The odds are against a simple ACA stabilization bill

Why Alexander doesn’t feel better about the markets

Price's rule would boost payments for medical equipment

What happens to privacy rules in a hurricane

Pacemakers are now less likely to get hacked

Why physicians aren’t ready for Medicare payment changes

Good morning ... There's nothing easy about putting together a simple Affordable Care Act stabilization bill, as Sens. Lamar Alexander and Patty Murray are about to find out. And it looks like there's a pay boost in the works for medical equipment suppliers.

Looking for more options to help the Hurricane Harvey recovery? Here's a great list by the Texas Tribune.

What we're watching this week: Govs. John Kasich and John Hickenlooper release ACA stabilization plan. Expected late in the week.

What we're watching next week: Senate HELP Committee hearings on bipartisan ACA stabilization bill, Sept. 6 and 7; markup of Senate funding bill for HHS, dates TBD.

What we're watching in September: Senate Finance Committee hearing on CHIP reauthorization. Also, Healthcare Security Forum, sponsored by the Healthcare Information and Management Systems Society, Sept. 11-13.

The hotline is still open for tips and feedback: david@axios.com.

National

A briefcase with a red cross on the front.

mustard

Keep up with health care politics, policy and business

Axios Vitals

Lessons for the next act on health care

How Alexander and Murray will get senators on board

About those HHS advertising cuts...

The looming Tar Heel health care giant

The Kasich-Hickenlooper tradeoff

Medigap changes are coming

Thanks for reading!

Happy Friday, and this is it — my last issue of Vitals! But not to worry. I'm passing the torch to Sam Baker next week (after the holiday weekend on Tuesday), and you will be lucky to have him in your inbox every morning because he will make Vitals better, smarter, and faster.

Thanks to all of your for your time and attention, and please encourage all of your friends to sign up as Sam reboots the franchise. I'll start a broader role at Axios next week, so keep in touch and let me know what we can do better: david@axios.com.

What we're watching next week: Senate HELP Committee hearings on bipartisan ACA stabilization bill, Sept. 6 (insurance commissioners) and Sept. 7 (governors). 2017 Wells Fargo Healthcare Conference in Boston, Sept. 6-7; Senate Finance Committee hearing on CHIP reauthorization, Sept. 7; markup of Senate funding bill for HHS, dates TBD.

Also, Kasich and Hickenlooper discuss their ACA proposal at a joint American Enterprise Institute-Center for American Progress event, Sept. 8. RSVP here.

What we're watching in two weeks: Senate HELP Committee hearings on bipartisan ACA stabilization bill, Sept. 12 and 14. Also, Healthcare Security Forum, sponsored by the Healthcare Information and Management Systems Society, Sept. 11-13.

The cancer drug pricing firestorm

What Tennessee’s insurance commissioner wants

How to keep ACA stabilization narrow

Maine governor wants to call Medicaid expansion “welfare"

Medicare’s hospital data dump

Good morning ... Quick reminder that the Sam Baker era of Vitals begins next week. I'll hand off to him after Labor Day, and he'll guide you through the next big stories in health care politics, business, and technology. I'll still pop up from time to time, probably in flashbacks or maybe a dream sequence.

What we're watching today: Govs. John Kasich and John Hickenlooper are expected to release their ACA stabilization plan.

What we're watching next week: Senate HELP Committee hearings on bipartisan ACA stabilization bill, Sept. 6 and 7; 2017 Wells Fargo Healthcare Conference in Boston, Sept. 6-7; markup of Senate funding bill for HHS, dates TBD.

Let me know what we missed: david@axios.com.

No “bare counties” doesn’t mean no problems

Here’s why pharmaceutical advertising is skyrocketing

Uninsured rate falls — just a bit

Gilead’s expanding portfolio of expensive drugs

How Harvey will affect health care providers

Drug price lawsuit against CVS is dropped

Good morning, and let's start with a bit of news: It's my last week writing Vitals! Starting next week, Sam Baker will be your host. He's got that rare ability to make you smarter about health care, even the wonkiest parts, while keeping it quick, easy and fun. Vitals 2.0 will be way better, so now's the time to get all of your friends to sign up.

