"This is major. The impact really cannot be overstated," said Topher Spiro, a frequent critic of the Trump Administration's efforts to repeal the Obama health law. "States that do this will bifurcate the market, segregating healthy people from sick people."
"This new guidance from the Trump administration on state waivers continues a theme of trying instead to make end-runs around the ACA's rules," said Larry Levitt of the Kaiser Family Foundation.
"This will likely widen the gap between red states and blue states for access, affordability, regulation, and protections for pre-existing conditions," Levitt added.
What's at work here is that the Trump Administration is using the immense rule-making powers granted to the feds under the Obama health law - the Affordable Care Act - in order to shape the law more to the liking of Republicans and the White House.
The new rules were issued as Democrats have been attacking Republicans over the issue of coverage of pre-existing conditions, arguing that GOP plans - like those issued on Monday - would have the effect of putting people in insurance coverage which does not coverage all pre-existing medical problems.
"President Trump is desperate to change the subject from health care to immigration because he knows that health care is the number one issue Americans care about," said House Democratic Leader Nancy Pelosi.
"Republicans in Congress are putting health care coverage for the elderly and Americans with pre-existing conditions on the chopping block," said Sen. Ron Wyden (D-OR).
Republicans look at it much differently - they say these efforts are the natural backlash to a system set up by the Obama health law which forces a system upon many Americans that doesn't work for them.