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Democrats were over the moon Tuesday when Maine became the first state to adopt the Affordable Care Act's Medicaid program through a ballot initiative. Buoyed by that success, advocates are already looking ahead to similar ballot measures in other states.
Reality check: There are limits to how far that strategy can take them. Some of the biggest and most politically important states on that list — the ones that would be the biggest coups for expansion supporters — are bad candidates for referendums like Maine's, according to Jonathan Schleifer, executive director of the Fairness Project, which works on progressive ballot initiatives.
The bottom line: The pro-expansion effort will largely remain a grind through state legislatures. On that front, advocates have their eyes on Kansas, North Carolina and Virginia. They're also hoping Georgia and Tennessee could come into play down the road.
As expected, Maine Gov. Paul LePage said yesterday he's not interested in implementing a Medicaid expansion, even though Tuesday's referendum means he's legally obligated to do so.
Here's what happens next, per the Bangor Daily News:
The UPMC health system in Pittsburgh said this week it will spend $2 billion to build three new, glitzy specialty hospitals that focus on treating specific diseases. But Axios' Bob Herman reports that UPMC's plan, and other similar hospital system investments, raises concerns about whether hospital organizations that hold a lot of financial and political power are wasting health care dollars to entrench their positions.
The catch: These kinds of projects can just be ways to maximize revenue, experts say — especially since UPMC will be investing in new treatments that are expensive, and since its new facilities don't necessarily match what the health care system needs.
What they're saying:
Go deeper: Read Bob's full story here.
A handful of Senate Republicans freaked out earlier this week over the Congressional Budget Office changing its view of the ACA's individual mandate — changes, Republicans feared, that would make it less attractive to repeal the mandate in a tax overhaul. CBO released its updated analysis yesterday, and the changes are … not that dramatic.
The bottom line: These updates aren't big enough to change the underlying dynamics of trying to repeal the mandate through a tax overhaul: It would still provide a lot of budgetary savings, but also would still leave millions of people without insurance.
Why now? Both of those effects — the savings to the federal government and the number of newly uninsured people — will probably get smaller in the future. CBO said it's undertaking a more comprehensive review of how it models the individual mandate, and after that process is over, the effects of repealing the mandate will likely come out "smaller than the numbers reported in this document."
Sen. Ron Johnson is planning to introduce a bill today that would bar enforcement of the ACA's employer mandate for 2015. The IRS is just now collecting penalties from employers that didn't offer health insurance to their full-time workers in 2015; Johnson's two-page bill would simply bar that collection.
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