And don't worry, I'm not going anywhere. I'll still be editing and contributing to Vitals — while taking a broader role to work across all areas of Axios coverage. So with that, here's the health care news you need to know.

What did we miss? Lemme know: david@axios.com.

What could happen next on ACA taxes

Pharma leads profitable second quarter for health care

Why narrow networks matter in hurricanes...

...and why employers want more of them

While we were week-offing...

Good morning ... Vitals is back, and I wish we were coming back to better news. Hoping my Texas friends are safe and dry, and with power. If you're looking for ways to help, Texas Gov. Greg Abbott and city leaders say the American Red Cross is your best bet: www.redcross.org, or 1-800-RED-CROSS. (You can make a $10 donation by texting HARVEY to 90999.)

Meantime, we've got a look at why a delay in Affordable Care Act taxes is considered a must-do by industry lobbying groups, and yet there's no clear path forward.

Let me know what else is at the top of your post-Labor Day health care list: david@axios.com.

Data: Axios/Ipsos; Chart: Nicki Camberg/Axios

A substantial minority of Latino Americans disagree with Democratic policies and messaging on immigration and policing, Axios-Ipsos polling shows.

The big picture: Majorities still support Democratic policies on both issues as well as climate change. But the national survey shows the greatest friction points — with significant differences by age and backgrounds.

By the numbers: Just over half of respondents — 51% — said it's more important to help immigrants escape poverty and violence in their home countries and succeed in the U.S., while 43% said it's more important to secure America's borders and help American citizens.

On policing, 56% said it's more important to overhaul their practices and protect Black, Latino, Asian and Native Americans from unfair treatment, while 40% said it's more important to support the police and use the tactics they think are most effective.

Climate change showed a clearer alignment with Democrats: 60% said it's more important to shift to renewable energy and electric vehicles to minimize the impact of a warming world, while 37% said it's more important to protect oil and energy workers' jobs.

What we're watching: Party ID has a strong correlation with views. On immigration, 61% of Latino Democrats and 54% of independents prefer to help immigrants while 83% of Latino Republicans say it's more important to protect the border.

On policing, 70% of Democrats and 58% of independents want changes to protect people of color, while 77% of Republicans say it's more important to support the police.

Between the lines: The backstories of the poll participants mattered as well. About three-fourths of respondents of Central American origin said they cared most about helping immigrants get away from poverty and violence — by far the highest of any group by origin.

Zoom in: The poll found notable disagreements by age, with those under 50 more likely to emphasize helping immigrants escape hardship, and those over 65 placing a higher priority on securing America's borders.

On policing, six in 10 respondents ages 18-29 and 30-49 said it was more important to overhaul police tactics and protect people of color, compared with 51% of those age 50-65. 

Nearly 53% of Latinos age 65 and older said it was more important to support the police.

On climate change, respondents living in the South were narrowly split — 51% to 47% in favor of shifting to clean energy vs. protecting jobs. By contrast, respondents from the Northeast, Midwest and West heavily favored the transition to renewable energy and electric vehicles.

What they're saying: "Broadly speaking, Hispanic Americans still lean Democratic and look like they're in step with these specific Democratic policies,"  said Ipsos vice president Mallory Newall. But the poll is "a reminder that Hispanic Americans are not a monolith when it comes to these issues."

"In particular, immigration is where things become more complex, and that shows the nuance that's needed, on both sides of the aisle, when talking about these issues."

Methodology: This Axios/Ipsos Latino Poll was conducted July 21-28 by Ipsos' KnowledgePanel®. This poll is based on a nationally representative probability sample of 1,012 Hispanic/Latino adults age 18 or older.

The margin of sampling error is ±3.8 percentage points at the 95% confidence level, for results based on the entire sample.

Editor's note: The story and graphic have been corrected to refer to respondents' origin rather than "country of origin."

Axios-Ipsos poll: Latino fault lines over immigration, police

Most Latinos still support Democratic policies, but a new poll shows where the greatest friction lies.

