#it might as well just have had a page that said ‘disabled people shouldn’t participate in kink’

[boneless-mika]

Hating The New Topping Book is a lonely experience

[knowyourincantations]

Minding One’s Limits - Cho/Ginny

For Sapphic September 2019 Day 6: “Take us home.”  from @rockmarina​‘s prompt list.

G-rated | 1,548 words | EWE, Post-Hogwarts, Established Relationship, Disabled Character, Light Angst, Fluff

(AO3 | My other Sapphic September 2019 works: AO3 | Tumblr)

Minding One’s Limits

As much as Cho had been enjoying the morning, when they ducked out of the newly opened Quidditch museum to sit down for a cuppa in a nearby cafe, she almost collapsed into a chair with relief.

While Ginny went up to the counter to order for them, she let herself hunch over and grimace through the pain. The museum was larger than either of them had anticipated, and they hadn’t made it through even half of it before it was time for a rest and morning tea.

The day had started out so well, more energy than she’d felt in a while, and her pain levels delightfully low, perhaps from sheer excitement alone.

But now she felt as though a building had crumbled down on top of her.

“I got us some scones with cream and jam,” Ginny said as she neared the table again, sliding into the seat opposite Cho’s and depositing her bag over the back of her chair. “And I ordered Earl Grey for a change. They have rose petals in theirs, I thought that would be nice to try. Sound alright?”

Cho fought the weight dragging her down to sit up a little straighter and smile at her.

“Sounds lovely,” she said.

“I’m glad we went a bit further,” Ginny said, peering around the cafe. It was muggle, and only a few tables were occupied. All the places close to the museum had been packed, and the mere sight of them and the sound pouring out of them had made Cho cringe. “A week after opening and the museum is still being flooded.”

“I suppose lots of other people thought waiting a bit would be a good idea too,” Cho said, shifting in her chair to try and ease the pain in her legs.

“I still can’t believe that first exhibit,” Ginny breathed, gesturing wildly. “It hardly counts as Quidditch but the similarities are there. It predates the information in all the books on Quidditch history I’ve read. They really weren’t bluffing in their ads in the Daily Prophet, they really do have newly uncovered history found nowhere else.”

Cho nodded, drinking in Ginny’s excitement. It made her fatigue feel stronger to see her gesture so exuberantly, but she loved to see her so excited.

“I could have done without the taxidermic snidget display though,” she said, wrinkling her nose. “They could have constructed replicas. Even transfigured something, like they did for the active displays.”

The practice of using a living creature as the snitch was a dark stain on the sport’s history as far as she was concerned. And she was still trying to forget the materials used for the early Quaffles.

“I agree,” Ginny said, scrunching up her face as well. “But I suppose they’ve been sitting around in cupboards for so long they may as well be used. At least they included information about the conservation efforts going on. I didn’t realise they were still endangered.”

Cho shifted in her chair again and Ginny’s focus sharpened on her. It was on the tip of Cho’s tongue to say she was fine, but Ginny was already reaching for her bag.

“Sorry,” she muttered, digging through it. “We should have popped out for a break an hour ago. I shouldn't have let myself lose track of time.”

Under her breath, she whispered a notice-me-not charm, and then passed a pain potion over to Cho. She was always so quick to blame herself, and Cho couldn’t stand it.

“I lost track of time myself,” Cho said firmly, taking the potion and downing it. The merest fraction of her pain eased a few moments later, and her stomach sank. She’d have to switch potions again soon. “I’ve been looking forward to this for weeks.”

Ginny took the vial from her and slipped it back into her bag, then reached across the table and took her hand.

“We don’t have to see everything at once. Don’t push yourself too hard,” she said gently.

Old frustration wormed its way to the surface until Cho felt tears pricking behind her eyes. She shook her head and forced it back down. It wasn’t the time to dwell on how the things that had once been so easy were now so hard.

“I’m fine,” she said. “I’m really enjoying myself.”

It didn’t look like Ginny was buying it, but their scones and tea were brought over a moment later and she let the subject drop.

While they ate and sipped their tea, which really was lovely, Ginny kept her distracted by talking about the exhibits they’d seen. She got particularly fired up about the historic fight for the inclusion of women into the sport at all, and then the one for the end of gender segregation in teams.

