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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

Updated 4 hours ago - World

Mexican President López Obrador tests positive for coronavirus

Mexico's President Andrés Manuel López Obrador during a press conference at National Palace in Mexico City, Mexico, on Wednesday. Photo: Ismael Rosas/Eyepix Group/Barcroft Media via Getty Images

Mexican President Andrés Manuel López Obrador announced Sunday evening that he's tested positive for COVID-19.

Driving the news: López Obrador tweeted that he has mild symptoms and is receiving medical treatment. "As always, I am optimistic," he added. "We will all move forward."

4 hours ago - Politics & Policy

Sarah Huckabee Sanders to run for governor of Arkansas

Sarah Huckabee Sanders at FOX News' studios in New York City in 2019. Photo: Steven Ferdman/Getty Images

Former White House press secretary Sarah Huckabee Sanders will announce Monday that she's running for governor of Arkansas.

The big picture: Sanders was touted as a contender after it was announced she was leaving the Trump administration in June 2019. Then-President Trump tweeted he hoped she would run for governor, adding "she would be fantastic." Sanders is "seen as leader in the polls" in the Republican state, notes the Washington Post's Josh Dawsey, who first reported the news.

Coronavirus has inflamed global inequality

Illustration: Aïda Amer/Axios

History will likely remember the pandemic as the "first time since records began that inequality rose in virtually every country on earth at the same time." That's the verdict from Oxfam's inequality report covering the year 2020 — a terrible year that hit the poorest, hardest across the planet.

Why it matters: The world's poorest were already in a race against time, facing down an existential risk in the form of global climate change. The coronavirus pandemic could set global poverty reduction back as much as a full decade, according to the World Bank.

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