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The Senate's health-care overhaul would quickly pull $215 billion in federal funding out of the health care system, and those cuts could later grow as high as $4 trillion, according to a new analysis from the consulting firm Avalere Health.

Why it matters: Avalere is a respected and independent voice, and because the Congressional Budget Office won't have time to completely evaluate the bill's effects before a vote, this will likely be one of the best estimates we have available.

Expand chart

Data: Avalere Health Consulting; Cartogram: Lazaro Gamio / Axios

What Avalere found: The bill, sponsored by Sens. Lindsey Graham and Bill Cassidy, would redistribute federal health care dollars while also shrinking the overall pot. Avalere's analysis looks at how the cuts would grow over time:

  • 2020-2026: Total federal spending would shrink by $215 billion; 34 states and Washington, D.C. would lose money, compared with the status quo, while seven states would get more.
  • By 2027, the total national cut would climb to $489 billion.
  • 2027-2036: Federal spending would shrink by more than $4 trillion, and every state would be getting less than they're on track to get under current law.

Key caveat: The Graham-Cassidy bill would roll federal funding for the Affordable Care Act's premium subsidies and Medicaid expansion into a single pool, then convert it into block grants to the states. Those grants are set to expire in 2026. Avalere analyzed the bill as written — with that money disappearing completely — but the bill's supporters say Congress would obviously step in to authorize a new round of grants.

Go deeper

Suspect in FedEx shooting identified as 19-year-old former FedEx employee Brandon Hole

Crime scene investigators walk through the FedEx parking lot in Indianapolis the day after a mass shooting left nine dead, including the gunman, who took his own life. Photo: Jeff Dean/AFP via Getty Images.

The suspected gunman in Thursday's mass shooting at an Indianapolis FedEx facility that left at least eight people dead and multiple others wounded, has been identified by local police as 19-year-old Brandon Hole, a former employee of FedEx, a company spokesperson Bonny Harrison told the AP.

The latest: Law enforcement has not yet uncovered the shooter's motive. Police Chief Randal Taylor said Friday morning that the warehouse employed a "significant" number of Sikhs, AP reports, and the Sikh Coalition confirmed that members of its community were among those who were injured and killed.

The legacy of Bernie Madoff

Bernie Madoff, architect of the largest Ponzi scheme in American history, died on Wednesday in federal prison, 11 years into his 150-year sentence.

Axios Re:Cap digs into Madoff’s crimes, what they revealed about America's financial system and what changed after the scheme came crashing down with Diana B. Henriques, author of the The Wizard of Lies: Bernie Madoff and the Death of Trust.

Updated 3 hours ago - World

Russia to expel 10 U.S diplomats, ban top Biden officials in response to sanctions

Photo: Alexei Druzhinin\TASS via Getty Images

Russia will expel 10 U.S. diplomats and add eight current and former U.S. officials to its no-entry list in retaliation for sanctions that the Biden administration leveled at Moscow on Friday, Russian foreign minister Sergey Lavrov said Friday.

Why it matters: The measures come after the U.S. said it would expel 10 Russian intelligence officers operating under diplomatic cover, as part of a broad package of sanctions retaliating against the SolarWinds hack of federal agencies and Russia's interference in the 2020 election.

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