Sign up for our daily briefing

Make your busy days simpler with Axios AM/PM. Catch up on what's new and why it matters in just 5 minutes.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on the day's biggest business stories

Subscribe to Axios Closer for insights into the day’s business news and trends and why they matter

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Stay on top of the latest market trends

Subscribe to Axios Markets for the latest market trends and economic insights. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sports news worthy of your time

Binge on the stats and stories that drive the sports world with Axios Sports. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tech news worthy of your time

Get our smart take on technology from the Valley and D.C. with Axios Login. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Get the inside stories

Get an insider's guide to the new White House with Axios Sneak Peek. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Denver news?

Get a daily digest of the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Des Moines news?

Get a daily digest of the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Twin Cities news?

Get a daily digest of the most important stories affecting your hometown with Axios Twin Cities

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Tampa Bay news?

Get a daily digest of the most important stories affecting your hometown with Axios Tampa Bay

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Charlotte news?

Get a daily digest of the most important stories affecting your hometown with Axios Charlotte

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Nashville news?

Get a daily digest of the most important stories affecting your hometown with the Axios Nashville newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Columbus news?

Get a daily digest of the most important stories affecting your hometown with the Axios Columbus newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Dallas news?

Get a daily digest of the most important stories affecting your hometown with the Axios Dallas newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sign up for Axios NW Arkansas

Stay up-to-date on the most important and interesting stories affecting NW Arkansas, authored by local reporters

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

A Florida doctor examines a patient. Photo: J. Pat Carter / AP

Politicians often criticize Medicaid, the public health insurance program for more than 74 million Americans, as a "broken" program that needs structural and financial changes. But the people who operate state Medicaid programs say that while the program isn't perfect, it mostly functions well.

What we're hearing: Dozens of public officials, health insurance executives, providers and consultants met in Chicago on Monday at a conference run by Health Management Associates, which has become the de facto consulting shop for the Medicaid industry and includes many former Medicaid directors and federal Medicaid staff. Many were relieved the Republican plan to cut Medicaid spending failed, but they know states have to do a better job explaining how the complex programs work today.

The Republican health care plan would have slashed Medicaid funds. There's no other way to view the congressional proposals, according to state Medicaid directors. "It would be a fundamentally different program," California Medicaid Director Mari Cantwell said. "It was about cutting the Medicaid program to be something else."

Congress could still cut Medicaid. Cantwell told me her agency is "still concerned" Congress could gut federal Medicaid funds to help pay for tax reform.

States will tinker with waivers. Seema Verma, head of the federal Centers for Medicare and Medicaid Services, has helped design many conservative Medicaid waivers. Red states may feel emboldened to copy ideas like those from Indiana. However, "innovation is not going to get you what you need," Kansas Medicaid Director Mike Randol said. What will? "Delivery system reform."

Medicaid is more than just a program for low-income people. The political fights can obscure the fact Medicaid also helps vulnerable populations including kids and adults with disabilities, frail seniors, the blind, and people who are home-bound. "We have very sick people that we're taking care of and we need to spend money on," Cantwell said. "It's not a homogenous population."

Medicaid matters a lot to the people who have it. Matt Salo, head of the National Association of Medicaid Directors, said he used to get calls every week from people who were willing to pick up and move to new states if it meant Medicaid would cover their kids' conditions. "That's the kind of motivation that really speaks to the populations we serve," Salo said.

Say hello to more managed care. Medicaid agencies continue to move away from paying for every procedure or treatment. Instead, states are paying fixed amounts of money to health insurance companies to operate the programs. But privatizing Medicaid is a polarizing issue, especially among some providers. Mario Molina, who was recently ousted from his family-owned Medicaid insurer, Molina Healthcare, acknowledged that not all managed-care programs have delivered on their promises. "There's not a lot of demonstration that managed care is actually making health better, access better, health care status better," he said.

Go deeper

Poll: U.S. leadership approval rebounds from Trump low

A Gallup report published Tuesday found approval of United States leadership in 46 countries and territories hit 49% — up from 30% at the end of Donald Trump's presidency, and matching former President Obama's first year (2009).

Why it matters: Biden's efforts to reengage with the international community following the Trump administration appear to be improving the global approval ratings for U.S. leadership, though this poll does not take into account the withdrawal from Afghanistan in August.

"No-code" miracle for startups

Expand chart
Data: Interactive Advertising Bureau; Table: Axios Visuals

The U.S. has reached a tipping point in its shift from the industrial economy — one that relied on the buildout of hardware — to an information economy that relies on the transfer, storage and implementation of data, according to a new report.

Why it matters: This shift towards a data and information-based economy has allowed more businesses to establish themselves and scale quickly and at a very low cost. As such, the number of jobs created by the commercial internet has more than tripled since 2012.

Amazon's small business shield

Illustration: Aïda Amer/Axios

Amazon is touting the success of small sellers on its platform through the pandemic — and warning that antitrust legislation could jeopardize that success and blow up its open-marketplace model.

Why it matters: As online shopping became a lifeline for both businesses and consumers during the pandemic, Amazon reaped big benefits, but also saw its regulatory risk grow.