ATLANTA (AP) — Georgia’s state government will for the first time run its own marketplace for individual health insurance under a law that Gov. Brian Kemp signed Tuesday.

The Republican governor said during a ceremony at the state Capitol that the law would create a better way of people “knowing and comparing their health care insurance options” and bring “further competition to the field.”

“Georgians know their needs and those of their families best,” he said.

The law is one of three big changes that could affect hundreds of thousands of Georgians who get subsidized health insurance through the state and federal government.

Kemp’s administration also plans to launch in July a partial expansion of Medicaid to insure some able-bodied adults who have incomes below the poverty line but are working or attending school. And like all states, Georgia is reviewing the eligibility of all its 2.4 Medicaid recipients as a pandemic-era rule ends that blocked the state from removing any beneficiaries.

Senate Bill 65, allowing the state marketplace, took effect with Kemp’s signature. It reverses an earlier law which blocked the state from establishing its own health care exchange. That law was part of an effort to blockade Georgia from participating in the Affordable Care Act under then-President Barack Obama. However, the federal government has been providing coverage through the Healthcare.gov website, and nearly 900,000 Georgians signed up for individual coverage during the yearly enrollment period that ended Jan. 15.

Many Georgians with incomes above the poverty line can buy the policies at little to no cost because of federal premium subsidies, although copayments can be substantial. People with higher incomes can also buy policies on the individual market.

Georgia has not embraced the Obama-era changes. Kemp continues to refuse a full Medicaid expansion without work requirements, a step that could provide insurance for hundreds of thousands. But having Insurance Commissioner John King run a marketplace aimed at Georgians dials down the total disdain state Republicans once had for the Affordable Care Act. The state has also been spending hundreds of millions to subsidize high-cost claims, a step credited with lowering premiums on the individual market and enticing more insurers to offer coverage outside metro Atlanta.

Insurance Department spokesperson Weston Burleson said Georgia officials hope to launch the state marketplace as early as this November. However, federal officials could push back Georgia’s launch date until 2024. Federal rules usually require states to spend at least 15 months constructing their own marketplace.

The state market will be different from the one Kemp originally envisioned. He had wanted to place insurance offerings in the hands of private brokers who could sell both policies offering the bundle of coverage required under the Affordable Care Act, as well as policies with lesser benefits. Those policies might have been cheaper, but Laura Colbert, the executive director of Georgians for a Healthy Future, said they would have been worse for consumers.

“That would have really rolled Georgia back to the bad old times where insurers really had the leg up on consumers, where it was incredibly hard to compare plans,” Colbert said, calling Kemp’s original plan a “non-marketplace.”

President Joe Biden’s administration balked at Kemp’s plan, and after a legal wrangle, Kemp agreed to a central state marketplace that would only sell federally approved policies.

Kemp administration officials say they’re prepared to launch the marketplace quickly because of all the work they did on the earlier proposal, on which they spent at least $31 million.

A state-based market could have some advantages, Colbert said. For example, she suggested Georgia could extend its enrollment period past the normal Nov. 15-Jan. 15 window. She also suggested offering to let people buy health insurance using their income tax refunds, and a one-stop application for Medicaid, Peach Care insurance for children and the state marketplace.

“Some state-based marketplaces have done some really innovative things. I think it’s TBD on whether Georgia will get there or not,” Colbert said.

SEATTLE (AP) — Washington Gov. Jay Inslee is calling lawmakers back to work after they rejected a bill setting out a new statewide drug policy — a development that has put the state on the brink of decriminalizing possession of fentanyl and other drugs while also depriving it of much-needed investments in public health.

Lawmakers adjourned their regular session late last month after voting down a bill that would keep drug possession illegal and boost services for people struggling with addiction. Many liberal Democrats objected to criminalizing drugs, while conservative Democrats and Republicans insisted they must be to provide incentive for people to enter treatment.

Inslee has called that unacceptable, and on Tuesday he set a special legislative session beginning May 16 to give them another chance.

“Cities and counties are eager to see a statewide policy that balances accountability and treatment, and I believe we can produce a bipartisan bill that does just that,” Inslee said.

A temporary law that makes possession of small amounts of drugs a misdemeanor expires on July 1, so if lawmakers fail to pass a bill, Washington would become the second state — after neighboring Oregon — to decriminalize drug possession. Cities and counties would be free to adopt their own approaches to drug possession and paraphernalia, creating a patchwork of laws that could undermine efforts to treat addiction as a public health issue.

Lawmakers said Tuesday they were increasingly optimistic they can reach a compromise to avoid those consequences.

“I’ve cleared my schedule,” said state Rep. Roger Goodman, D-Kirkland. “I’m working day and night on this.”

