employers opt into the public system and people covered as newborns age into the workforce, “I think it’s a reasonable assumption that the employer market would deteriorate," Levitt said.
• This new version of Medicare would still have a role for private insurers, similar to what Medicare has now. They could create their own networks of doctors and hospitals.
• Your costs: Middle- and upper-income households would still need to pay a premium, and some out-of-pocket costs. Both would be capped based on income. This means the tax increases would likely be lower than Sanders’ plan.

The big picture: The U.S. health care system is by far the most expensive in the world, and yet despite that spending, we have worse health outcomes than similar countries. We're also an outlier among other rich countries because we don't guarantee coverage to everyone.

• Sanders' plan to blow up that system is what forced the issue onto Democrats' front burner — and he's not looking to back down now on the specifics.

The bottom line: You might love the new system or you might hate it — but either way, "if you like your plan, you can keep it" is not a promise you're likely to hear from Sanders.

Between the lines: Health care costs will keep rising throughout the system — everything gets more expensive over time, hospitals are continuing to consolidate, and the next wave of drugs will be wildly expensive. But private insurance may feel the biggest squeeze.

• Hospitals get paid more from private insurance than they do from Medicare and Medicaid. They say government programs don’t pay them enough to stay in business, and that they make up the difference by charging higher prices for private plans.
• As Baby Boomers continue to retire, shifting out of their employer plans and into Medicare, more of hospitals’ work will be reimbursed at lower Medicare rates — creating more pressure to make up more revenue through more price increases on private coverage.
• “Will employers be the place of last resort over and over and over again, and is that sustainable?” Democratic health care consultant Chris Jennings said.

Critics say hospitals are misrepresenting how far their Medicare payments go, but either way, it's the prevailing logic in how prices are set.

What they’re saying: Jennings is among the policy experts arguing that employers have a strong incentive to get more proactive about cost control now. In recent years, they’ve responded to rising costs mainly by shifting more of the overall burden onto employees.

• But that hasn’t done much to control the underlying price of care, which just keeps rising.
• “This trend line continues, and we may be getting to this inflection point here that’s just unsustainable: ‘I can’t be the [only] entity that’s paying these rates,’” Jennings said.

The bottom line: Businesses don't have the same cost control leverage that government payers do, meaning that becoming engaged in politics will be their primary route to reprieve.

• If they don't, the consequences could be dire, experts warn.
• “I do not think it’s sustainable, not if [employers] continue to have expectations of meaningful return on investment for their shareholders and having access to capital based on their capacity to produce earnings to grow their companies," said John Bardis, a former Trump administration health official.
• “I think it’s the most serious financial problem facing the country during the next 20 years," Bardis added.

Go deeper:

• If there's a turning point on health costs, it'll come from employers
• The unique problem with U.S. health care
• The hot new corporate health care trends are old and lukewarm