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Good morning ... If you sometimes get frustrated with works of modern art that think they're more clever than they really are, then you gotta hand it to the Serralves Museum in Portugal, where what appeared to be an artistic representation of a hole in the ground turned out to actually be an eight-foot hole in the ground. A guy even fell in.

1 big thing: Medicaid's slow and steady progress
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The Affordable Care Act has turned out to be remarkably durable, despite years of sustained political attacks and self-inflicted wounds — and that's especially true of its expansion of Medicaid.

Expansion is inching forward even in the deep red states that have so far been the biggest holdouts.

  • Nebraska's secretary of state has said he expects to certify this week that the expansion will be on the ballot this November, per AP.
  • It would be the third state with an expansion initiative on the ballot this year, along with Utah and Idaho. Montana voters will also decide whether to keep their states's expansion going past 2019.
  • If all of those initiatives pass — which, of course, isn't guaranteed — then a total of 37 states will have adopted the expansion.

Medicaid advocates are fighting — and winning — on several fronts.

  • Virginia expanded Medicaid just this year, through the normal legislative process after Democrats made significant gains in the state.
  • Advocates have picked their spots on ballot initiatives, eschewing expensive states with arduous rules and focusing on smaller states where they have a real shot at victory.

And in the courts, advocates have had some preliminary success in slowing down a push by GOP governors and the Trump administration to impose work requirements that would roll back expansion coverage.

  • A federal judge in Washington, D.C., blocked Kentucky's work requirements from taking effect earlier this summer, and a lawsuit filed last week challenges similar rules in Arkansas.
  • Gov. Matt Bevin had countersued the Kentuckians who sued to block his version of work requirements. A judge dismissed his suit yesterday — which isn't a surprise, but is still good news for expansion advocates.

The bottom line: The federal government still pays for the majority of expansion coverage, and that's an attractive deal even for a lot of Republican governors. And though work requirements could significantly roll back those coverage gains, they'll have to get through the courts first.

2. Mergers don’t lower some hospital costs

New research suggests hospitals aren't saving a lot of money on routine expenses after they merge with or acquire other hospitals, Axios’ Bob Herman reports this morning.

Why it matters: Lowering costs is one of the primary justifications hospitals give for consolidating, but this developing research indicates that argument doesn't carry a lot of weight.

By the numbers: Hospitals that were acquired in the past several years saved an average of 1.5% annually on supplies, devices and other equipment, according to the study. That equates to just a fraction of the savings that hospitals touted as a benefit of their mergers.

  • Hospitals have argued that bigger systems will have more negotiating power for the things they have to buy, which will lower costs overall.
  • Most of the savings the study identified came from reduced prices for items like spine and joint devices. But costs were not significantly lower across the board.

What they’re saying: "We view this potential 'synergies on input cost' argument much more skeptically now than going into this study," said Matt Grennan, study author and a health care management professor at the University of Pennsylvania.

3. HHS frees up ACA money for states

The Trump administration announced yesterday that it's giving $8.6 million in leftover ACA funds to states, which can use the money to strengthen their ACA marketplaces, my colleague Caitlin Owens reports.

The details: The grant money is being divided between 30 states and Washington, D.C. It can be used for things like finding new ways to expand affordable insurance options and improving access to mental health and substance abuse treatments.

Why it matters: It isn't a lot of money, but it's at least a symbolic gesture that the administration is interested in working with states to improve the individual market.

4. Hospitals see more scooter injuries

Turns out barreling down city sidewalks at 15 miles per hour on a type of device you’ve never used before may be somewhat dangerous.

“We are seeing daily injuries from users of the motorized scooters, as well as some injuries to pedestrians who were hit by riders or tripped over scooters left on sidewalks,” the medical director of the emergency room at UCLA hospital told BuzzFeed News.

  • Golden Gate Urgent Care, in San Francisco, said it “absolutely saw several people coming in to several of our centers subsequent to scooter injuries.”

There’s no way know for sure how many people are headed to the ER for a scooter-related injury, because there’s no billing code for scooters — injuries are still catalogued as pedestrian or mechanical falls.

  • But anecdotally, they seem to be causing a fair number of injuries, according to BuzzFeed, and San Francisco is taking the lead on a more comprehensive way to track those wounds.

What we're watching today: The Senate continues to debate appropriations for HHS. Medicare and Medicaid Administrator Seema Verma testifies at a Senate governmental affairs committee hearing on Medicaid fraud and overpayments.

What else is new? Let me know: baker@axios.com.