Like other states, Washington has wrestled with what to do with an overdose crisis worsened by the widespread availability of cheap, deadly fentanyl. Public drug use is rampant in cities around the state, and deaths have soared.

Several Washington cities have already contemplated or passed new drug laws in the absence of legislative action. Seattle City Attorney Ann Davison and two City Council members, Sara Nelson and Alex Pedersen, have proposed a ban on public use.

“Our hands-off approach to people using illegal drugs in public has resulted in rampant street crime and a death toll rivaling that of COVID-19 in Seattle,” Nelson said in a statement. “Complacency is no longer an option.”

The Washington Supreme Court in 2021 struck down the state law making drug possession a felony. The court said it was unconstitutional because it did not require prosecutors to prove that someone knowingly had the drugs. Washington was the only state in the country without that requirement.

In response, lawmakers that year made intentional drug possession a misdemeanor and required police to refer offenders to evaluation or treatment for their first two offenses — but there was no obvious way for officers to track how many times someone had been referred, and availability of treatment remained inadequate.

Lawmakers made the measure temporary — having it expire July 1, 2023 — to give themselves two years to come up with a long-term policy.

But as this year’s session ended late last month, a measure billed as a compromise was voted down in the Democratic-controlled House 55-43. It would have increased potential penalties for drug possession, making it a gross misdemeanor punishable by up to a year in jail, rather than a misdemeanor punishable by up to 90 days.

It also would have eliminated the requirement that police refer a person’s first two offenses for treatment rather than prosecution, enabling officers to arrest someone for a first offense if they thought it appropriate, while also encouraging police and prosecutors to divert cases. Judges could impose jail time for people who refuse treatment or repeatedly fail to comply.

It would have made clear that public health workers could not be prosecuted for giving out drug paraphernalia, such as clean glass tubes for smoking fentanyl.

And it would have included funding for drug crisis centers; a pilot program for health engagement hubs where users could access clean drug paraphernalia and connect with other services; and expanded access to withdrawal medication in jails and prisons.

Without those provisions of the bill being passed, the state’s approach to drugs amounts to “an entire diversion system with nothing to divert people to,” said Caleb Banta-Green, a research professor at the University of Washington School of Medicine.

“We need $50 million to $100 million statewide and a health engagement hub in each county, and we could cut deaths in half in a year,” he said. “We know what to do.”

Democratic and Republican lawmakers agree on the need to increase services, with many saying they have no intention of returning to the punitive approach of the war on drugs.

But Republicans objected that the bill did not do enough to ensure accountability for offenders; would preempt local bans on drug paraphernalia; and would create recovery residences where those trying to maintain sobriety might stay with those who continue to use drugs.

“I want these people to get better,” said Rep. Greg Cheney, R-Battle Ground, a lawyer with experience in drug courts, said during a floor debate last month. “But not requiring them to acknowledge they have a problem is not the right path to go.”

Many liberal Democrats, meanwhile, said they were opposed to making drug possession a crime at all. Rep. Tarra Simmons, of Bremerton, who spent time in prison on drug charges before becoming a lawyer and a lawmaker, said she was willing to vote to make it a misdemeanor as part of a compromise that would increase services.

But a gross misdemeanor is actually worse than its old status as a felony, she suggested, because the felony came with a sentencing recommendation of zero to six months for the first three offenses; the gross misdemeanor is up to a year in jail. Judges in municipal courts around the state could keep punishing those struggling with addiction, she said.

“It was really hard for me not to vote for all the good things in that bill,” Simmons said. “But we don’t need to cause people more pain in order to help them.”

WASHINGTON (AP) — Eli Lilly and Co. said Wednesday its experimental Alzheimer’s drug appeared to slow worsening of the mind-robbing disease in a large study.

In the 18-month trial, people in the early stages of Alzheimer’s who received infusions of donanemab showed 35% less decline in thinking skills compared to those given a dummy drug, Lilly announced in a press release.

The drug is designed to target and clear away a sticky protein called beta-amyloid that builds up into brain-clogging plaques that are one hallmark of Alzheimer’s.

A similar amyloid-targeting drug, Eisai and Biogen’s Leqembi, recently hit the market with similar evidence that it could modestly slow Alzheimer’s — and also some safety concerns, brain swelling or small brain bleeds.

Donanemab also comes with that risk. Lilly said in its study, the brain side effects caused the deaths of two participants and a third also died after a serious case.

The preliminary study results haven’t been vetted by outside experts. Indianapolis-based Lilly plans to release more details at an international Alzheimer’s meeting this summer and is seeking Food and Drug Administration approval of the drug.