Good morning ... Situational awareness: Carl Icahn published an open letter this morning formalizing his opposition to the Cigna-Express Scripts merger.
Alexandria Ocasio-Cortez campaigns for Abdul el-Sayed in Michigan. Photo: Bill Pugliano/Getty Images
Tonight's primary elections will include an important referendum on a growing trend: Progressive gubernatorial candidates vowing to implement some form of single-payer at the state level.
What to watch: Michigan's Democratic primary, which will be held tonight, includes Abdul el-Sayed — a progressive candidate (and former Detroit health commissioner) who has said he'll bring "Medicare for All" to Michigan.
No state has ever made single-payer work. But that's not stopping a handful of Democratic candidates from promising to try. The Washington Post's Dave Weigel runs through some of them:
The problem is money. States would largely have to pay for their versions of single-payer on top of existing federal programs, not instead of them.
Why it matters: As unlikely as state-level single-payer might be, gubernatorial candidates' embrace of the idea is still a clear sign of where Democrats are headed.
Go deeper: Axios followed el-Sayed last week as he campaigned with newly minted progressive icon Alexandria Ocasio-Cortez.
The average insurance deductible keeps going up, as does the number of people covered by high-deductible plans. And only about half of those people get help from their employers to save up for potential medical bills, according to a new study in Health Affairs.
Why it matters: Higher deductibles don't just require people to pay more out of pocket each year. They also expose those consumers to the complexities of the health care system, including the way prices are set.
Also from Health Affairs: The level of competition among insurance companies has affected Affordable Care Act premiums more than any other factor.
By the numbers: Premiums are 50% higher this year in areas with just one insurer than in areas with two insurers.
How it works: Jessica Van Parys, the Hunter College economics professor who conducted the study, suggests that insurers underpriced their ACA offerings in the first few years to capture market share, then raised their prices over the years.
The Food and Drug Administration released new guidance yesterday to expand the use of medication-assisted treatment, or MAT, for addiction.
What's happening: The agency is giving drugmakers additional ways to demonstrate the effectiveness of MAT products, my colleague Caitlin Owens reports.
Why it matters: This is a step toward the FDA's goal of a comprehensive approach to the opioid epidemic, with a focus on harm reduction.
Illustration: Sarah Grillo/Axios
Mental health is a big focus at this week's Black Hat cybersecurity conference, Axios' Joe Uchill reports.
The big picture: Black Hat has a large industry presence, and shining a light on topics that tend to be discussed outside the corporate eye — things like suicide, stress load, mental illness and trauma — may force major employers in the field to think about those issues, too.
Mental illness and suicide: "In the past year I know several people in the community have taken their own lives," said Jay Radcliffe of Boston Scientific. "It’s a sad thing, and something I feel responsible to talk about."
Go deeper: Subscribe to Codebook, Joe's cybersecurity newsletter.
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