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

2 hours ago - World

China-Iran deal envisions massive investments from Beijing

Illustration: Aïda Amer/Axios

China and Iran have negotiated a deal that would see massive investments flow into Iran, oil flow out, and collaboration increase on defense and intelligence.

Why it matters: If the proposals become reality, Chinese cash, telecom infrastructure, railways and ports could offer new life to Iran’s sanctions-choked economy — or, critics fear, leave it inescapably beholden to Beijing.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 7 p.m. ET: 13,048,249 — Total deaths: 571,685 — Total recoveries — 7,215,865Map.
  2. U.S.: Total confirmed cases as of 7 p.m. ET: 3,353,348— Total deaths: 135,524 — Total recoveries: 1,031,856 — Total tested: 40,282,176Map.
  3. World: WHO head: There will be no return to the "old normal" for foreseeable future — Hong Kong Disneyland closing due to surge.
  4. States: Houston mayor calls for two-week shutdownCalifornia orders sweeping rollback of open businesses — Cuomo says New York will use formula to determine if reopening schools is safe.
  5. Education: Los Angeles schools' move to online learning could be a nationwide tipping point.

House Judiciary Committee releases transcript of Geoffrey Berman testimony

Geoffrey Berman. Photo: Alex Wong/Getty Images

The House Judiciary Committee on Monday released the transcript of its closed-door interview with Geoffrey Berman, the former top federal prosecutor in Manhattan who was forced out by Attorney General Bill Barr last month.

Why it matters: House Democrats have seized on Berman's testimony, in which he claimed the attorney general sought to "entice" him into resigning so that he could be replaced by SEC chairman Jay Clayton, to bolster allegations that the Justice Department has been politicized under Barr.