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Photo: Joe Raedle/Getty Images

Medicaid, Medicaid, Medicaid. It hasn’t been the dominant national theme, even in an election season dominated by health care, but Medicaid has more on the line tonight than any other area of health policy.

By the numbers: 17 states haven’t adopted the Affordable Care Act’s Medicaid expansion. Three of those states — Idaho, Nebraska and Utah — have initiatives on the ballot today to expand Medicaid. And six more have gubernatorial races rated as toss-ups by the Cook Political Report. If all nine of those states ended up expanding Medicaid, more than 1.6 million people would be newly eligible for coverage, according to the Kaiser Family Foundation’s estimates.

That’s an upper bound, obviously — it’s by no means safe to assume all of these states will end up expanding. But Florida alone could cover more than 700,000 new people; the universe of possible coverage gains here is large, even without a clean sweep.

Two expansion states also face big decisions tonight.

  • Maine’s gubernatorial race could determine whether it actually implements the expansion voters approved last year.
  • Montana voters will decide whether to retain the Medicaid expansion, relying on a tobacco tax to pay for the state’s share of the costs. Tobacco companies have spent millions urging Montanans to not to renew the expansion.

The bottom line: Expanded Medicaid coverage, much of it in red or purple states, is one of the most consequential on-the-ground changes these midterms could produce.

What else we're watching:

1. The balance of power in Congress (duh).

  • Significant Democratic gains would take ACA repeal even further off the table, and would vindicate Democrats' relentless focus on health care throughout the campaign season.
  • It would also put more pressure on industry groups to get their small-but-significant lobbying priorities, like pharma's "donut hole fix," done in the lame-duck session.
  • But nothing major is likely to happen in the next 2 years.

2. California's dialysis initiative: The dialysis industry has raised a record $110 million to defeat a ballot initiative that would cap its profits.

  • Even in a state as liberal as California, cutting into the health care industry's bottom line is no easy task.

3. Other ballot initiatives:

  • Ohioans will vote on a constitutional amendment that would classify offenses related to drug possession as misdemeanors — largely in response to the state's opioid epidemic.
  • A ballot measure in Massachusetts would enforce a new ratio of nurses to patients in some hospital facilities.
  • The soda industry is spending millions to support ballot initiatives in Oregon and Washington state that would ban local governments from enacting soda taxes, as the New York Times explained. (A similar approach has already worked in California.)

Go deeper:

Go deeper

2 hours ago - World

Brazil begins distributing AstraZeneca coronavirus vaccine

Containers carrying doses of the Oxford/AstraZeneca vaccine arrive in Brazil. Photo: Maurio Pimentel/AFP via Getty Images

Brazil on Saturday began distributing the 2 million doses of the AstraZeneca coronavirus vaccine that arrived from India Friday, Reuters reports.

Why it matters: Brazil has the third highest COVID-19 case-count in the world, according to Johns Hopkins University data. The 2 million doses "only scratch the surface of the shortfall," Brazilian public health experts told the AP.

Sullivan speaks with Israel's national security adviser for the first time

Israeli national security adviser Meir Ben Shabbat U.S. Photo: Mazen Mahdi/Getty Images. U.S. national security adviser Jake Sullivan. Photo: Chandan Khanna/Getty Images

U.S. national security adviser Jake Sullivan spoke on the phone Saturday with his Israeli counterpart Meir Ben Shabbat, Israeli officials tell Axios.

Why it matters: This is the first contact between the Biden White House and Israeli prime minister's office. During the transition, the Biden team refrained from speaking to foreign governments.

Biden speaks to Mexican president about reversing Trump's "draconian immigration policies"

Mexican President Andrés Manuel López Obrador. Ismael Rosas/Eyepix Group/Barcroft Media via Getty Images

President Biden told his Mexican counterpart, Andrés Manuel López Obrador, on a phone call Friday that he plans to reverse former President Trump’s “draconian immigration policies.”

The big picture: The Biden administration has already started repealing several of Trump’s immigration policies, including ordering a 100-day freeze on deporting many unauthorized immigrants, halting work on the southern border wall, and reversing plans to exclude undocumented people from being included in the 2020 census.

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