Cho listened and participated less and less. By the time they finished the pot of tea, Ginny reached for her hand again.

“Time to go home?” she asked.

“No,” Cho said quickly, only realising she’d slumped when she had to fight to pick herself up.

“We really can come back another day,” Ginny said, looking concerned. “There’s so much to see, it’s better to draw it out really, otherwise it’s like an information overload.”

It made sense, but they were already so close.

“Just a bit longer?” Cho asked.

Ginny pursed her lips but nodded. She waited patiently while Cho struggled out of her chair, joints grown stiff after sitting still for so long after being on her feet for too long before sitting down. She even kept her mouth shut as Cho’s first steps were more like hobbling along than walking.

They were halfway back to the museum when the pain grew too much. Cho turned into an alley and leaned against the wall.

Ginny sighed and took her hand, giving it a gentle squeeze.

“I know this is a lot about your own expectations for yourself, but in case you’re worried, I’ve had a thoroughly lovely morning, and don’t mind at all if we go home now,” she said.

Cho closed her eyes in a grimace against shooting pains in her ankles and calves. She inhaled sharply and held her breath for a few moments.

When she exhaled, she sagged against the wall in defeat.

“Alright,” she said, squeezing Ginny’s hand in return. “Take us home.”

Ginny gently pulled her close and glanced around. Where the alley opened to the street, a few people passed by. As soon as the way was clear, Ginny Apparated them away.

When they landed in their bedroom, frustration welled up in Cho again, but she let Ginny ease her onto the bed without a fuss.

“I’ll make a hot water bottle for your ankles,” Ginny said, skimming a hand down Cho’s leg to rest on her left ankle for a moment.

Cho closed her eyes and grimaced. “I can do it myself.”

Ginny sighed and leaned over her to meet her eye. Cho looked away. She was getting too defensive, she knew. It wasn’t about Ginny, and she was lucky that Ginny knew that and didn’t get too frustrated with her.

“It’s been a long morning,” Ginny said softly. “Give yourself some credit. We saw several exhibits, and that was after waiting in line to get in. We’ll go again another day.”

“Fine,” Cho muttered. She couldn’t argue Ginny’s point, it was the longest she’d been on her feet in a long time. She should be proud of that and not let herself get wound up. It wasn’t like it was new anymore. “Can you grab the book I was reading off the arm of the sofa since you’re going that way?”

Ginny nodded and ducked down to kiss her quickly. When she left the room, Cho sagged into the bed and groaned. She let herself have a few moments before struggling up and tugging off her shoes.

It hurt to spread out her toes, but she did, rubbing at her feet and then her ankles. She may as well have not taken any pain potion at all, and made a note to look into another alternative.

When Ginny returned, she had propped herself upright against the headboard, sagging against the pillows and far more tired than she had been before they’d Apparated away. Ginny set a hot water bottle over her ankles and handed her the book.

Instead of wandering off to do something else, she clambered into the other side of the bed with a pile of information booklets they’d picked up at the museum.

Cho sat stiffly for a moment, then leaned against her side. With a soft sigh, Ginny turned and kissed the side of her head then snuggled down deeper against the pillows.

“I really am enjoying today,” Ginny said softly.

Cho stared at the open pages of her book and tried to think back to before the pain and fatigue had set in. She really had lost track of time herself, looking at exhibits and finding herself distracted enough to ignore the warning signs of reaching her limit.

“Me too,” she replied, more to herself than Ginny. It was important she didn’t forget the good parts of each day.

“I’m glad,” Ginny whispered, like it was a secret, before kissing the side of her head again.

End.

If you enjoyed reading this, please consider reblogging so others might see it too and/or leaving a comment/kudos on AO3 =)

[chasholidays]

Pls write Bellarke in Agent Carter (Bellamy as Daniel Sousa) because them bonding over being treated like shit for their gender/disability is what I live for. I would love to see dramatic Bellamy move across the country after being turned down by Clarke only to find out later that she actually was busy (but the wikia pages don't really mention it, so if you haven't seen the show, don't worry about it). (if you haven't seen it, the Agent Carter and Daniel Sousa MCU wikia pages have the best info)

The first thing Bellamy says to Clarke Griffin is, “You must be the new secretary.”

Her eyes flick up to him, barely even looking. “I must be.”

