Jun 13, 2017

Iowa's big ideas could be hard to implement

Linley Sanders / AP

Iowa's insurance regulators have some ideas for how to rescue their state's Affordable Care Act exchange — namely, by restructuring the ACA's tax credits into something a lot more similar to the House's health care bill. But it's not clear whether the federal government has the technical capacity to implement these changes, even if wanted to, or how quickly it could do so.

The IRS systems would need to make eligibility determinations using different criteria than they're using now, and pay out a different type of subsidy, as well. All for just one state, and in short order.

"Could you change the subsidy structure six months before open enrollment? My instinct would be no," said Sean Mullin, a senior director at former HHS Secretary Mike Leavitt's consulting firm.

Why it might get a hearing: Iowa's proposal is at least plausible, Mullin said — slimming down to one plan design would probably help, and these are the kinds of policy changes you'd think the Trump administration would be open to. But, he noted, other states are still waiting for answers on far more straightforward waiver requests.

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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

President Trump signed a $2.2 trillion coronavirus relief package on Friday, as infections in the U.S. topped 100,000 and more cities experience spikes of the novel coronavirus.

The big picture: The U.S. has the most COVID-19 cases in the world, exceeding China and Italy, per data from Johns Hopkins. A second wave of American cities, including Boston, Detroit, New Orleans and Philadelphia, are reporting influxes of cases.

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Italy on Friday reported 969 COVID-19 deaths over a 24-hour period, marking the deadliest single-day for the country since the global outbreak began, according to data from the Health Ministry.

The big picture: The U.S. now leads the world in confirmed coronavirus cases, as the number of global cases nears 600,000. Governments around the world are trying to curb the medical and financial fallout of COVID-19, as infections surge across Europe and the U.S.

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Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 9 p.m. ET: 595,800 — Total deaths: 27,324 — Total recoveries: 131,006.
  2. U.S.: Leads the world in cases. Total confirmed cases as of 9 p.m. ET: 103,942 — Total deaths: 1,689 — Total recoveries: 870.
  3. Federal government latest: President Trump signed the $2 trillion coronavirus stimulus bill to provide businesses and U.S. workers economic relief.
  4. State updates: Nearly 92% of cities do not have adequate medical supplies — New York is trying to nearly triple its hospital capacity in less than a month.
  5. World updates: Italy reported 969 coronavirus deaths on Friday, the country's deadliest day.
  6. Business latest: President Trump authorized the use of the Defense Production Act to direct General Motors to build ventilators for those affected by COVID-19. White House trade adviser Peter Navarro has been appointed to enforce the act.
  7. 🏰 1 Disney thing: Both Disney World and Disneyland theme parks in the U.S. are closed until further notice.
  8. What should I do? Answers about the virus from Axios expertsWhat to know about social distancing.
  9. Other resources: CDC on how to avoid the virus, what to do if you get it.

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