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Jefferson Health's flagship hospital in Philadelphia. Photo: Jefferson Health

The Federal Trade Commission and Pennsylvania's attorney general want to block the proposed merger between Jefferson Health and Einstein Health Network, arguing the combined system would control too much of the hospital services market in the Philadelphia area and consequently would have unfair pricing power.

Why it matters: This is the first time in more than three years that the FTC has challenged a large hospital merger, and this action could force Jefferson and Einstein to abandon their plans.

Flashback: The FTC hasn't opposed a major hospital merger since 2016, when it urged Tennessee and Virginia officials to block the merger between Mountain States Health Alliance and Wellmont — a deal that ultimately went through and created what's known today as Ballad Health.

  • The FTC hasn't formally challenged hospital mergers in court since 2015, when it went on a spree against hospitals deals in West Virginia, Pennsylvania and Illinois. Two of those three merger proposals ultimately folded.

What they're saying: Jefferson and Einstein would control 60% of inpatient services in northern Philadelphia and at least 70% of inpatient rehab services in the broader Philadelphia area, the FTC said.

  • The systems sent a statement saying they believe they have a "strong and comprehensive case" as to how the merger would benefit patients and not reduce competition.
  • A trial will start in September.

Between the lines: Jefferson and Einstein would have about $6.5 billion in annual revenue, according to financial filings. The system's footprint would be large enough around Philadelphia that health insurers may have a hard time excluding it from networks, regardless of what the system charges.

  • And given that hospital mergers usually lead to higher prices and no improvement in care quality, the FTC believes patients in the area would be getting a particularly raw deal.

The bottom line: The FTC hasn't challenged a lot of hospital mergers lately, even though there has been a lot of deal-making, but it has a decent track record of winning.

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Top general: U.S. losing time to deter China

Stanley McChrystal. Photo: Alex Wong/Getty Images

Stanley McChrystal, a top retired general and Biden adviser, tells Axios that "China's military capacity has risen much faster than people appreciate," and the U.S. is running out of time to counterbalance that in Asia and prevent a scenario such as it seizing Taiwan.

Why it matters: McChrystal, the former commander of U.S. and NATO forces in Afghanistan, recently briefed the president-elect as part of his cabinet of diplomatic and national security advisers. President-elect Joe Biden is considering which Trump- or Obama-era approaches to keep or discard, and what new strategies to pursue.

Progressives shift focus from Biden's Cabinet to his policy agenda

Joe Biden giving remarks in Wilmington, Del., last month. Photo: Roberto Schmidt/AFP via Getty Images

Some progressives tell Axios they believe the window for influencing President-elect Joe Biden’s Cabinet selections has closed, and they’re shifting focus to policy — hoping to shape Biden's agenda even before he’s sworn in.

Why it matters: The left wing of the party often draws attention for its protests, petitions and tweets, but this deliberate move reflects a determination to move beyond some fights they won't win to engage with Biden strategically, and over the long term.

Dave Lawler, author of World
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Venezuela's predictable elections herald an uncertain future

The watchful eyes of Hugo Chávez on an election poster in Caracas. Photo: Cristian Hernandez/AFP via Getty

Venezuelans will go to the polls on Sunday, Nicolás Maduro will complete his takeover of the last opposition-held body, and much of the world will refuse to recognize the results.

The big picture: The U.S. and dozens of other countries have backed an opposition boycott of the National Assembly elections on the grounds that — given Maduro's tactics (like tying jobs and welfare benefits to voting), track record, and control of the National Electoral Council — they will be neither free nor fair.