Illustration: Aïda Amer/Axios

Several states have made ambitious attempts to address health care costs, only to be thwarted by the hospital industry.

Why it matters: States' failures provide a warning to Washington: Even policies with bipartisan support — like ending surprise medical bills — could die at the hand of the all-powerful hospital lobby.

The big picture: Hospitals are the biggest contributor to rising health care spending, and states are on the leading edge of trying to curtail those costs.

Driving the news: Hospitals' most recent political victory came in North Carolina, where large systems were able to remain in state employees' health plan without agreeing to the state's proposed payment rates, according to the Charlotte Observer.

  • Last month, hospitals killed a California proposal to curb surprise medical bills. It would have limited how much hospitals could charge insurers for out-of-network emergency care, according to California Healthline, and hospitals said it would have given insurers too much incentive to exclude hospitals from their networks.
  • And in June, Washington state passed a law to create a public insurance option — but only after hospitals secured higher payment rates than the proposal had initially called for. The public plan's low costs wouldn't be worth much if too few providers agreed to accept it.

What we're watching: Congress and the Trump administration are trying to pull off several reforms that hospitals oppose — including price transparency measures and a federal prohibition on surprise billing that would be similar to California's.

  • And new public insurance plans are central to Democratic presidential candidates' health care plans.

The bottom line: If the state battles are any indication, all of those political battles will be difficult, if not impossible, to win.

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Updated 31 mins ago - Health

World coronavirus updates

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

New Zealand Prime Minister Jacinda Ardern said it's too early to say whether next month's elections will be postponed after she announced Tuesday four people had tested positive for COVID-19 after no local cases for 102 days.

Zoom in: NZ's most populous city, Auckland, has gone on lockdown for 72 hours and the rest of the country is under lesser restrictions.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Annelise Capossela/Axios

  1. Global: Total confirmed cases as of 8 p.m. ET: 20,188,678 — Total deaths: 738,668 — Total recoveries: 12,452,126Map.
  2. U.S.: Total confirmed cases as of 8 p.m. ET: 5,138,850 — Total deaths: 164,480 — Total recoveries: 1,714,960 — Total tests: 63,252,257Map.
  3. States: Georgia reports 137 coronavirus deaths, setting new daily record Florida reports another daily record for deaths.
  4. Health care: Trump administration buys 100 million doses of Moderna's coronavirus vaccine.
  5. Business: Moderna reveals it may not hold patent rights for vaccine.
  6. Sports: Big Ten scraps fall football season.

Voters cast ballots in Minnesota, Georgia, Connecticut, Wisconsin and Vermont

Photo: Spencer Platt/Getty Images

Primary elections are being held on Tuesday in Minnesota, Georgia, Connecticut, Vermont and Wisconsin.

The big picture: Georgia and Wisconsin both struggled to hold primaries during the coronavirus pandemic, but are doing so again — testing their voting systems ahead of the general election. Rep. Ilhan Omar (D-Minn.) is facing a strong challenger as she fights for her political career. In Georgia, a Republican primary runoff pits a QAnon supporter against a hardline conservative.