Sign up for our daily briefing

Make your busy days simpler with Axios AM/PM. Catch up on what's new and why it matters in just 5 minutes.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on the day's biggest business stories

Subscribe to Axios Closer for insights into the day’s business news and trends and why they matter

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sign up for Axios Pro Rata

Dive into the world of dealmakers across VC, PE and M&A with Axios Pro Rata. Delivered daily to your inbox by Dan Primack and Kia Kokalitcheva.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sports news worthy of your time

Binge on the stats and stories that drive the sports world with Axios Sports. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tech news worthy of your time

Get our smart take on technology from the Valley and D.C. with Axios Login. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Get the inside stories

Get an insider's guide to the new White House with Axios Sneak Peek. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Denver news?

Get a daily digest of the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Des Moines news?

Get a daily digest of the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Twin Cities news?

Get a daily digest of the most important stories affecting your hometown with Axios Twin Cities

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Tampa Bay news?

Get a daily digest of the most important stories affecting your hometown with Axios Tampa Bay

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Charlotte news?

Get a daily digest of the most important stories affecting your hometown with Axios Charlotte

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Nashville news?

Get a daily digest of the most important stories affecting your hometown with the Axios Nashville newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Columbus news?

Get a daily digest of the most important stories affecting your hometown with the Axios Columbus newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Dallas news?

Get a daily digest of the most important stories affecting your hometown with the Axios Dallas newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Austin news?

Get a daily digest of the most important stories affecting your hometown with the Axios Austin newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Atlanta news?

Get a daily digest of the most important stories affecting your hometown with the Axios Atlanta newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Philadelphia news?

Get a daily digest of the most important stories affecting your hometown with the Axios Philadelphia newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Chicago news?

Get a daily digest of the most important stories affecting your hometown with the Axios Chicago newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sign up for Axios NW Arkansas

Stay up-to-date on the most important and interesting stories affecting NW Arkansas, authored by local reporters

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top DC news?

Get a daily digest of the most important stories affecting your hometown with the Axios DC newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Senate Democrats discuss Brett Kevanaugh's nomination, in light of his views on the ACA. Photo: Tom Williams/CQ Roll Call

The Affordable Care Act may soon find itself in legal jeopardy yet again, if the tea leaves from a federal judge's hearing in Texas yesterday are any indication.

The big picture: Most on-the-ground accounts of the hearing say Judge Reed O'Connor seemed open to red states' latest challenge to the health care law, raising the prospect that what was once seen as a long-shot lawsuit could be a more serious threat than many experts had anticipated.

The details: O'Connor's questioning yesterday seemed to suggest that he "may seek to roll back at least some of the consumer protections at the core of the law," the L.A. Times' Noam Levey reports from Fort Worth.

  • "O’Connor returned repeatedly to arguments that architects of the healthcare law made in 2010 and afterward that requiring people to have insurance was crucial to the popular consumer protections in the law," Levey writes.

Between the lines: It's true that the Obama administration argued that the individual mandate and the law's protections for pre-existing conditions were legs of the same stool.

  • Now that Congress has zeroed out the penalty for being uninsured, though, Democrats argue that if Congress wants to design an unbalanced stool, that's its prerogative.
  • But O'Connor "gave only cursory treatment to the baseline question of whether the individual mandate without an accompanying penalty could stand as constitutional" and instead skipped straight ahead to questions about how much more should fall along with it, per Modern Healthcare's Susannah Luthi.

O'Connor even wondered if this might have been Republicans' endgame all along — that they zeroed out the mandate penalty secure in the knowledge that it could reopen the Supreme Court's 2012 decision upholding the mandate.

  • “Why isn’t that the proper intent to be drawn from the 2017 enactment?” O’Connor asked, according to Politico's Paul Demko.

O'Connor said yesterday that he expects to rule soon on the initial questions in Texas' lawsuit over the ACA. That's a gamble for Republican candidates in the midterm elections, especially House incumbents who are already on the hook for years of anti-ACA votes.

  • Democrats want to make this lawsuit, and its challenges to the ACA's protections for people with pre-existing conditions, a centerpiece of a midterms strategy that's focused on health care.
  • If O'Connor indicates before November that he's inclined to strike down the entire law or its most popular consumer protections, it'll be hard to brush off this case as irrelevant or to downplay Democrats' warnings — even though Texas could still lose on appeal.

The bottom line: If you're a Republican trying to dodge attacks that say you would let insurers once again deny coverage for pre-existing conditions, a pre-midterms ruling doing exactly that, in a lawsuit backed by the Trump administration, is not your ideal outcome.

  • Of course it doesn't help that, even more than eight years after the ACA became law, Republicans still don't have a competing plan to ensure that people with pre-existing conditions would be able to access coverage for those conditions.

Meanwhile, as expected, Supreme Court nominee Brett Kavanaugh said basically nothing of substance yesterday about this case or anything else related to health care.

Go deeper

NYC to impose vaccine mandate on private employers

New York City Mayor Bill de Blasio (D) announced a new COVID vaccine mandate for private companies during a Monday interview with MSNBC's "Morning Joe."

Why it matters: De Blasio said it was a "first-in-the-nation measure" and will go into effect starting Dec. 27.

D.C.-Beijing tensions are shifting markets

Illustration: Aïda Amer/Axios

U.S. markets stand to lose $2 trillion in value if D.C. and Beijing drift further apart.

Why it matters: Political chasms are showing up in new securities regulations that put companies and investors in a bind. The rules are also another reflection of how much relations between the world’s largest economies have cooled, even as they remain economically interdependent. 

4 hours ago - Health
Axios Investigates

Documents reveal the secrecy of America's drug pricing matrix

Illustration: Aïda Amer/Axios

American businesses spend hundreds of billions of dollars a year on prescription drugs, and the bills keep getting bigger. But some of the companies promising to help rein in those costs prevent employers from looking under the hood.

Why it matters: Documents provided to Axios reveal a new layer of secrecy within the maze of American drug pricing — one in which firms that manage drug coverage for hundreds of employers, representing millions of workers, obscure the details of their work and make it difficult to figure out whether they're actually providing a good deal.