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Illustration: Rebecca Zisser/Axios

As Democratic presidential candidates debate their ideal health care system, blue states are making incremental — yet significant — changes to the existing one.

Why it matters: In the states where they have power, Democrats are creating a blueprint for how the ACA could evolve under Democratic control in Washington.

Where it stands: California recently passed the most ambitious expansions of the ACA to date.

  • It made the ACA's premium subsidies available to middle-class people, and made undocumented children and young adult immigrants eligible for the state Medicaid program.
  • "This isn’t just the ACA warmed over. This is actually taking steps beyond it to make it better," said Peter Lee, executive director of Covered California, the state ACA exchange.

Other states have also made significant changes.

What's next: If a future Democratic president wanted something less ambitious than "Medicare for All," these reforms will provide a starting point.

The other side: Republican-led states are surging ahead on their own reforms, like adding work requirements to Medicaid.

The bottom line: "Red states and blue states are moving in very different directions on health care, taking advantage of new flexibility on the one hand and combating efforts by the Trump administration on the other," said Larry Levitt of the Kaiser Family Foundation.

Go deeper:

Go deeper

Bryan Walsh, author of Future
41 mins ago - Health

Schools face an uphill battle to reopen during the pandemic

Illustration: Aïda Amer/Axios

President Biden's plan to accelerate the reopening of K-8 schools faces major challenges from a still out-of-control pandemic and more contagious coronavirus variants.

Why it matters: The longer American kids miss in-person schooling, the further they fall behind. But the uncertain state of the science on the role young children play in the pandemic continues to complicate efforts to reopen schools.

Focus group: Former Trump voters say he should never hold office again

Illustration: Sarah Grillo/Axios

"Relief" is the top emotion some swing voters who used to support Donald Trump say they felt as they watched President Biden's swearing-in, followed by "hope."

Why it matters: For voters on the bubble between parties, this moment is less about excitement for Biden or liberal politics than exhaustion and disgust with Trump and a craving for national healing. Most said Trump should be prohibited from ever holding office again.

Updated 15 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Eniola Odetunde/Axios

  1. Health: Most vulnerable Americans aren't getting enough vaccine information — Fauci says Trump administration's lack of facts on COVID "very likely" cost lives.
  2. Politics: Biden unveils "wartime" COVID strategyBiden's COVID-19 bubble.
  3. Vaccine: Florida requiring proof of residency to get vaccine — CDC extends interval between vaccine doses for exceptional cases.
  4. World: Hong Kong to put tens of thousands on lockdown as cases surge.
  5. Sports: 2021 Tokyo Olympics hang in the balance.
  6. 🎧 Podcast: Carbon Health's CEO on unsticking the vaccine bottleneck.