“It’s a pleasure to meet you. I’m looking forward to working with you.”

“I doubt it,” she says. “Did you need something? Copies, coffee?”

He frowns, taken aback. “No, I just wanted to introduce myself. Bellamy Blake.”

“Clarke Griffin,” she says. She’s still not looking at him. “A pleasure.”

It’s as much of a dismissal as he’s ever heard, and he’s not sure what else to say but goodbye.

He figures it out when Kane comes in and introduces her to the room at large. “Everyone, this is Clarke Griffin. Our newest special agent.”

*

It takes him a day to come up with what he wants to say to her. It was an honest mistake, but he knows from being on the receiving end of many such honest mistakes himself, he knows it’s not a comfort to hear that he had made an assumption he shouldn’t have. For every person whose mistake really was honest, there are five more who are pretending. Agent Griffin has apparently dealt with it enough that she doesn’t even bother with corrections, just lets the error slide and waits for the truth to come out on its own.

So a simple apology seems easiest. He goes to her desk and starts with, “Excuse me.”

He can see her shoulders tense, but when she sees him, she relaxes.

That’s something.

“I just wanted to apologize,” he says. “For the other day.”

“I should apologize too,” she says, to his surprise. “I should have just corrected you.”

“I assume you spent the entire morning with people who knew who you were asking you to get them coffee.”

That makes her smile. “I did. I thought everyone had heard about me by the time you showed up.”

“I’m not exactly in the loop for gossip. I heard some talk of a secretary, and nothing about the new agent.” He pauses, but then adds, “Before I lost my leg, I’d get asked if I was a janitor.”

“And after?”

He taps his crutch. “No one thinks I can do anything useful with just one leg.”

“So you’re saying all I have to do to keep people from asking me to make coffee is lose a leg?”

He lets out a surprised bark of laughter before he can stop himself, but Clarke looks pleased and a little relieved, so he doesn’t apologize. Aside from his sister and his friend Raven, he’s not sure anyone’s ever made a casual joke about his injury, and it’s amazing how nice it is.

“You could try it,” he says. “I’m sure we have someone in lockup who would be happy to take one of yours off.”

“We’ll see how many copies I have to make, but I might take you up on that.”

“I am sorry,” he says.

She shakes her head. “You don’t have to apologize. As soon as you left, one of the secretaries told me you must not know. I’m sorry for giving you the cold shoulder.”

“You has no reason to think better of me than anyone else.”

“So no one needs to apologize,” she says, with a small smile. “And we can start over.”

“Sure.” He shifts on his crutches, freeing his hand so he can offer it to her. “Bellamy Blake.”

She shakes with a firm grasp he’s sure she’s had to work on to be taken seriously. “Clarke Griffin,” she says. “Nice to meet you.”

*

“So, I guess birds of a feather really do flock together, huh, Blake? I thought you’d be happy we finally had someone more useless than you. Must be nice to not be at the bottom of the barrel.”

Bellamy takes a breath, counts to five under his breath before he says anything. He basically always wants to punch John Murphy, but it’s gotten worse in the last week. Still, the last thing Agent Griffin needs is him fighting for her honor. She can take care of herself. She wouldn’t thank him for doing it for her.

“As long as you’re around, I know I’m not at the bottom of anything, Murphy. If you were better at your job, you’d have something to do other than worry about getting a new coworker.”

“You hoping she’s going to fuck you? I don’t blame you, must be hard to find someone willing to put the effort in, but someone like her must be gagging for it.”

This time, he has to count to ten. “Sounds like you’ve put a lot more thought into this than I have. Thanks for worrying, but I think it’s probably easier if I handle my romantic life and you take handle your own.” He pauses, for effect now, instead of to get his temper in control. “Then again, with your track record, I can see why you’d want my help. Haven’t seen many people willing to put the effort into dealing with a dick like you. I mean yours,” he adds, innocent, and Murphy’s eyes flash.

But he just shakes his head. “Well, I’m rooting for you crazy kids. If two freaks can’t find happiness together, who can?”

He takes off before Bellamy can respond, which probably counts as a win for Bellamy, but it’s hard to feel good about it. It’s exhausting, spending every fucking day fighting just to prove he belongs as much as anyone else does.