Deep Dive - Great Hispanic Shift

A substantial minority of Latino Americans disagree with Democratic policies and messaging on <a class="gtmContentClick" data-vars-link-text="immigration" data-vars-click-url="https://www.axios.com/politics-policy/immigration" data-vars-item="in_content_link" href="https://www.axios.com/politics-policy/immigration" target="_self">immigration</a> and policing, <a class="gtmContentClick" data-vars-link-text="Axios-Ipsos polling shows." data-vars-click-url="https://www.ipsos.com/en-us/news-polls/latinos-lean-democratic-on-climate-and-safety-midterms" data-vars-item="in_content_link" href="https://www.ipsos.com/en-us/news-polls/latinos-lean-democratic-on-climate-and-safety-midterms" target="_blank">Axios-Ipsos polling shows.</a>The big picture: Majorities still support Democratic policies on both issues as well as climate change. But the national survey shows the greatest friction points — with significant differences by age and backgrounds.

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

Data: Axios/Ipsos; Chart: Jacque Schrag/Axios

Democrats thinking about moving to another state are about twice as likely to consider blue states than red or swing states — and Republicans' preference for red states over the alternatives is even more pronounced — according to the latest findings from our Axios-Ipsos Two Americas Index.

Why it matters: Ideological self-segregation may only be accelerating in these inflationary, post-Roe times. 

30% of Americans surveyed said they've thought about moving in the past six months.

Abortion rights, racial equality and LGBTQ protections were much more likely to influence Democrats' decision-making, while Republicans were more likely to be motivated by a search for lower taxes.

The big picture: Politics isn't the main reason people consider moving to another state. The biggest drivers are more likely to be economic reasons, like cost of living and jobs, or personal or family reasons, the poll found.

Black and Hispanic Americans were more likely than white Americans to say they'd been thinking of moving states.

But if people are considering a move, they're also likely to think about which states reflect their political and social values — whether through state laws or how new neighbors might view the world.

What they're saying: "For the most part, people look to be going to a safe space for them, for their ideological identity," said Ipsos pollster and senior vice president Chris Jackson.

Justin Gest, an associate professor at George Mason University who studies the politics of demographic change and advises the project, said though politics isn't usually the primary reason why people move, "People who have other reasons to locate are clearly choosing with some respect to their values. These trends are only going to continue."

By the numbers: Republicans were more likely to consider moving to red states (51%) than blue states (20%) or swing states (28%).

Democrats were more likely to consider moving to blue states (48%) than red states (25%) or swing states (27%).

More than half of Republicans (58%) and Democrats (55%) said they thought about moving to a state where the government better reflects their political and policy values, while 69% of Democrats and 65% of Republicans considered moving to a state that's a closer match with their cultural and social values.

Overall, 38% of those who considered relocating wanted to move to red states, 34% to blue states, and 28% to swing states.

Current swing-state residents thinking about moving were about evenly split among moving to a blue state, red state or another swing state.

The intrigue: Overall, 38% of respondents eyeing a move said they were interested in a state where their vote would “count” more.

Zoom in: Cost of living was the top-cited driver among respondents overall — 63% of Republicans thinking about a move and 45% of Democrats. Family, other personal reasons, jobs and taxes also were major reasons.

38% of Republicans and 23% of Democrats said tax-related concerns were driving their thoughts about wanting to move.

But, but, but:  Social issues were significant factors for Democrats, too.

For Democrats, abortion (24%), race (23%) and LGBTQ+ issues (18%) were driving concerns. That was true to a much smaller degree for Republicans (16%, 10% and 10% respectively).

About one in five Democrats and Republicans cited gun issues as contributing to their thinking.

Methodology: This Axios/Ipsos Poll was conducted July 27-28 by Ipsos on their online survey panels in English. This poll is based on a sample of 1,006 general population adults age 18 or older, weighted on age, gender, race/ethnicity, education, and location to be nationally representative.

The margin of sampling error is ±3.8 percentage points at the 95% confidence level, for results based on the entire sample of adults.

Two Americas Index: Red-blue migration

A new poll finds that ideological self-segregation may be accelerating.

Political polarization

Axios-Ipsos poll: Americans support long COVID protections

The majority favors treating it as a disability and giving stronger support to people who have it.

