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Illustration: Aïda Amer/Axios

Even the most ambitious Democratic-controlled states have ended up with new health plans that are much more moderate than anything being proposed by Democratic presidential candidates — or even what was initially proposed in their states.

Why it matters: States are significantly more limited in their authority than the federal government, but the efforts of Colorado, Washington and California show just how hard massive health care disruption is.

Driving the news: Colorado state agencies last week released their final proposal for the state's public option, which is scheduled to become available in 2022.

  • While an earlier draft had proposed hospital payment rates that were between 175% and 225% of Medicare, the updated version says that each hospital's rate will be determined individually through a formula that is yet to be developed — punting the decision.
  • "Obviously, where those prices ultimately land will have a big effect ton whether this proposal actually reduces spending. If the state cannot hold the line, then the potential for this type of proposal to reduce spending evaporates," the Brookings Institution's Matthew Fielder said.
  • The proposal also relies on private insurers to offer the plan — meaning that while it's highly regulated, it is not a fully government-run plan.

The big picture: Colorado's situation — along with other states' — provides a real-world contrast with some Democrats' plans to eliminate private insurance and slash provider payment rates.

  • Washington's public option is similarly structured as a partnership with private insurers, and while it caps provider rates at 160% of Medicare, this is a higher rate than initially proposed, as the NYT reported. Like Colorado's plan, provider participation is voluntary.
  • California took a different approach, expanding eligibility for Affordable Care Act enrollees and paying for the health benefits of some unauthorized immigrants.

What they're saying: "As much as there was a whole lot of energy behind more government intervention in health care after the 2018 election, I think that energy ran smack into some practical issues," Georgetown's Sabrina Corlette said.

The bottom line: Colorado's public option "demonstrates just how much space there is between doing nothing and implementing Medicare for All when trying to increase access to insurance and reduce costs," said Avalere's Chris Sloan.

Go deeper

U.S. friends in Latin America are turning to China

Illustration: Shoshana Gordon/Axios

The U.S. is losing Latin America to China without putting up a fight, Ecuador’s ambassador to Washington told Axios, laying bare her frustrations with early inattention from the Biden administration.

Why it matters: Ecuador isn't alone. China has deepened its engagement in the region, and it's now the top trading partner for many of the region's largest economies. That gives Beijing considerable leverage in a region historically dominated by the U.S., and makes Latin America a major frontier in the global competition for influence.

1 dead, 14 injured in shooting at Kroger grocery store near Memphis

One person was killed and 14 others were injured Thursday in a shooting at a Kroger grocery store in Collierville, Tenn., near Memphis, the town's spokesperson Jennifer Casey said, per CNN.

What they're saying: "I've been involved in [police work] for 34 years and I have never seen anything like [this]," Police Chief Dale Lane said at a press conference.

3 hours ago - Health

CDC panel recommends Pfizer boosters for high-risk individuals, people 65 and up

Photo: Marco Bello/Anadolu Agency via Getty Images

A key panel at the Centers for Disease Control and Prevention on Thursday recommended the Pfizer-BioNTech coronavirus booster shots for people 65 years old and older, as well as those at high risk of severe COVID-19.

Why it matters: The approval is the near-final step in making the booster shots available to tens of millions of Americans, and comes a day after the FDA approved Pfizer boosters for the two groups. CDC director Rochelle Walensky is expected to announce her recommendation soon.