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Illustration: Aïda Amer/Axios

With legislation in Congress likely to be blocked by partisan division and interest group opposition, much of the real action in health care this year will be in the states.

The big picture: States don’t have the money or purchasing power the federal government does, but their decisions nevertheless affect millions of people, and they could signal the future of federal reform.

What to watch: Colorado and Washington are implementing public insurance options that could be a model for Democrats at the federal level.

  • Both plans would be privately administered, and would pay providers 160% of Medicare rates, or more.
  • It’s not yet clear whether they’d be open to very many people with employer-based coverage, or how many providers will accept this coverage.
  • Pennsylvania and New Jersey are taking over their Affordable Care Act marketplaces from the federal government.
  • California is embarking on an ambitious state-financed coverage expansion.

State interest in Massachusetts-like cost controls may grow, as could interest in using Medicaid to pay for non-medical services for high cost patients, as North Carolina is doing.

The other side: Idaho and other red states are promoting short-term insurance plans as an alternative to the Affordable Care Act.

  • Georgia is seeking ACA waiver plan to ditch the state’s marketplace, with consumers enrolling through insurers and web brokers, and a subsidy scheme allowing healthier consumers to choose skimpier plans that do not meet all ACA standards. 
  • Tennessee is seeking a form of per capita cap within Medicaid, with broad flexibility and favorable terms for the state.
  • Red states’ efforts to implement work requirements for Medicaid appear to be faltering in the face of adverse court decisions and opposition. But the Trump administration is still approving them.

Go deeper

Salesforce rolls the dice on Slack

Illustration: Sarah Grillo/Axios

Salesforce's likely acquisition of workplace messaging service Slack — not yet a done deal but widely anticipated to be announced Tuesday afternoon — represents a big gamble for everyone involved.

For Slack, challenged by competition from Microsoft, the bet is that a deeper-pocketed owner like Salesforce, with wide experience selling into large companies, will help the bottom line.

FBI stats show border cities are among the safest

Data: FBI, Kansas Bureau of Investigation; Note: This table includes the eight largest communities on the U.S.-Mexico border and eight other U.S. cities similar in population size and demographics; Chart: Naema Ahmed/Axios

U.S. communities along the Mexico border are among the safest in America, with some border cities holding crime rates well below the national average, FBI statistics show.

Why it matters: The latest crime data collected by the FBI from 2019 contradicts the narrative by President Trump and others that the U.S.-Mexico border is a "lawless" region suffering from violence and mayhem.

Miriam Kramer, author of Space
2 hours ago - Science

The rise of military space powers

Illustration: Aïda Amer/Axios

Nations around the world are shoring up their defensive and offensive capabilities in space — for today's wars and tomorrow's.

Why it matters: Using space as a warfighting domain opens up new avenues for technologically advanced nations to dominate their enemies. But it can also make those countries more vulnerable to attack in novel ways.