Deep Dive - Long COVID

Coronavirus

Most Americans think long COVID is a disability and approve of giving stronger support to people who have it, including workplace protections and free medical care, according to an <a class="gtmContentClick" data-vars-link-text="Axios-Ipsos poll" data-vars-click-url="https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index" data-vars-item="in_content_link" href="https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index" target="_blank">Axios-Ipsos poll</a>.<ul><li>And they overwhelmingly favor requiring health insurance companies to cover treatment for it.</li></ul>

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

Data: General Social Survey; Chart: Erin Davis/Axios Visuals

Most Americans in recent polls think Roe v. Wade should be upheld but have no absolute position on abortion, saying it should either be mostly legal or mostly illegal.

The big picture: Years of polling have shown that Americans recognize gray areas in a way that you'd never hear about if you just listened to the politicians and the activists.

The closest thing to a consensus view: "It depends. It's not a simple yes or no answer," said Hannah Hartig, a research associate at Pew Research Center.

Between the lines: Here's what the polls really tell us — and what to remember as emotions rise over the likelihood that the Supreme Court is about to overturn Roe v. Wade.

1) Most Americans are in the middle. In Gallup polling going back to 1975, the most common view has been that abortion should be "legal only under certain circumstances" — not that it should be "legal under any circumstances" or "illegal in all circumstances."

How broad that middle is depends on the wording of the question and how many options are provided. With Gallup, 48% said it should be legal only under certain circumstances as of May 2021.

But in a Pew Research Center survey conducted in March 2022, 71% said abortion should be legal in most cases, illegal in most cases, or legal or illegal with some exceptions.

"Most people kind of live in the gray zone," said Ipsos pollster and senior vice president Chris Jackson. 

2) But majorities still want to uphold Roe v. Wade. When asked about it specifically, 54% in a Washington Post/ABC News poll in April said Roe should be upheld, as did 63% in a Fox News poll April 28-May 1.

Both were conducted before Politico reported on the draft Supreme Court opinion that would overturn Roe.

In Gallup polling going back to 1989, majorities have opposed overturning Roe, and support for overturning it has rarely risen above a third of Americans.

3) It depends on the categories and the questions. As with many polls on other topics, pollsters have found different answers on abortion by combining different groups and wording the questions in different ways.

For example, the anti-abortion group Susan B. Anthony List released a poll of battleground states this week that found that 49% held what it defined as a "pro-life" view: 36% said abortion should be "illegal except in the case of rape, incest or a threat to the mother’s life," and 13% said it "should always be illegal."

Pro-abortion rights groups, however, point to poll findings that suggest many people who are personally against abortion don't want the government to prevent others from getting one. They cite a Washington Post/ABC News question that found 75% agreed that the decision "should be left to the woman and her doctor," compared to 20% who said it should be regulated by law.

The bottom line is "who has power and control over these decisions," said Tresa Undem, a pollster who studies public opinion on abortion.

4) Democrats have moved more than Republicans. In a recent summary of abortion polling, Ipsos noted that there wasn't a lot of difference between Democrats and Republicans in the 1970s — but there's now about a 35-point difference in support for the right to obtain a legal abortion for any reason.

One reason: a big jump in Democratic support in the past few years, according to data from the General Social Survey.

"Democrats have become more liberal in the last decade or so, while Republicans have become a little more conservative," said Jackson.

5) People are weighing multiple questions. One example: nearly half of Americans — 48% — say there are cases where abortion is morally wrong but also should be legal, according to the Pew survey.

"For most people, this isn't just a legal question. It's also a moral question," said Besheer Mohamed, a senior researcher at Pew.

Another sign, according to the Pew survey: One in three agreed that life begins at conception, "so a fetus is a person with rights" — but also said the abortion decision "should belong solely to the pregnant woman."

And in the Fox News poll — the same one that found support for upholding Roe v. Wade — 54% said they'd favor banning abortion in their state after 15 weeks except in medical emergencies. That's a scenario similar to the Mississippi law in the Supreme Court case that could overturn Roe.

"There’s a black hole of what ifs," said Undem. "The clearest sense of opinion I get is that people tend to know every situation is different and want government out of these decisions. They are also reluctant to impose their personal beliefs on other people."

6) It's too early to know the election impact. Democrats have always warned that  overturning Roe would lead to a political earthquake — but while there are some midterm races that are being closely watched, the polling doesn't suggest a huge shift yet.

An Ipsos-Reuters poll taken right after the Supreme Court decision leaked found that two thirds of Americans would be more likely to vote for a candidate who supported a law legalizing abortion if Roe is overturned.

