This refrain may sound familiar: If you qualify for Medicaid but you like your “Obamacare” plan, you can keep it … unless you can’t.

That’s the confusing and mixed message residents are getting from the state and insurance companies now that Louisiana has become the 31st state to expand Medicaid coverage under the Affordable Care Act.

About 375,000 people — mostly the working poor — are expected to get free health insurance coverage through the expanded program, which is mostly subsidized by the federal government.

Tens of thousands of those Louisiana residents — the total is not known — already have health insurance policies through what is called the federal marketplace, an Obamacare program that pays most of their insurance premiums.

The state says people who bought individual policies through the federal marketplace but now qualify for Medicaid under the state expansion can keep their Obamacare plans if they prefer them over Medicaid. They just have to keep paying their share of the premiums.

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The results of a recent poll conducted by the University of Southern California (USC) and the LA Times make it clear there is far from a consensus on the quality and affordability of healthcare in the Golden State. Less than half of those surveyed (44%) felt that healthcare in California was good or excellent, while a plurality (48%) felt that healthcare in the state was fair or poor.

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States that expanded Medicaid realized a 49.5 percent decline in the uninsurance rate, compared to a 33.8 percent decline in the uninsurance rate in non-expansion states since 2012, according to a Department of Health and Human Services report released today.

The department is touting the results of the study, which was conducted by its Office of the Assistant Secretary for Planning and Evaluation, as evidence that the roughly 20 states that have not yet expanded the program should do so.

“Today’s report is a clear reminder of the important role Medicaid expansion plays in improving access to quality, affordable care while addressing and improving overall health for millions of Americans,” HHS Secretary Sylvia Burwell said in a statement.

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John McCain is running for reelection like it’s 2010.

The Arizona Republican has made his opposition to Obamacare — which dominated Senate races across the country six years ago — a central point of his campaign, by all accounts, the toughest reelection fight of his career.

He’s betting that shrinking coverage options and premium increases that could go as high as 65 percent if insurers get their way will resonate with Arizona voters, even as most of his Republican colleagues running this year have moved on to other issues.

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Gov. Matt Bevin of Kentucky promised big changes were coming to Medicaid — and on Wednesday, he unveiled his plan. Bevin said the plan, “Kentucky Helping to Engage and Achieve Long Term Health” (or Kentucky HEALTH), will ensure the program’s long-term fiscal stability. Bevin’s predecessor, Steve Beshear, expanded Medicaid in Kentucky to adults making as much as 138 percent of the federal poverty level. Kentucky HEALTH is for that same population, plus all non-disabled adults currently covered under traditional Medicaid. The plan has two pathways: an employer premium assistance program and a high-deductible, consumer-driven health plan.

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The three key questions to ask of any Medicaid financing proposal that ends the open-ended federal reimbursement are: 1) what is the level of federal commitment? 2) how are the funds divided among the states? and 3) how are state incentives affected? Sensible Medicaid reform must accomplish two aims: reduce the unsustainable trajectory of federal and state Medicaid spending, and produce better outcomes for people most in need of public assistance. Although much more work needs to be done, the House task force proposal would take steps to accomplish both aims.

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Today, after years of hearings and speeches and debates, the Paul Ryan-led House of Representatives has done something it has not done before: it has released a comprehensive, 37-page proposal to reform nearly every federal health care program, including Medicare, Medicaid, and Obamacare. No proposal is perfect—and we’ll get to the Ryan plan’s imperfections—but, all in all, we would have a far better health care system with the Ryan plan than we do today.

The first thing to know about the Ryan-led plan — part of a group of proposals called “A Better Way” — is that it’s not a bill written in legislative language. Nor is it a plan that has been endorsed by every House Republican.

Instead, it’s a 37-page white paper which describes, in a fair amount of detail, a kind of “conversation starter” that House GOP leadership hopes to have with its rank-and-file members, and with the public, in order to consolidate support around a more market-based approach to health reform.

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House Speaker Paul Ryan’s policy plan for health care, as expected, leans heavily on market forces, more so than the current system created by Obamacare. The proposal contains a host of previously proposed Republican ideas on health care, many of which are designed to drive people to private insurance markets.

Importantly for conservatives, as part of a full repeal of the Affordable Care Act, the current law’s mandates for individuals and insurers would disappear under the GOP plan. It would overhaul Medicare by transitioning to a premium support system under which beneficiaries would receive a set amount to pay for coverage. The plan also would alter Medicaid by implementing either per capita caps or block grants, based on a state’s preference.

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Alaska, one of the reddest states in the country, is essentially bailing out its insurance market to prevent Obamacare from collapsing.

A bill passed by the heavily GOP state Legislature to shore up its lone surviving Obamacare insurer is awaiting the signature of Gov. Bill Walker, a Republican-turned-independent who was endorsed two years ago by former vice presidential candidate Sarah Palin. The legislation, originally proposed by Walker, sets up a $55 million fund — financed through an existing tax on all insurance companies — to subsidize enrollees’ costs as the state struggles with Obamacare price spikes and an exodus by all except one insurance company.

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The White House is urging states to be more aggressive against health insurance companies as it looks to prevent expected and widespread premium hikes of 10 percent or more this year.

The federal health department announced Wednesday that it will dole out about $22 million to boost state-level “rate reviews,” considered one of the strongest weapons against premium increases.

Under the system, health insurers are required to justify rate increases to state insurance departments, some of which have the power to reject “unreasonable” increases. With the new funding, federal health officials hope states can hire outside insurance experts to dig deeper into the proposed rates and prove the hikes are unjustified.

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