It must be exhausting for Agent Griffin too, which is why he stops by her desk at the end of the day and says, “Do you want to get a drink?” Her expression clouds over, and he realizes his mistake. “Because it’s been a long week and I need a drink,” he says. “I thought you might too. My best friend works at a bar, and some other friends will be there. Ladies, as well as men.”

Her shoulders slump. “That would be lovely, yes. Why don’t you tell me where to meet you and I’ll come in an hour or so?”

“Sounds good,” he says. “I’ll see you in an hour or so.”

*

It becomes a part of their routine, Fridays spent at the bar, trading stories of who’s been awful this week, of how hard it was climbing through the ranks, trying to earn respect with limited success. They discuss the different ways they cope, Bellamy admitting his distaste for the macho posturing he participates in, Clarke admitting she sometimes wishes she could just throw a punch instead of playing it cool.

His feelings for her are inevitable, the natural evolution of how much he enjoys her company, how much he admires her, how much time they spend together and how well they get along. For all he tries to fight it, he falls hard, and for all he tells himself she’s not interested in him, he can’t help hoping. He knows that she’s still nursing a broken heart, that she lost a lover and that’s part of why she relocated. The last thing he wants is to make her think this has all been a ruse, that he’s been playing a long game, getting close to her just because he wants something.

The last thing he wants to do is lose her.

“She knows you better than that,” is what Miller tells him. “Not saying she feels the same way, hell if I know. But I think she knows you well enough that she isn’t going to think you faked everything about your relationship.”

“She knows you like her,” Raven adds. “Hell, she knows you respect her and value her as a person. Like Miller said, she might not say yes, but she’ll know you’re not just asking because you think she’s attractive. You’re attracted to her because you got to know her, you didn’t get to know her because you were attracted to her.”

“I know. Trust me, I didn’t want this to happen.” He scrubs his face. “She doesn’t have a lot of allies. I don’t want her to lose me.”

“You don’t have a lot of allies either,” Miller says. “I know how many assholes there are in your office. She’s not the only one with something to lose, so maybe even if it goes wrong, you guys could keep each other.”

He squints between Miller and Raven. “You really think this is a good idea.”

Raven shrugs. “I think you’d be happier and she would be too. Seems like it’s worth asking. I don’t think you’re going to ruin your life.”

“Thanks.” He runs his hand through his hair. “Okay. I’ll think about it. Good talk, team.”

Clarke shows up a few minutes later, sliding onto the stool next to him, smiling at him, setting his heart racing.

“Hey, sorry I’m late. Got caught up in a project. Did I miss anything?”

“Nope,” says Bellamy, returning her smile easily. “Nothing at all.”

*

The next Friday, he waits until most everyone has left and stops by Clarke’s desk. She’s on the telephone and holds up her hand, so he waits, reminding himself to not be nervous, that this isn’t a big thing. He’s just asking a question. She’ll say yes or no, and they’ll proceed from there.

“Hi, sorry,” says Clarke, looking flustered. “What’s up?”

“Everything okay?”

“It’s fine. Just following up on some cases. Drinks tonight? I probably need one.”

It’s as perfect an opening as he could ask for. “Yeah, I was going to ask, um–you want to do drinks just the two of us tonight? Somewhere a little nicer, maybe.”

For a second, her face is just frozen, but then he sees the change in it, and he knows the answer before she even opens her mouth. “Bellamy, I’m so sorry, I–”

“It’s fine,” he says. “I thought I’d ask. We can just do the usual. Miller’s working, I bet he’ll give you a free drink if you tell him how bad your day was.”

She opens and closes her mouth. “I hope so.” Her phone starts ringing again, and she winces. “Fuck, I’m sorry, I have to–”

“Go ahead. See you at the bar in a few hours?”

“Assuming my phone ever stops ringing.” She bites the corner of her mouth. “I’m sorry.”

“You don’t have anything to apologize for. See you tonight?”

“Yeah,” she says. “See you tonight.”

She sounds like she means it, but it’s six months before he sees her again.

*

In his line of work, people move. They appear and disappear without warning, off on new projects, chasing leads, sent away to where they’re most useful. It happens all the time, and everyone expects it. He knows better than to take it personally.

Still, if it had been him, he would have made time to say goodbye to Clarke before he left.

