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Illustration: Aïda Amer/Axios

The fact that “Medicare for All” would eliminate Medicaid hasn’t gotten nearly as much attention as its elimination of private insurance. But it’s a move that would largely eliminate states’ role in the health care system.

Why it matters: State Medicaid programs are leaders in experimenting with delivery and payment reforms, efforts to control drug costs, and addressing social causes of ill health, such as poverty and poor housing. All of those projects would still be important in a single-payer world.

How it works: Sen. Bernie Sanders’ bill would move most Americans into its new single-payer system, including people with private insurance but also virtually all of the 73 million people covered by Medicaid and the Children’s Health Insurance Program.

Winners: States would reap huge savings. Medicaid is the single largest item in most state budgets.

  • The effects on safety-net hospitals and clinics would vary, depending largely on how payment rates under the new plan compare to today’s Medicaid rates.
  • The uninsured in states that have not expanded Medicaid also would be big winners.

Yes, but: The change would all but eliminate states’ role in health care, where they have been leaders not just in providing coverage, but also driving efficiency and testing new models of care.

  • Those reforms — and the idea of states as laboratories of reform — would pretty much disappear, and the balance of federalism in health would fundamentally change.

The bottom line: For advocates of a single national plan, eliminating the patchwork of state Medicaid programs would be progress. For fans of a federal-state balance, it’s a big problem.

  • Either way, Medicaid is a large and generally popular program, and its future at least deserves a bigger role in the debate.

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Inhofe loudly sets Trump straight on defense bill

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Senator Jim Inhofe told President Trump today he'll likely fail to get two big wishes in pending defense spending legislation, bellowing into his cellphone: "This is the only chance to get our bill passed," a source who overheard part of their conversation tells Axios.

Why it matters: Republicans are ready to test whether Trump's threats of vetoing the bill, which has passed every year for more than half a century, are empty.

Conspiracy theories blow back on Trump's White House

Sidney Powell. Photo: Tom Williams/CQ-Roll Call, Inc via Getty Images

President Trump has rarely met a conspiracy theory he doesn't like, but he and other Republicans now worry the wild tales told by lawyers Sidney Powell and Lin Wood may cost them in Georgia's Senate special elections.

Why it matters: The two are telling Georgians not to vote for Republicans David Perdue and Kelly Loeffler because of a bizarre, baseless and potentially self-defeating theory: It's not worth voting because the Chinese Communist Party has rigged the voting machines.

2 hours ago - Politics & Policy

Bolton lauds Barr for standing up to Trump

John Bolton. Photo: Jabin Botsford/The Washington Post via Getty Images

John Bolton says Attorney General Bill Barr has done more to undercut President Trump's baseless assertions about Democrats stealing the election than most Senate Republicans by saying publicly that the Justice Department has yet to see widespread fraud that could change the election's outcome.

What he's saying: “He stood up and did the right thing," Bolton said in a Wednesday phone interview.