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It’s Tuesday, the traditional day for elections and for our pause-and-consider newsletter on politics and policy. We think of it as a mini-magazine in your inbox.

LET’S TALK ABOUT MEDICAID
By Lisa Desjardins, @LisaDNews ([link removed])
Correspondent

Hello from just outside the chambers of House Speaker Mike Johnson.

I am waiting with a handful of other reporters as a small group of House Republicans try to work out a compromise over the party’s “One, Big, Beautiful Bill.” ([link removed]) (I am looking for a shorthand for the bill, perhaps OB3?)

Republicans do not have the votes for this — yet. But they could agree at any point in the next day or two. If not, they face a weekend standoff or the possibility of leaving for Memorial Day recess without the progress Johnson has promised.

There is much at stake here. We’d like to pull off one major piece and break down some highlights. Let’s talk about Medicaid.

The basics
* Medicaid is the federal health care program for low-income Americans.
* Close to 71.3 million Americans ([link removed]) get their health care this way.
* CHIP is the Children’s Health Insurance Program, which, along with states, provides health care for kids whose families can’t afford health care but earn too much to qualify for Medicaid.
* Nearly 7.3 million American kids ([link removed]) are enrolled in CHIP.
* Income thresholds: As this chart by the Kaiser Family Foundation shows ([link removed]) , it varies by state and can vary on whether you have children or are pregnant.
* Medicaid expansion is a program in which the federal government pays 90 percent of the cost for any state that expands Medicaid to include those making up to 138 percent of poverty. In 2025, that is $21,597 a year for individuals or $44,367 for families of four.
* 40 states (plus Washington, D.C.) ([link removed]) have Medicaid expansion.


The funding

We are about to get really nerdy.

The federal government and states share the costs of Medicaid. But the rate of federal sharing varies by state, based on a formula.

Something called FMAP, the Federal Matching Assistance Program, helps determine how much each state gets, based on the state’s average income level. These range ([link removed]) from a 50 to 77 percent match in the states.

But that match rate is just one half of the formula. The other is how much states spend. Medicaid is often the largest single expenditure for any state. The largest portion of money comes from the state’s general fund or general budget.

But states also use something called a “provider tax,” which is a fee charged on health care providers. Think nursing homes or hospitals.

Here is the thing about the provider tax. It is a system whereby states can actually profit.

Think about it this way. States charge hospitals and nursing homes a fee. They spend that fee on Medicaid, upping the amount the federal government must match. (More state spending triggers more federal match.) And then those federal dollars go back to the state and to the providers, as people get care. So states and providers don’t lose money, in theory.

But they trigger more federal matching.

Why it matters

Fiscal conservative holdouts who oppose the current “One Big Beautiful Bill” want action on these provider taxes and potentially on the FMAP level.

But the latest draft instead reforms Medicaid primarily by setting up new work requirements for “able-bodied” people, or those without disabilities, in the program. That requirement is currently set to phase in over the next two years.

Per the Congressional Budget Office ([link removed]) , this Republican Medicaid plan would lead to 8.6 million Americans losing their health insurance over the next decade.

(Changes to the Affordable Care Act would lead to millions more losing coverage, per CBO.)

Republicans argue that these are programs the United States cannot afford.

And all of it revolves around precisely how Medicaid works, and how states pay for it.
More on politics from our coverage:
* Watch: After Biden’s diagnosis, a look at how prostate cancer affects men ([link removed]) in the U.S.
* One Big Question: How has Biden’s diagnosis changed the conversation, politically speaking? NPR’s Tamara Keith and Amy Walter of the Cook Political Report with Amy Walter discuss. ([link removed])
* A Closer Look: How federal funding cuts have hit nonprofits ([link removed]) and the communities they serve.
* Perspectives: An expert on why Moody’s downgrade to the U.S. credit rating triggers warning signs for the economy. ([link removed])

A SCHOOL LIBRARIAN ON WHY SHOWCASING BANNED BOOKS IS VITAL
[link removed]

A “Little Banned Library” seen in Houston. Photo by Callaghan O'Hare/Reuters
By Rawan Elbaba, @rawanelbaba ([link removed])
Digital Producer

Christine Zirneklis, @cazzirneklis ([link removed])
Director, Communications and Partnerships for Student Reporting Labs

Librarian Pete Biddle has run a banned book club for middle and high schoolers in El Paso, Texas, for years.

In a state that has seen ongoing efforts to restrict or ban certain books ([link removed]) , Biddle says he doesn’t have a problem when a parent is concerned about a particular type of book their child is reading.

“I respect the parent’s wishes and what they believe in, but I have to draw the line when they say, ‘Well, I don’t want anybody to read this book,” he told the “On Our Minds” podcast. ([link removed]) “That’s when the problem happens.”

When he showcases banned books ([link removed]) , Biddle wants to make sure his students understand why they are challenged. He also lists statistics, such as which books are banned the most, who’s behind the complaints and why they want the books restricted. Showcasing this kind of information around book bans is vital knowledge, he said.

The state Legislature this session has debated several proposals related to what kind of materials kids access in school. Biddle pointed to Senate Bill 13, which in part would require librarians to have their book selections approved ([link removed]) by “school library advisory councils” run by parents.

“When we start doing the ‘why’ and knowing, we can start having conversations back and forth because communication is key,” he said.

Student reporters Marium Zahra and Aruja Misra joined Biddle’s banned book club at their middle school library in sixth grade. At the time, they were both nervous about fitting in. Now, as high school students, Zahra sees Biddle as an inspiring figure who encourages young people to “seek out the truth and gain new knowledge about basically anything we can.”

Biddle’s philosophy “really epitomizes why communication is so important for our library and why it has allowed our classrooms to become safe havens for us to learn,” she added.

New episodes of the “On Our Minds” podcast ([link removed]) produced by PBS News Student Reporting Labs ([link removed]) will be released every Wednesday through June 4.

Listen to the full episode ([link removed])
More on art and politics from our coverage:
* Listen: Author Viet Thanh Nguyen on the role art and education play in "abolishing the conditions of voicelessness." ([link removed])
* Watch: Kennedy Center faces a crossroads as it is pulled into partisan politics. ([link removed])
* Check Out: A little-known library and museum support agency is facing massive cuts ([link removed]) after a Trump executive order.

THIS WEEK’S TRIVIA QUESTION
By Joshua Barajas
Senior Editor, Digital

Medicaid has been a fixture in the U.S. health care system for decades.

Since it was first created in 1965 under the Social Security Act, the joint federal and state program has provided health care to a wide swath of Americans ([link removed]) – from children to adults with disabilities who couldn’t afford insurance plans on their own.

By the early 1980s, all U.S. states have opted into Medicaid to help eligible enrollees pay for health care.

Our question: Which U.S. state was the last one to opt into Medicaid?

Send your answers to [email protected] (mailto:[email protected]) or tweet using #PoliticsTrivia. The first correct answers will earn a shout-out next week.

Last week, we asked: Which U.S. president has vetoed three of the 27 reconciliation bills since 1980?

The answer: Bill Clinton. ([link removed]) Clinton vetoed his first reconciliation bill in 1995, saying at the time that the Republican-led Balanced Budget Act ([link removed]) included the “biggest Medicare and Medicaid cuts in history,” as well as rollbacks to environmental protections and a tax increase on working families. “We must balance the budget,” Clinton said ([link removed]) , “but we must do it in a way that honors the commitments that we all have and that keeps our people together.”
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