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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's next: 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

Mike Allen, author of AM
17 mins ago - Politics & Policy

Biden's inauguration signals a great American reset

President Biden prepares to walk the abbreviated parade route in front of the White House after the inauguration. Photo: Mark Makela/Getty Images

President Biden had exited his Cadillac with the new "46" license plates and was strolling a short stretch of Pennsylvania Avenue toward his new home when he spotted "Today" show weather legend Al Roker.

The big picture: Biden dropped Jill Biden's hand — no warning — and trotted over to the delighted Roker. POTUS gave Roker a fist bump and said, "Gotta keep doing this!" It was a very Joe moment in a day that was designed to signal a return to normality in a turbulent America.

Chuck Schumer is now majority leader as 3 new Democratic senators are sworn in

Sen. Chuck Schumer (D-N.Y.) is officially Senate majority leader after the inauguration of Vice President Kamala Harris and the swearing-in of new Sens. Alex Padilla (D-Calif.), Jon Ossoff (D-Ga.) and Raphael Warnock (D-Ga.).

Why it matters: With a 50-50 Senate, Schumer will control a narrow majority with Harris as the tie-breaking vote. Democratic control of the Senate is crucial to President Biden's agenda, from getting his coronavirus relief proposal passed to forgiving student debt.

1 hour ago - Technology

QAnon faces the music

Illustration: Eniola Odetunde/Axios

Supporters of former President Donald Trump who thought he was about to stop the inauguration, seize power and crush his enemies were left blinking in the sunlight Wednesday as President Biden took the oath of office.

Why it matters: It's an inflection point for anyone who realizes they've been strung along by QAnon and related strands of pro-Trump magical thinking. They could either retreat from conspiracy theories or tumble deeper down the rabbit hole.

You’ve caught up. Now what?

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