But it also found that only a third said they'd be angry if Roe were overturned — mainly Democrats (51%) rather than independents (25%) or Republicans (24%).

Jackson noted that the actual ruling hasn't come yet and it's still early for most Americans to know what they might do about it in the midterms, or where abortion would rank in comparison to other issues like inflation. "The big question is, is that [anger] sustained ... until the election?"

Bill to protect abortion rights fails to pass Senate

Red states race to enact new abortion restrictions

Polling shows America in the middle on abortion

Americans are conflicted and recognize gray areas, even as most want to protect Roe v. Wade.

Axios Explains: Abortion

Most Americans in recent polls think Roe v. Wade should be upheld but have no absolute position on abortion, saying it should either be mostly legal or mostly illegal.The big picture: Years of polling have shown that Americans recognize gray areas in a way that you&#x27;d never hear about if you just listened to the politicians and the activists.

Axios/Ipsos poll; Chart: Jacque Schrag/Axios

Most Americans are unaware of both goals of the Federal Reserve's dual mandate: stable prices and maximum employment, according to an Axios-Ipsos poll.

Why it matters: It's not surprising that public understanding of the Fed is so low. Most people aren't economists and have lives. But these are the Fed's biggest and most difficult jobs — and the poll shows how little Americans understand or appreciate them.

By the numbers: Fewer than 1 in 10 respondents in our poll knew the Fed is supposed to maximize employment, and only about a third knew it's expected to stabilize prices.

The biggest response in both cases was "don't know" — but about four in 10 answered, incorrectly, that it's false to say the Fed is tasked with maximizing employment.

The big picture: The Fed's approval ratings are low right now, with just 28% saying it does an excellent or good job — down from 38% in March 2021.

Despite the Fed's apolitical nature, its approval ratings are affected by the political divide in the United States — with 39% of Democrats saying it does an excellent or good job, compared to just 17% of Republicans and 27% of independents.

Between the lines: "Don't know" was the most common answer to most questions in our poll. But some people who gave definitive answers assume the Fed has more power than it actually does.

For example, 49% agreed with the statement that the Fed "is responsible for the boom/bust cycles of the U.S. economy."

Nearly a quarter of Americans — 24% — said the Fed controls mortgage rates. In reality, it affects mortgage rates only indirectly.

In other cases, they underestimated the Fed's independence, with 24% saying the president can order the Fed to address inflation. In reality, he can tell the Fed to do anything he wants, but he can't force them to act.

The one Fed action a (slight) majority knew about: 51% knew it increased interest rates in March.

Methodology: This Axios/Ipsos Poll was conducted April 22–25 by Ipsos' KnowledgePanel®. This poll is based on a nationally representative probability sample of 1,015 general population adults age 18 or older.

Axios-Ipsos poll: The Fed knowledge gap

Most Americans are unaware of the Fed's dual mandate goals: stable prices and maximum employment.

Modern Money and Markets

Most Americans are unaware of both goals of the Federal Reserve&#x27;s dual mandate: stable prices and maximum employment, according to an <a class="gtmContentClick" data-vars-link-text="Axios-Ipsos poll" data-vars-click-url="https://www.ipsos.com/en-us/news-polls/Axios-Federal-Reserve-2022" data-vars-item="in_content_link" href="https://www.ipsos.com/en-us/news-polls/Axios-Federal-Reserve-2022" target="_blank">Axios-Ipsos poll</a>.Why it matters: It&#x27;s not surprising that public understanding of the Fed is so low. Most people aren&#x27;t economists and have lives. But these are the Fed&#x27;s biggest and most difficult jobs — and the poll shows how little Americans understand or appreciate them.

After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Sections

Axios Local

Axios gets you smarter, faster with news & information that matters.

About

Subscribe

David Nather

Stories

Two Americas Index: Red-blue migration

Axios-Ipsos poll: Latino fault lines over immigration, police

Polling shows America in the middle on abortion

Axios-Ipsos poll: Americans support long COVID protections

Axios-Ipsos poll: The Fed knowledge gap

Newsletter editions

Vitals - September 5, 2017

Vitals - August 4, 2017

Vitals - August 3, 2017

Vitals - August 2, 2017

Vitals - August 1, 2017