For Donald Trump, Indiana Gov. Mike Pence is in many ways a safe choice as a running mate. Staid, conservative and respectable, Pence embodies GOP politics as usual -- in contrast to Trump, a profoundly unusual nominee. Several media organizations reported that Trump's choice was an effort to mollify the factions of the Republican Party that still have reservations about Trump's agenda.
In one respect, though, Pence would represent an important deviation from the party line.
Last year, Pence reached an agreement with the Obama administration to expand Medicaid in Indiana, taking advantage of the Affordable Care Act, the president's controversial health-care reform.
Like other Republicans, Pence has said he supports repealing the reform, also known as Obamacare -- but that did not stop Pence from compromising with the administration in the meantime to broaden the scope of the law in his state.
The deal Pence struck offers some idea of how Republicans might pursue health-care policy if Trump wins in the fall. While accepting a basic premise of Obama's reform, Pence also insisted on a number of conservative modifications for Indiana.
In most states, beneficiaries of Medicaid do not pay premiums or other out-of-pocket expenses. Pence, however, oversaw the creation of a byzantine system that, while expanding access to Medicaid for Indiana residents living in or near poverty, also required them to share more of the cost.
Most adults added to the program in Pence's system are required to save money each month in a personal health savings account. The money in those accounts would then be used to pay for future medical expenses for the beneficiary.
Those with incomes above the poverty level who fail to make monthly contributions to their accounts lose coverage and are barred from applying again for six months. Those in poverty who do not make these contributions are still covered, but under a less generous plan, which does not cover optical and dental services for adults and requires co-payments.
No one is fully exempt from making the contributions. Even those with no income whatsoever must find a way to save a nominal $1 each month to receive the plan's full benefits.
These provisions limited the costs of Indiana's Medicaid program by forcing participants to pay more. Yet the federal government is paying for the expansion anyway and states with more conventional expansions of Medicaid are saving money. So an important lesson of Pence's program was to demonstrate conservative theories about reforming Medicaid in practice.
The idea of requiring beneficiaries of Medicaid to pay premiums to save the government money often appears in conservative proposals in health care.
The white paper on health care that Speaker Paul D. Ryan and his Republican colleagues in the House put forward last month, for example, called for states to have the flexibility to charge "reasonable, enforceable premiums" in Medicaid. That document also suggested that states should be allowed to require beneficiaries to fulfill work requirements.
Notably, however, the document also endorsed a few of the basic principles of the Affordable Care Act. Ryan and his colleagues would require insurers to cover people with preexisting medical conditions, and they would use federal subsidies to help families defray the cost of insurance -- as in the current law.
Among the Affordable Care Act's most trenchant critics, these concessions were cause for consternation. "House Republicans would repeal ObamaCare only to replace it with slightly modified versions of that law’s worst provisions," Michael Cannon wrote in Forbes.
Republicans either agreed in principle with some of the olutions Obama negotiated to the problems of affordability and access in health care, or they thought that repealing those provisions would be too unpopular politically.
Likewise, Pence might have thought that expanding Medicaid for poor residents of his state was the right thing to do, or that opening a channel for more federal money to be paid to doctors and hospitals in Indiana was good politics.
Whatever the motivations, Pence, like Republicans in Congress, found a way to justify their qualified support for some of the ideas in the Affordable Care Act by making conservative modifications.
If Trump and Pence win in November, Republicans' approach to health care could be similar. Making changes while preserving the basic structure of Obamacare could allow them to claim they had fulfill their promise to repeal the act.