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A year and a half after the Affordable Care Act brought widespread reforms to the U.S. healthcare system, Chicago's Cook County Health & Hospitals System has made its first profit in 180 years. Seven hundred miles south, the fortunes of Atlanta's primary public hospital, Grady Health System, haven't improved, and it remains as dependent as ever on philanthropy and county funding to stay afloat. The disparity between the two "safety net" hospitals, both of which serve a disproportionate share of their communities' poorest patients, illustrates a growing divide nationwide. (Respaut, 7/23)

Gov. Steve Bullock will discuss with a federal official Montana's plan to expand Medicaid that recently entered a public-comment period. The Democratic governor traveled with his health policy adviser and deputy chief of staff to Washington, D.C., Wednesday morning to meet with U.S. Secretary of Health and Human Services Sylvia Burwell .... They will discuss the premiums and copays that are expected to receive particular scrutiny before the federal government's decision to support or deny the state's waiver for expanding government-subsidized health insurance. (7/22)

They have no power to stop Gov. Bill Walker’s plan to unilaterally expand Medicaid by the end of the summer, but some members of the Legislative Budget and Audit Committee would still like to hold a meeting about it. The committee met in Anchorage on Wednesday to discuss a number of issues related to education but held a brief discussion at the end about holding a meeting on Medicaid expansion. ... Ultimately the decision rests with committee chairman Rep. Mike Hawker, an Anchorage Republican who supports Medicaid expansion. He told the committee that he asked for legal opinions on the matter and that everything confirmed the governor’s ability to act alone in expanding Medicaid. (Buxton, 7/22)

North Dakota's costs for the Medicaid expansion under the Affordable Care Act have increased since the original estimate during the 2013 legislative session. The North Dakota Department of Human Services' initial estimate of $2.9 million to $8.2 million for the 2017 fiscal year. "We knew when we prepared those estimates that it was an estimate," said Maggie Anderson, executive director of the the Department of Human Services. "You have to start somewhere." (Magee, 7/22)

Officials at Connecticut’s health insurance exchange say they’re trying to limit any coverage gaps for the 1,300 people who will no longer be eligible for Medicaid starting September 1. James Michele, director of operations at Access Health CT, said Wednesday that letters will be sent to recipients later this week, followed by robo-calls informing people about how to get replacement, private insurance coverage through the exchange. The state’s new two-year, $40.3 billion budget reduced the income levels for certain people to qualify for Medicaid. The group includes parents and caregivers of children in the HUSKY insurance program. About 18,000 more will lose coverage next year. (Haigh, 7/22)

More than 100,000 people bought private health plans through the state’s health insurance exchange for this year, but a survey of customers found that more than one in three haven’t used their coverage and more than one in four don’t have a primary care physician. (Levin Becker, 7/22)