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WASHINGTON — Medicaid emerged Monday as perhaps the singular issue on which the Republican bid to overhaul the Affordable Care Act will live or die.

House Republicans unveiled their official plan to repeal and replace much of the health care law, including dramatic changes to Medicaid, the insurance program that covers low-income Americans and that was expanded under Obamacare. Republicans want to convert the program from the open-ended entitlement it is now to a program with a hard spending limit.

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Only hours earlier, however, a critical group of Senate Republicans released a letter rejecting earlier leaked versions of the House plan because of the Medicaid provisions. They each represent states that chose to expand Medicaid under the health care law, after the US Supreme Court made the expansion optional instead of mandatory in a 2012 ruling.

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