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Expand chart
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

47 mins ago - Science

The "war on nature"

A resident stands on his roof as the Blue Ridge Fire burned back in October in Chino Hills, Calif. Photo: Jae C. Hong/AP

Apocalyptic weather is the new normal because humans are "waging war on nature," the UN declared on Wednesday.

What they're saying: "The state of the planet is broken," said UN Secretary-General António Guterres, reports AP. “This is suicidal.”

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Health: Nursing homes are still getting pummeledU.S. could hit herd immunity by end of summer 2021 if Americans embrace virus vaccines, Fauci says.
  2. Politics: Pelosi, Schumer call on McConnell to adopt bipartisan $900B stimulus framework.
  3. World: U.K. clears Pfizer-BioNTech vaccine for mass rollout — Putin says Russia will begin large-scale vaccination next week.
  4. Business: Investors are finally starting to take their money out of safe-haven Treasuries.
  5. Sports: The end of COVID’s grip on sports may be in sight.

Pelosi, Schumer call on McConnell to adopt bipartisan $900B stimulus framework

House Speaker Nancy Pelosi on Nov. 20. Photo: Drew Angerer/Getty Images

House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-N.Y.) on Wednesday urged Senate Majority Leader Mitch McConnell (R-Ky.) to use a $908 billion bipartisan coronavirus relief framework as a basis for jumpstarting negotiations.

Why it matters: The framework, introduced by a group of bipartisan senators on Tuesday, calls for significantly less funding than Pelosi had previously demanded — a sign that Democrats are ready to further compromise as millions of Americans endure economic hardship.