Axios

The Ohio Department of Insurance said Thursday that regional health insurer CareSource will sell Affordable Care Act plans in Paulding County in 2018. Every county in Ohio now has at least one ACA insurer after Anthem pulled out in June.

Why it matters: People in every U.S. county who buy coverage on the ACA exchanges will have at least one health insurance option for next year (assuming all insurers finalize their commitments). State insurance departments have been working all summer to fill the so-called bare ACA counties following many insurer exits.

Key quote: "Making sure coverage is available has been our goal through this process, but this is a temporary solution and one that only applies to 2018." — Ohio Department of Insurance Director Jillian Froment

President Trump has spent a good portion of his morning on Twitter — apparently browsing memes while taking a break from attacking GOP congressional leaders. A roundup of his AM missives thus far:

Iowa officials have filed a far-reaching waiver that would massively reform pieces of the Affordable Care Act in the state, the Wall Street Journal reports. This could pave the way for other states to file and implement ambitious changes to the health care law without having to wait for Congress to act.

What the waiver does:

• Creates a market with only one insurance plan.
• Makes premium subsidies flat payments tied to age and income.
• Eliminates subsidies that help low-income people with out-of-pocket costs.
• Requires consumers to prove they've maintained continuous coverage.
• Establishes a reinsurance program to help insurers with expensive enrollees.

Context: The ACA is not working well in Iowa (partially due to the state's own implementation decisions). Earlier this year, there was set to be no insurance option for 2018 in most of the state until Medica stepped in. That averted disaster, but means there is no competition in most counties. If the waiver is approved, Wellmark Blue Cross and Blue Shield will participate in the marketplace.

Medicare is the largest purchaser of health care services in the country, and over the past decade, there's been a gradual change in how those taxpayer dollars are spent, according to data from the independent Medicare Payment Advisory Commission.

Since 2006, Medicare is shifting money from physician practices and inpatient hospitals (where a person needs an overnight stay), and toward private health insurers and other companies that run the Medicare Advantage and Part D prescription drug programs. Spending also has increased in outpatient settings.