Get the latest market trends in your inbox

Stay on top of the latest market trends and economic insights with the Axios Markets newsletter. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Denver news in your inbox

Catch up on the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Des Moines news in your inbox

Catch up on the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Minneapolis-St. Paul news in your inbox

Catch up on the most important stories affecting your hometown with Axios Minneapolis-St. Paul

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tampa-St. Petersburg news in your inbox

Catch up on the most important stories affecting your hometown with Axios Tampa-St. Petersburg

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Kentucky Gov. Matt Bevin. Photo: Bill Pugliano / Getty Images

By making their Affordable Care Act marketplaces and Medicaid programs more conservative, the leaders of several red states may actually strengthen the ACA and Medicaid by creating a stronger Republican constituency for both programs.

The bottom line: As they make a series of changes — through waivers and other means — to swing the programs to the right, those state leaders are building a broader political base for the programs in red states. That could make ACA repeal and Medicaid cuts an even tougher sell in the future than it is now.

Where it stands: With the collapse of the efforts to repeal and replace the ACA, the action in health policy has shifted from Capitol Hill to the states and the Department of Health and Human Services. Disputes are erupting over policy, principle, and legal questions.

  • Idaho is one flashpoint, where the state has tried to permit insurers to offer skimpier but cheaper non-ACA compliant plans to the healthy that could push up premiums for sicker people. The federal government has stopped the state from moving ahead, while leaving the door open for it to accomplish its aims in a different way. 
  • Kentucky has been another hot zone, as the state is being sued to block its Medicaid work requirement approved under a new waiver.
  • Indiana and Arkansas are two other states with controversial waiver provisions.
  • Waivers themselves are under fire.  They are supposed to be used for research and demonstration purposes, but administrations have long pushed the boundaries of waiver authority to pursue their own policy goals.  

These changes to the ACA and Medicaid could have enormous consequences for consumers in these states. But Kentucky, Indiana, Arkansas, Idaho and Iowa have already fashioned more red-state-friendly programs, and more will follow.

Many of these red-state initiatives will have staying power as the political winds shift, but probably not all of them.  Kentucky changed directions when Gov. Matt Bevin, a Republican, replaced former Gov. Steve Beshear, a Democrat. So did Pennsylvania when Democratic Gov. Tom Wolf replaced former Gov. Tom Corbett, a Republican.

What to watch: As they come to own the changes they have made, Republican governors and legislative leaders could resist any future GOP efforts in Washington to repeal the ACA or drastically cut or change Medicaid. And they could move the opinions of donors and Republicans in their states as they talk up what they have done at home.

The impact: As the Kaiser Family Foundation reported recently, the ACA achieved its highest rating in February in our 86 tracking polls, with 54% of the public giving the ACA a favorable rating. But Republican opinion on the ACA has remained stubbornly negative, with 78% of Republicans giving the law an unfavorable rating in the same poll.

Assuming Republican state leaders want to put the best face on their changes with their voters, Republican views of the ACA could start to move in a more positive direction in Idaho, or Iowa, or in other states that may do similar things now that they believe the Trump administration will give them more leeway.  

Democrats, advocates and liberals will continue to resist red state strategies and waivers they believe are harmful. Conservatives in red states will pursue changes they want to make to the ACA and Medicaid. That is how our system works. The end result, which won't make either side happy, could well be a broader political constituency for both the ACA and Medicaid.

Go deeper

Wall Street wonders how bad it has to get

Illustration: Aïda Amer/Axios

Wall Street is working out how bad the economy will have to get for Congress to feel motivated to move on economic support.

Why it matters: A pre-Thanksgiving data dump showed more evidence of a floundering economic recovery. But the slow drip of crumbling economic data may not be enough to push Washington past a gridlock to halt the economic backslide.

2 hours ago - Health

Moderna to file for FDA emergency use authorization for COVID-19 vaccine

Photo illustration by STR/NurPhoto via Getty Images

Moderna announced that it plans to file with the FDA Monday for an emergency use authorization for its coronavirus vaccine, which the company said has an efficacy rate of 94.1%.

Why it matters: Moderna will become the second company to file for a vaccine EUA after Pfizer did the same earlier this month, potentially paving the way for the U.S. to have two COVID-19 vaccines in distribution by the end of the year. The company said its vaccine has a 100% efficacy rate against severe COVID cases.

The social media addiction bubble

Illustration: Annelise Capossela/Axios

Right now, everyone from Senate leaders to the makers of Netflix's popular "Social Dilemma" is promoting the idea that Facebook is addictive.

Yes, but: Human beings have raised fears about the addictive nature of every new media technology since the 18th century brought us the novel, yet the species has always seemed to recover its balance once the initial infatuation wears off.