Murphy’s the one who tells him she’s back, which makes sense, given how much shit he gave Bellamy about Clarke “dumping” him when she first left. Aside from Miller and Raven, there’s no one else as invested in Bellamy’s non-relationship with Clarke as Murphy is.

“Seen your girlfriend yet?” is what he asks, and it takes Bellamy a minute to make the connection.

“I don’t have a girlfriend right now,” he says. Before, he would have made a crack about it, maybe said he didn’t know Murphy’s mother was in town, but Clarke got him thinking about the way that speaking to Murphy in his own language could be damaging to women, so he’s trying to be less combative.

Then his brain catches up with what Murphy actually said, and he nearly loses his balance. He can’t mean her. He can’t. Bellamy must just be hoping.

Murphy looks triumphant. “So, she didn’t tell you she was back. I knew it.”

“More evidence that she’s not my girlfriend. What do you want, exactly?”

“I don’t get you, Blake,” he finally says, and Bellamy shrugs on shoulder.

“The feeling is mutual. I have work to do.”

Word that Clarke is back spreads around the office and the knowledge takes up residence under Bellamy’s skin. The whole day, he’s itchy and anxious, torn between his desire to see her and his nervousness about what they are to each other. He knows it probably wasn’t personal, that she was on business, important business, that she left suddenly, without time for goodbyes, but it still hurt.

He stays late, working until he’s sure the building is empty, but of course she’s waiting for him in the lobby. She looks a little tired, like she’s had a rough few months, and his annoyance flags.

She’s probably had a worse time than he has. She probably needs a friend.

“Hi,” he says. “I heard you were back.”

“Yeah. I thought–” She worries her lip, but when he eyes meet his, they’re steady and certain. “I thought we could get dinner, and I could fill you in. If you’re still–if you want.”

“Dinner,” he repeats.

“I had a lot going on. There was–I’m not good at trusting people. But while I was gone, all I could think about was–” She smiles. “Okay, most of what I was thinking about was what I was doing and making sure I stayed alive. But I thought about you a lot too. I had this fantasy about showing up at the bar and asking if I could buy you a drink, but the timing didn’t work out. So–dinner. Since I didn’t have time for the drink.”

“Dinner would be nice,” he says, mouth a little dry. “That’s why you said no?” he can’t help adding. He’d been so ready for her to turn him down, it never occurred to him that the end of her sorry might not have been I don’t think of you like that.

“Yeah, I just–I didn’t think I had time. Until I got things figured out.”

“And they’re figured out now?”

“I hope so, yeah. Want to get dinner and hear all about it?”

“Yeah, I’d love to,” he says.

They get the drink after dinner, and Clarke tugs him down for a kiss before they part, and Bellamy will admit, she was worth the wait.

[charlesjening]

Here’s What You Missed From This Week’s Mega CPA Exam Information Webcast

I tried earlier this week to gently encourage you little shits to attend the webcast held Thursday by folks from NASBA and the AICPA who think CPA exam candidates deserve to be as informed as possible, so hopefully you took my advice and were in attendance.

Now, for those of you who had to tend to your grandmother in the hospital or simply disregarded my advice because you think I’m stupid, I tuned in and took notes so I can report back on the important bits. Don’t say I’ve never done anything for you.

Overall, there wasn’t anything particularly groundbreaking revealed during the hour-ish webcast, although there was one tidbit you might be interested in. AICPA’s Joe Maslott, who is with the Examinations team, said that while the exam is currently offered on a “window” schedule, year-round testing could be a possibility “in the future.”

So yeah, maybe those of you currently tackling the exam don’t and shouldn’t care about something that you may or may not see during your active test taking, but who knows, maybe some now-16-year-old future accountant will Google this article in the future and be informed. Or something.

One thing to note from the webcast is that the AICPA and NASBA really, REALLY want you to use the resources they’ve developed to educate yourself on exam content. Contrary to popular belief, they don’t want you to fail miserably and end up flipping burgers at Wendy’s; they do genuinely want candidates to be prepared and well-informed. That said, a viewer poll during the webcast revealed that only 11.2% of participants have accessed and thoroughly reviewed the CPA Exam Blueprints, a pretty bad-ass document that highlights just about everything you need to know.

