>>I thought that Medicaid money was controlled by each state in accordance with federal guidelines. I know that how Medicaid money is spent varies from state to state.

States file a formal budget request to DHS for Medicaid and other health programs. I saw quite a few requests to build on already good immunization rates mostly to improve adult immunization, but budget allocation each time was $0 for the representative sample I looked at.

In December the GOP filed a health plan paper (mostly ignored by media that seems to prefer the problematic 2017 plan) describing devolution of more healthcare funding to individual states that apparently can spend their allocation in innovative and locally appropriate ways. My view would be that insurance/funding schemes benefit from scale. A small insurer feels the heat from a Porsche crash more than a large insurer; also true for healthcare. JMHO.

>>Anyway, that's just one of the problems. Any bill that contains "omnibus", "comprehensive" or "emergency" should read "PORK BARREL" .

Yes, there's a buffet of awful behaviors that voters fail to punish. IMHO the voters would respond well to an "identify the pork barrelers" campaign, but that's not in media interests.