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.

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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: Tory Lysik/Axios

About one in three Americans prefers strong unelected leaders to weak elected leaders and says presidents should be able to remove judges over their decisions, according to the latest findings from our Axios-Ipsos Two Americas Index.

Why it matters: The findings from this poll shatter the myth that Americans overwhelmingly agree on a common set of democratic values around checks and balances on elected leaders, protection of minority rights and freedom of speech.

They're also a reality check against President Biden's speech that portrayed threats to democracy as solely driven by Republican supporters of former President Trump who refuse to accept that he lost the 2020 election.

What we're watching: In this poll, significant minorities of Republicans and Democrats supported non-democratic norms in about equal percentages — and Democrats were more likely than Republicans to say presidents should be able to remove judges when their decisions go against the national interest.

Many Americans also believe the government should follow the will of the majority even at the expense of ethnic and religious minority groups' civil rights.

And roughly a third said the federal government should be able to prosecute members of the news media who make offensive or unpatriotic statements.

Respondents younger than 35 or with household incomes below $75,000 a year were more likely to favor strong unelected leaders and to support prosecuting the media or empowering presidents to remove judges.  

The big picture: If you're looking for good news in this poll, it is primarily that the people who embrace the anti-democratic views are still in the minority. 

But the findings are a reminder that for all of the attention and congressional hearings around the Jan. 6 Capitol riot, anti-democratic views take many forms.

What they're saying: "There's a lot of anti-democratic sentiment, a lot more than we might have expected," said Justin Gest, an associate professor at George Mason University who studies the politics of demographic change and advises the project.

The survey's questions pose "hard tests" for society, Gest said — tradeoffs between "what's expedient and best for the individual, and what actually sustains the integrity of our political institutions."

Values like minority rights, separation of church and state and freedom of the press are "key foundations" of democracy but "they're far from being fully supported by Americans," Gest said. "These are things you'd think would be universal."

By the numbers: One in three surveyed agreed that it's better to have a strong, unelected leader than a weak elected leader — with a larger share of Republicans (42%) than Democrats (31%) sharing that view.

With judges, it was Democrats who outnumbered Republicans: 42% of Democrats agreed that the president should be able to remove judges when their decisions go against the national interest, compared to 29% of Republicans and 35% overall. That may reflect the conservative majority on the Supreme Court, and its decision earlier this year overturning Roe v Wade.

More than a third of Americans (38%) agreed that the government should act in the interests of the majority even if it conflicts with ethnic and religious minority groups' rights, with Republicans (39%) and Democrats (38%) agreeing at roughly the same rate. The question doesn't specify which ethnic or religious minorities.

28% said the government should consult religious leaders before making decisions — including 33% of Republicans and 24% of Democrats — while 57% disagreed.

A third of Americans — 34% among both Republicans and Democrats — said the federal government should have the power to prosecute members of the news media who make offensive or unpatriotic statements. A slight majority (51%) disagreed.

Methodology: This Axios/Ipsos Poll was conducted Sept. 1-2 by Ipsos on their online survey panels in English. This poll is based on a sample of 1,001 general population adults age 18 or older, weighted on age, gender, race/ethnicity, education, and location to be nationally representative.

The credibility interval is ±3.8 percentage points for results based on the entire sample of adults.

Two Americas Index: Democracy deniers

The new poll suggests a large minority of Americans is willing to get rid of basic democratic norms.

Political polarization

Two Americas Index: Red-blue migration

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

Democrats thinking about moving to another state are about twice as likely to consider blue states than red or swing states — and Republicans&#x27; preference for red states over the alternatives is even more pronounced — according to the latest findings from our <a class="gtmContentClick" data-vars-link-text="Axios-Ipsos Two Americas Index" data-vars-click-url="https://www.ipsos.com/en-us/news-polls/axios-ipsos-two-americas-index" data-vars-item="in_content_link" href="https://www.ipsos.com/en-us/news-polls/axios-ipsos-two-americas-index" target="_blank">Axios-Ipsos Two Americas Index</a>.Why it matters: Ideological self-segregation may only be accelerating in these inflationary, post-Roe times.

Note: Respondents could choose up to two answers out of 10 options. Data: Axios/Ipsos Poll; Chart: Jared Whalen/Axios

Americans' most common worry if Democrats keep control of Congress is the economy worsening, while concerns about a GOP takeover are more divided, according to an Axios-Ipsos poll.

Why it matters: If the economy and inflation are on voters' minds more than other issues come November, the burden will fall on President Biden and his party.

It will likely be easier for Republicans to mobilize voters around those concerns than for Democrats to focus on any particular case against Republican control.

Americans' concerns about Republicans are divided among the economy, President Biden being blocked from getting things done, and too much focus on divisive social issues and election conspiracy theories.

What they're saying: "The economy remains the single biggest issue facing the country. That puts added pressure on the Democrats and President Biden for what happens with the economy," said Ipsos vice president Mallory Newall.

"If things get worse, the public will hold them accountable."

Another warning sign for Democrats, according to Ipsos senior vice president Chris Jackson: "Democratic support for Democrats is pretty tepid, whereas Republican opposition to Democrats is solid."

Between the lines: Overall, voters aren't significantly more worried about Democrats keeping control of Congress or Republicans winning it. What worries them most is a divided government, which could happen if Republicans win the House but Democrats keep the Senate.

53% say they would be worried about one party controlling the Senate and the other controlling the House.

