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J. Scott Applewhite / AP

The Senate health care bill, which Majority Leader Mitch McConnell has said will be released on Thursday, will contain optional state waivers of some Affordable Care Act insurance regulations, according to two senior GOP aides. But those waivers may not end up in the final bill — because they could get stripped out for violating Senate budget rules.

Here's why: The Congressional Budget Office has to give its cost estimates for the bill before Republicans can argue their case to the Senate parliamentarian that the waivers should be allowed. (The bill has to comply with Senate budget rules, and she decides whether it does.) And there's a good chance that she'll rule that the waivers, including essential health benefits, have to come out. One of the aides described the parliamentarian as "skeptical."

The Senate has long said that altering the ACA's regulations would not comply with the rules of the process the GOP is using, but the House included the state waivers in their final bill.

So that means Republicans may only be able to make the ACA's current state waivers more flexible. It's unclear how many members know this, but conservatives — who were pushing to waive even more of the ACA regulations than the House did, or even require states to opt into the regulations rather than out — will surely be disappointed.

Which ACA regulations would be covered in the state waivers:

  • Essential health benefits, or the list of 10 services insurers must cover.
  • The medical loss ratio, or the regulation of how much premium income insurers must spend on patient claims.
  • The age rating band, or the requirement that premiums for older people be no more than three times the amount of premiums charged to younger people.
  • The actuarial value, or the requirement that plans cover a certain percentage of a person's total health care costs.

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Updated 2 hours ago - Politics & Policy

Omicron dashboard

Illustration: Shoshana Gordon/Axios

  1. Health: Axios-Ipsos poll: Omicron's big numbersAnother wave of death — FDA limits use of Regeneron and Lilly antibody treatments — Fauci: "Confident" Omicron cases will peak in February.
  2. Vaccines: Pfizer begins clinical trial for Omicron-specific vaccine — The shifting definition of fully vaccinated.
  3. Politics: Biden admin withdraws temporary vaccine-or-test mandate for large employers — New York Supreme Court strikes down Gov. Hochul's mask mandate for public areas — Sarah Palin tests positive, delaying defamation trial — Virginia school boards sue Gov. Youngkin for lifting mask mandate.
  4. World: U.K. to lift travel testing requirement for fully vaccinated — Beijing Olympic Committee lowers testing threshold ahead of Games.
  5. Variant tracker

The Robinhood M&A rumor mill churns

Illustration: Sarah Grillo/Axios

Robinhood's valuation is now just over $11 billion, a fraction of where it traded in August and below that of its last private round of funding. Cue the M&A mongers.

Why it matters: It's not just Robinhood—falling values of growth-oriented tech stocks have raised speculation that formerly high-flying fintechs could be snapped up by more well-capitalized buyers.

3 hours ago - Health

Student's death renews calls for schools to stock opioid overdose drug

Photo: Amy Davis/Baltimore Sun/Tribune News Service via Getty Images

A Connecticut student's death has renewed calls for schools to stock and administer naloxone, a drug that can quickly reverse the effects of an opioid overdose.

Why it matters: U.S. drug overdose fatalities reached six figures in a 12-month period for the first time in November, and synthetic or natural opioids were the cause of a majority of the overdoses.