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.

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Updated 1 hour ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

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  3. Politics: Trump signs 4 executive actions on coronavirus aid — Democrats slam Trump, urge GOP to return to negotiations
  4. Public health: Fauci says chances are "not great" that COVID-19 vaccine will be 98% effective — 1 in 3 Americans would decline COVID-19 vaccine.
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  6. Schools: How back-to-school is playing out in the South as coronavirus rages on — Princeton, Johns Hopkins, Howard to hold fall classes online.

Trump signs 4 executive actions on coronavirus aid

President Trump speaking during a press conference on Aug. 8. Photo: Jim Watson/AFP via Getty Images

President Trump on Saturday signed four executive actions to provide relief from economic damage sustained during the coronavirus pandemic after talks between the White House and Democratic leadership collapsed Friday afternoon.

Why it matters: Because the Constitution gives Congress the power to appropriate federal spending, Trump has limited authority to act unilaterally — and risks a legal challenge if congressional Democrats believe he has overstepped.

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Photo: Houssam Shbaro/Anadolu Agency via Getty Images

Beirut residents are still clearing rubble from streets that appear war-torn, days after a blast that shocked the country and horrified the world.

Why it matters: The explosion is likely to accelerate a painful cycle Lebanon was already living through — discontent, economic distress, and emigration.