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Evan Vucci / AP

No, they don't just want to do whatever House Republicans are putting in their Obamacare replacement plan. By the end of the National Governors Association meeting this weekend, the GOP governors were closing in on a framework for Medicaid reform to recommend to Congress, I'm told — and it goes beyond the standard Republican proposals of block grants or per-person limits on the funding.

Here's how it would work:

  • If a state that expanded Medicaid wanted to keep the expansion, and the extra federal money that goes with it, they'd have to agree to "put the state on a budget" by eventually switching to per-capita caps or block grants.
  • If they're not willing to do that, they could keep the expansion, but they'd have to do it under the regular federal matching rate — they'd stop getting the extra funds.
  • For a state that didn't expand Medicaid, but wanted to do so now, they could add coverage of childless adults up to 100 percent of the federal poverty line — not the 138 percent under Obamacare. And they, too, would have to switch to per-capita caps or block grants in the future.
  • If they're not willing to switch to per-capita caps or block grants, they could cover everyone up to 100 percent of the federal poverty line, but only with the regular matching funds.

They'd also get more flexibility to help them live within a budget — including using managed care plans, having more ways to control prescription drug spending, and requiring premium contributions.

Why we're going to hear more about this: The Republican governors made it clear to Trump that they don't want any of their residents to lose coverage, and this is how they think they can avoid that problem. But first, they'll have to draft it into enough detail to get cost estimates — and find out what happens to coverage over the long term.

Go deeper

1 hour ago - World

Netanyahu and Israel reluctantly adjust to a post-Trump Washington

Netanyahu (R) and Biden in 2010. Photo: Avi Ohayon/GPO via Getty

Prime Minister Benjamin Netanyahu and his close aides are very nervous about the transition to a new U.S. administration after a four-year honeymoon with Donald Trump. One Israeli official told me it felt like going through detox.

What he's saying: Netanyahu congratulated Biden minutes after he was sworn in, saying in a statement that he looked forward to working together to "continue expanding peace between Israel and the Arab world and to confront common challenges, chief among them the threat posed by Iran."

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. State of play: New coronavirus cases down, but more bad news ahead.
  2. Politics: Biden set to immediately ramp up federal pandemic response with 10 executive actions — Scoop: Joe Biden's COVID-19 bubble.
  3. World: Biden will order U.S. to rejoin World Health OrganizationBiden to bring U.S. into global COVAX initiative for equitable vaccine access.
  4. Vaccine: Amazon offers to help Biden administration with COVID vaccine efforts.
Dion Rabouin, author of Markets
3 hours ago - Economy & Business

First glimpse of the Biden market

Photo: Jonathan Ernst-Pool/Getty Images

Investors made clear what companies they think will be winners and which will be losers in President Joe Biden's economy on Wednesday, selling out of gun makers, pot purveyors, private prison operators and payday lenders, and buying up gambling, gaming, beer stocks and Big Tech.

What happened: Private prison operator CoreCivic and private prison REIT Geo fell by 7.8% and 4.1%, respectively, while marijuana ETF MJ dropped 2% and payday lenders World Acceptance and EZCorp each fell by more than 1%.

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