Back in the day, candidates were stuck with the Content Specification Outlines, a behemoth chunk of information slapped into some semblance of order. As pointed out during the webcast by Pat Hartman of NASBA, the CSOs sucked pretty hard compared to the snazzy Blueprints, hence candidates should be grateful for the effort. OK, that’s not exactly what she said, but it was alluded to.

In the Blueprints you will find:

Content organized by Area, Group, and Topic along with score weighting.

Sample task statements that represent what you may be asked to do when testing.

Skill levels at which tasks are tested.

Reference materials that support the sample task statements.

Number of item types you must complete (multiple-choice questions, task-based simulations, and written communication tasks).

Score weighting of each item type.

All shit that you need if you don’t want to go into this thing completely blind. So yeah, use it. You can download the Blueprints directly from the AICPA, as well as access other candidates resources at their CPA exam information page.

One other point beaten to death like a two-legged horse was candidate preparation. I’m not talking about review, I’m talking about being prepared for exam day.

“Biggest issue we still have is people forgetting to bring their NTS [Notice to Schedule],” Hartman said.

She recommends printing the NTS out and keeping it in your wallet as soon as you receive it because you will not be able to take the exam without it.

They also touched on what is and isn’t allowed at Prometric on test day, which boils down to this: bring your pretty little behind and not much else to the exam. As always, phones and any other crap you don’t leave in your car are stored in a locker, and don’t even think about checking your phone on break or you’re going to be out on your ass and one step closer to an illustrious career in food service. An on-screen calculator is provided, but if you need a larger one due to visual issues, contact NASBA. In fact, if you need any sort of accommodation due to disability, just talk to NASBA in advance of your test date and they will make sure your Prometric test center is prepared to hook you up.

What’s the biggest takeaway from the webcast? There’s no magic order in which to take your exam sections, the AICPA doesn’t want you to fail, and candidates should use the numerous resources that have been developed with them in mind. Bam.

The post Here’s What You Missed From This Week’s Mega CPA Exam Information Webcast appeared first on Going Concern.

republished from Going Concern

[nothingman]

Nevada, with little fanfare or notice, is inching toward a massive health insurance expansion — one that would give the state’s 2.8 million residents access to a public health insurance option.

The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all Nevada residents, regardless of their income or health status.

The bill is currently sitting with Nevada Gov. Brian Sandoval, a Republican. His office did not respond to an inquiry about whether he would sign the bill or veto it.

Democrats in Washington have previously proposed a similar “Medicare for all” scheme, which would open up the public program for the elderly to Americans under 65. The idea has always fizzled out, however, due to a lack of political support.

“Medicaid for all” offers an alluring alternative to those proposals. For one, Medicaid coverage generally costs less than “Medicare for all” because the program pays doctors lower rates. This might make it a more alluring option for price-sensitive consumers worried about their monthly premium.

Because states have a large role in running Medicaid, they can move these proposals forward with less involvement of the federal government. A public option program like this has always failed at the federal level. But a liberal state such as Maryland or Connecticut — or, in this case, even a more centrist state like Nevada — might explore the option unilaterally.

This could mean that the path to a public option doesn’t run through Washington, DC. Instead, it runs right through Carson City.

Nevada’s plan to create “Medicaid for all,” explained

Nevada’s bill to allow a broader Medicaid buy-in is short, running just four pages. It would allow any state resident who lacks health insurance coverage to buy into the state Medicaid program, which would sell under the name the Nevada Care Plan.

“There is no way people can be productive members of society and take care of their families if health care is a privilege and not a right,” says state Assembly member Michael Sprinkle, who introduced the measure. “That’s really where this bill started, thinking through, how do we make health care a right in our state.”

Under his bill, people who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage instead. People who don’t qualify for anything would be able to use their own money to do the same. The plan would likely sell on Nevada’s health insurance marketplace, making it a public option to compete against the private health insurance plans also selling there.

The buy-in coverage would be pretty much identical to the coverage traditional Medicaid provides, although it would not cover emergency medical transportation (a benefit of the program tailored to the low-income population it traditionally serves).

Sprinkle (who told me his last name has led to some people calling the plan SprinkleCare) says they haven’t yet estimated how much enrolling in the Nevada Care Plan would cost individuals. The bill sponsors also have not determined whether buy-in Medicaid members would have a deductible or traditional copayments, which Medicaid typically does not have because of the low-income population it serves.