By contrast, 49% said they'd be worried about Democrats keeping control of Congress, while 46% said they'd be worried if Republicans win both the Senate and the House.

If Democrats keep control of Congress, more than four in 10 respondents — 43% — said they'd be worried about the economy or inflation getting worse

That's largely driven by Republicans (64%), but 38% of independents share that concern.

By comparison, just 18% worry that Democrats would spend too much time investigating former President Trump; 18% fear there would be no checks on Biden's power; and 16% are concerned that Americans' confidence in government would decline. 

If Republicans gain control, people would have several concerns of roughly equal weight:

24% say they're concerned that the economy or inflation could get worse, while 23% worry that Biden won't be able to get anything done.

21% are concerned Republicans would spend too much time on divisive social issues — which likely reflects a concern about abortion, according to Newall. (13% raised that concern about Democrats if they keep control.)

In addition, 19% worry that political violence will increase if Republicans win Congress. 18% say Trump's claims of election fraud could gain more traction, and 17% say Americans' confidence in the government could decline.

Methodology: This Axios/Ipsos Poll was conducted Sept. 23-26 with a national sample of 1,004 general population adults age 18 or older, randomly drawn from Ipsos' online panel, partner online panel sources and "river" sampling.

The poll has a credibility interval of ±3.8 percentage points for results based on the entire sample of adults.

Axios/Ipsos poll: Midterms warning for Democrats

Many Americans worry that the economy could get worse if they keep control of Congress.

Deep Dive - 2022 midterms

Americans&#x27; most common worry if Democrats keep control of Congress is the economy worsening, while concerns about a GOP takeover are more divided, 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/americans-worried-midterms-could-bring-divided-government-gridlock" data-vars-item="in_content_link" href="https://www.ipsos.com/en-us/news-polls/americans-worried-midterms-could-bring-divided-government-gridlock" target="_blank">Axios-Ipsos poll</a>.Why it matters: If the economy and inflation are on voters&#x27; minds more than other issues come November, the burden will fall on President Biden and his party.

More than 200 election deniers — candidates promoting baseless claims that the 2020 election was stolen from former President Trump — will appear on November general election ballots across the U.S.

Why it matters: Those who win will gain footing to affect future elections including the 2024 presidential race — through court challenges, administrative actions, executive orders, legislation, radical interpretation of law or the refusal to certify valid results, elections experts tell Axios.

Here's how the following offices could matter if they're won by election deniers.

Secretaries of state — They matter because they're the chief election officers in 24 states where they're elected by the voters, and in four others where they're appointed by the governor, according to the National Conference of State Legislatures. 

That would give election deniers enormous potential power to administer elections based on their false claims about the 2020 election — or refuse to stand up to pressure to change election results.

"The secretaries of state are key and no one knows about them," said New York University's Ruth Ben-Ghiat, author of "Strongmen: Mussolini to the Present." "These are figures who work in the background if democracy is robust."

Governors — A governor who disputes the 2020 election results can appoint chief election officials in five states (Florida, New Jersey, Pennsylvania, Texas and Delaware), according to NCSL. 

That would become an issue in Pennsylvania, where Republican nominee Doug Mastriano has talked about the importance of his secretary of state pick as he spreads false claims about the 2020 election.

The governor can also refuse to certify election results, as Kari Lake, the Republican nominee in Arizona, says she would have done with that state's results in 2020. 

Attorneys general — This office matters because a state attorney general can file lawsuits based on bogus stolen election claims, as Texas' Ken Paxton did in a lawsuit that was rejected by the Supreme Court.

House and Senate: They can certify a state's presidential election results in 2024 — or, as we saw in 2020, they can object and potentially throw an orderly presidential transition into chaos.

The bottom line: These offices are all important in making democracy work, but they're not the only ones that could matter if they fall into the hands of people who reject election results when they don't like the outcome.

"There are lots of places where people who don’t act in good faith could attempt to subvert election results," said Rick Hasen, an election law expert and director of UCLA Law's Safeguarding Democracy Project. "It could be down to poll workers in a precinct or a governor who signs a bogus certification of electors."

"The point is that our decentralization [of voting], which serves to be a strength in some ways, can also turn to be a weakness."

Election denial: The offices that matter

Here's how candidates who baselessly dispute the 2020 election results could gain power.

Illustration of a hand holding a pen with abstract ballot elements in the background.

More than 200 election deniers — candidates promoting baseless claims that the 2020 election was stolen from former President Trump — will <a class="gtmContentClick" data-vars-link-text="appear on November general election ballots" data-vars-click-url="https://projects.fivethirtyeight.com/republicans-trump-election-fraud/" data-vars-content-id="d2516181-1196-4aed-984d-738603f56073" data-vars-headline="Election denial: The offices that matter" data-vars-event-category="story" data-vars-sub-category="story" data-vars-item="in_content_link" href="https://projects.fivethirtyeight.com/republicans-trump-election-fraud/" target="_blank">appear on November general election ballots</a> across the U.S.Why it matters: Those who win will gain footing to affect future elections including the 2024 presidential race — through court challenges, administrative actions, executive orders, legislation, radical interpretation of law or the refusal to certify valid results, elections experts tell Axios.

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Stories

Axios/Ipsos poll: Midterms warning for Democrats

Election denial: The offices that matter

Two Americas Index: Democracy deniers

Two Americas Index: Red-blue migration

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

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