Good morning … Vitals and I are celebrating our anniversary today. It’s been exactly a year since I, Axios’ 62nd employee, starting sharing this newsletter with David Nather, Axios' 9th employee. Now we’re 112 strong — just yesterday, we officially outgrew our co-working space and moved into fancy new digs of our own.
Many thanks to all of you who have been loyal readers over the past year, especially those of you who write in to point out typos or offer your thoughts on what we’re covering. Your feedback is part of what keeps this job fun. Keep it coming!
The Virginia Capitol. Photo: Tracy A. Woodward/The Washington Post via Getty Images
After fighting it for four years, Virginia will soon adopt the Affordable Care Act's Medicaid expansion. Both chambers of the state legislature passed a budget bill last night that includes the expansion, which Gov. Ralph Northam is expected to sign.
Why it matters: Virginia is a big state — the expansion could cover as many as 400,000 people.
The catch: The plan Virginia lawmakers approved yesterday would include work requirements and premiums, similar to the restrictions other states have recently adopted.
Yes, but: Other states' work requirements have stirred more controversy because those states had already expanded, and are now seeking to trim their rolls.
Axios' Caitlin Owens notes a positive development in the opioid crisis: Doctors are increasingly using prescription drug monitoring programs — databases that track patients' drug history — in an effort to cut down on inappropriate prescriptions.
By the numbers:
What's next: The AMA says policymakers need to focus on stubborn barriers to treatment, including insurance coverage issues.
A few pieces of news out of President Trump’s comments yesterday during the Right to Try Act bill signing:
On drug prices: “Some of the big drug companies, in two weeks … because of what we did, they're going to announce voluntary massive drops in prices,” Trump said.
On the ACA: “We're going to have another exciting news conference over the next, what, three weeks? Four weeks? Two weeks? What do you think?” he said to HHS Secretary Alex Azar. “On health care. We're going to have great health care.”
On right to try: “Each year, thousands of terminally ill patients suffer while waiting for new and experimental drugs to receive final FDA approval ... And for countless patients, time, it's not what they have. They don't have an abundance of time.”
Health insurer Aetna and physician staffing firm Mednax are at each other's throats in federal court, accusing each other of using fraudulent or nefarious practices to boost profits — at the expense of sick infants.
The details, via my colleague Bob Herman:
What they're saying:
Between the lines: Both sides have some history to stand on, Bob notes. Upcoding is a major problem among providers, but there have also been instances of insurers pressuring doctors to reduce medical claims.
You didn't expect to hear the Trump administration accused of tough ACA enforcement, right? But a group of business associations says it's relying on an "unlawful and deeply flawed process" to enforce the ACA's employer mandate.
The issue: The IRS has begun sending out notices to businesses that it believes owe fines for failing to comply with the mandate. The tax agency has said some 30,000 employers are on the hook for a total of roughly $4.3 billion in fines.
The other side: A coalition of employer groups, including the National Restaurant Association and the National Retail Federation, say the administration is breaking the rules.
Axios sat down with leaders on both sides of the abortion-rights debate to talk about what's on the line in this year's midterms and thereafter.
What they're saying:
Correction: Yesterday's Vitals misstated the number of states that have not expanded Medicaid eligibility.
What else am I doing wrong? I'm a glutton for punishment so feel free to pile on: firstname.lastname@example.org.