Good morning ... "Population Bracketology," is a very fun little game brought to you by the Census Bureau. And it taught me that I have absolutely no mental picture of how big Tampa is, compared to almost any other medium-large city.
Did somebody forward you this newsletter? You can sign up for yourself here.
The Justice Department now wants the courts to strike down the entire Affordable Care Act — not just its protections for people with pre-existing conditions.
This is a stunning escalation, raising both the real-world and political stakes in a lawsuit where both the real-world and political stakes were already very high.
Where it stands: Judge Reed O'Connor ruled in December that the ACA's individual mandate has become unconstitutional, and that the whole law must fall along with it.
Why it matters: If DOJ ultimately gets its way here, the ripple effects would be cataclysmic. The ACA's insurance exchanges would go away. So would its Medicaid expansion. Millions would lose their coverage.
Politically, this makes no sense. Chuck Schumer and Nancy Pelosi must be dancing in the streets.
What they're saying:
Photo: Sha Hanting/China News Service/VCG via Getty Images
Y'know what was already on House Democrats' agenda for today, even before the DOJ news broke last night? A press conference to introduce a package of bills that would incrementally expand on the Affordable Care Act.
Details: Democrats' bills would expand the ACA's subsidies for both premiums and out-of-pocket costs.
Between the lines: These are pretty safe, standard Democratic ideas that would be a lot less newsworthy without the stark contrast Trump's Justice Department is providing.
My thought bubble: One press conference on one day is no big deal, but we've already watched Democrats build a narrative and a campaign message around health care — including this exact lawsuit. There's no reason to believe they can't do it again, especially with even more on the line in court.
Illustration: Aïda Amer/Axios
When we talk about the cost and complexity of the U.S. health care system, we usually don’t account for the time, money and labor donated by friends and family members — sometimes even strangers. But those unofficial supports are a large and growing part of American health care.
Caregivers spend their own money, take time away from work and provide help that would otherwise be very expensive — it would all add up to billions of dollars, if they were paid.
Patients also rely on friends, family and strangers to pay their bills.
Access to these unofficial support systems is not equal.
What's next: Lawmakers in several states are considering tax credits to help caregivers either hire professional help or defray certain costs, Kaiser Health News reports.
The bottom line, from Carroll: "Rides to the hospital are care. The time spent at home with those recuperating after procedures is care. Watching and monitoring and caring for the ill in their home is just as much care as doing the same in a hospital. We are willing to pay a fortune for the former, and almost nothing for the latter."
Photo: Jaap Arriens/NurPhoto via Getty Images
While we're on the subject of getting help in unusual places, Stat has an interesting and surprisingly optimistic piece about how digital health apps are helping potentially suicidal patients.
These are mainly apps designed for other, non-emergency purposes — like Ada, a chatbot that gives users the most likely diagnoses based on symptoms they report. More than 130,000 users have told the app they're having suicidal thoughts, according to Stat.
Strategies are mixed — one company told Stat it doesn't call the authorities when its clinicians sense a user in distress, but other operators, including tele-health companies where a nurse or doctor can see and hear their patient, said they've been able to intervene and help save lives.
Illustration: Aïda Amer/Axios
It's not just the U.S. and it's not just the anti-vaccination trend — the return of once-defeated diseases is a global phenomenon, Axios' Steve Levine writes.
Driving the news: Measles had been eliminated from the U.S. in 2000, but we're experiencing a resurgence of both measles and mumps, concentrated mainly in New York, Texas and Washington state.
Vaccination is the key factor in that equation, of course, and would be a safeguard against transmission. But, Steve notes, other cultural changes are also at play.
Thanks for reading. I always welcome your tips and feedback: email@example.com, or just reply to this email.