“Once the bill gets through the governor, we’re going to have a very active working group that will build off this framework to determine these things through regulation,” Sprinkle said.

Lots of advocates focus on “Medicare for all.” Why not “Medicaid for all”?

Democrats explored the possibility of a Medicare buy-in during the health care debate in 2009 and 2010. The buy-in option was relatively narrow, only allowing Americans over 55 to participate in the program. Those under the age threshold would still be limited to private health insurance plans.

Early versions of the Affordable Care Act included the buy-in provision. But the Senate was forced to drop the Medicare buy-in from its bill when it couldn’t get the entire caucus behind the idea. Health industries fought aggressively against the idea, which could disadvantage insurers by cutting into their market share.

In the wake of Trump’s election, health policy experts have begun to explore whether it might make more sense to build a national health care system around Medicaid rather than Medicare.

“Medicaid is the better fit,” Columbia University’s Michael Sparer recently wrote at the New York Times. It has a more generous benefits package, is less costly and is developing more innovative care-management strategies. Moreover, the integration of the Obamacare exchanges into Medicaid would be relatively seamless: Many health plans are already in both markets.

Medicaid and Medicare are similar programs in that they are publicly run and large, covering 62 million and 43 million Americans, respectively. They can use their large membership to negotiate lower prices with hospitals and doctors. Medicaid tends to have the lowest payment rates. On average, Medicaid pays 66 percent of what Medicare pays doctors.

In Nevada, Medicaid pays 81 percent of Medicare rates.

This has the advantage of keeping Medicaid a relatively low-cost program per person — but also the disadvantage of some doctors deciding not to accept Medicaid’s lower rates. A recent federal survey estimates that 68.9 percent of doctors are accepting new Medicaid patients, compared to 84.7 percent accepting new patients with private insurance.

Still, Medicaid enrollees generally report being relatively happy with their coverage. They look nearly identical to people with employer-sponsored coverage in surveys about how well they think their health plan works.

States have significant sway over how their health insurance programs work and whom they cover. Thirty-two states, for example, have historically participated in a Medicaid buy-in program that lets certain disabled Americans who don’t otherwise qualify for coverage pay to join the program.

States vary significantly in how much pregnant women can earn and still qualify for the program. Some states cover comprehensive dental benefits, while others cover nothing at all.

This variation is an opportunity for states that want to experiment with the public program by tacking on a buy-in option. If Nevada’s bill does become law, it will show other states how such a program might work — and if it works well, liberal states may be inclined to mimic the idea.

But the variation also makes it difficult to see Nevada serving as the start of a national public option. Yale University’s Jacob Hacker argues that while this option might work in a single state, trying to use Medicaid as the model for a national public option would mean people in different states would get significantly different coverage.

“If the argument is this will be a foundation for coverage for everyone, I think that’s questionable,” he says. “It’s going to be difficult to harmonize all the state efforts.”

Will the Trump administration get on board with “Medicaid for all”? Will a Republican governor?

One big obstacle for “Medicaid for all” in Nevada is getting key Republican officials on board.

Gov. Sandoval, a Republican, still hasn’t weighed in on the proposal, although Sprinkle says his staff have been involved in a working group around the bill.

“Anybody would look at this as groundbreaking and trendsetting, and that’s intriguing to a lot of people,” Sprinkle says. “The governor’s office and departments have been integral partners in the working group we’ve had, so that gives me a lot of optimism he’ll sign the bill.”

States that want to enroll new populations into their Medicaid programs typically need permission from the federal government. This means that the Trump administration — which has proposed slashing the Medicaid budget in half — would need to get on board with a significant expansion of the program.

That being said, the Nevada idea in theory shouldn’t expand federal costs. Individuals would be responsible for paying their own way onto the program, although it will likely be a challenge to set the right premium to ensure this outcome.

Again, Sprinkle is optimistic here. He says early conversations with the Center for Medicare and Medicaid Services have been positive, and he expects the administration to be receptive to the program.

As to whether other states might follow the Nevada example, that largely depends on what outcomes it has. If it increases coverage significantly at little cost to the government, state legislators elsewhere would likely take notice. But if it ends up covering few people or increasing government costs, Nevada could become a cautionary tale.

Or as Hacker put it, “When your lab blows up, nobody wants to repeat that experiment.”

via Vox - All