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Adapted from KFF; Chart: Axios Visuals 

Medicaid spending is rising even though enrollment is flat, according to the Kaiser Family Foundation’s annual survey of state Medicaid directors.

Why it matters: This is unusual. Historically, enrollment is the key driver of overall Medicaid spending, and the two have tended to rise or fall roughly in tandem.

Why it’s happening: Enrollment is flat largely because the economy is doing well. Medicaid’s rolls generally swell during a recession; low unemployment keeps the program steady.

  • Spending growth is outpacing enrollment growth because of high prescription drug costs, Kaiser says, particularly drugs to treat hepatitis and HIV.
  • Many states have also bolstered their coverage for mental health and addiction treatment services, in light of the opioid crisis.

What we’re watching: Enrollment is being pulled in both directions.

  • Red states’ embrace of work requirements will shrink their Medicaid programs.
  • But a combination of ballot initiatives and competitive governor’s races this year could bring more states into the Affordable Care Act’s Medicaid expansion, potentially causing an enrollment bump in 2019 or 2020.

Go deeper

How "naked ballots" could upend mail-in voting in Pennsylvania

Trump signs in Olyphant, Penn. Photo: Eric Baradat/AFP via Getty Images

Pennsylvania's Supreme Court ordered state officials last week to throw out mail-in ballots submitted without a required inner "secrecy" envelope in November's election, the Philadelphia Inquirer reports.

The state of play: The decision went under the radar alongside the simultaneous decision to extend the time that mail-in ballots could be counted, but Philadelphia's top elections official warned state legislators this week that throwing out so-called "naked ballots" could bring "electoral chaos" to the state and cause "tens of thousands of votes" to be thrown out — potentially tipping the presidential election.

Commission releases topics for first presidential debate

Moderator Chris Wallace. Photo: Drew Angerer/Getty Images

Fox News anchor Chris Wallace has selected what topics he'll cover while moderating the first presidential debate between President Trump and former Vice President Joe Biden next week.

What to watch: Topics for the Sept. 29 debate will include Trump and Biden's records, the Supreme Court, COVID-19, economic policy, racism and the integrity of the election, the Commission for Presidential Debates announced on Tuesday. Each topic will receive 15 minutes of conversation and will be presented in no particular order.

Fed chair warns economy will feel the weight of expired stimulus

Treasury Secretary Steven Mnuchin and Fed Chair Jay Powell bump elbows before House hearing on Tuesday. Photo: Joshua Roberts/Pool/AFP via Getty Images

Federal Reserve Chairman Jerome Powell told the House Financial Services Committee on Tuesday that the expiration of Congress' coronavirus stimulus will weigh on the U.S. economy.

Why it matters: Powell warned that the effects of dried-up benefits are a looming risk to the economy, even if the consequences aren't yet visible.

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