It’s the pragmatists versus the idealists in California’s latest quest for universal health care. Increasing numbers of lawmakers and advocates are pushing for policy goals that realistically can be accomplished this year. But there’s an unrelenting camp clinging to single-payer-or-bust.

The Golden State, which has been pushing back against the Trump administration on multiple fronts, is leaning toward the more incremental approach. This includes bills and budget items that would cover everything from insuring undocumented adults to preventing Medicaid work requirements and shielding the state from insurance products favored by the GOP, such as short-term plans.

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California is indeed the Golden State where Medicaid is concerned. The HHS Office of Inspector General (OIG) has found that, by exploiting Obamacare’s expansion of the program, California has enrolled hundreds of thousands of ineligible adults in Medicaid. Consequently, the state has bilked the federal government out of more than $1 billion in funding to which the state was not entitled. Indeed, these figures probably understate the amount of money that California officials have fraudulently extracted from the taxpayers. The OIG sampled a mere six-month period, from October 1, 2014 through March 31, 2015, to arrive at its damning assessment.

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The Trump administration said on Tuesday that 11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the ACA through their own marketplaces, enrollment remained the same as last year.

Ohio officials asked the Trump Administration on Friday to formally waive the Affordable Care Act individual mandate that requires residents to have health insurance, making it the first state to make such a waiver request.

Ohio’s Legislature called for the 1332 waiver last summer, and Congress zeroed out the financial penalty for not having coverage in its tax bill in December.

“The (tax) legislation zeroed out the penalty that is associated with the individual mandate … but … did not eliminate the mandate itself,” Ohio Department of Insurance Director Jillian Froment said in a March 30 letter to HHS Secretary Alex Azar. “That is why Ohio is submitting an application to waive [the mandate].”

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