National

Effective today, federal law bans many types of out-of-network medical bills and puts the onus on doctors and health insurance companies to resolve their payment disputes.

Why it matters: Consumers can breathe a sigh of relief because, in many scenarios, they should no longer face unexpected charges from doctors who are not in their insurance networks.

How it works: Patients still have to pay in-network copays, deductibles and other cost-sharing, which have been rising, but any additional out-of-network bills are now prohibited for the following services:

Emergency care in a hospital ER, a freestanding ER or urgent care center.

Elective care at an in-network hospital or surgery center, but where doctors — notably anesthesiologists, pathologists, radiologists and assistant surgeons — may be out-of-network. This is also known as "drive-by doctoring."

Of note: Ground ambulances are not included in this law, meaning three out of four insured people who take an ambulance ride are still at risk of facing surprise bills.

Behind the scenes: Instead of sending out bills, doctors and insurance companies have to resolve their differences while holding the patient harmless.

If the two sides can't agree on a payment rate within 30 days, either side can request the federal arbitration process.

The doctor and insurer then go to the arbiter with their best offer, and the arbiter picks one. 

An important point: The arbiter "must select the offer closest" to the median in-network rate unless other information "clearly demonstrates" the median in-network rate isn't appropriate, according to the government.

A host of medical providers, including the American Hospital Association and American Medical Association, are suing the government. They argue the median in-network rate shouldn't be the guiding factor for the arbiter, and the government went against Congress' intent by doing so.

Consumer protection experts have criticized the lawsuits, saying medical providers don't want guardrails on the arbitration system so they can extract higher rates.

Between the lines: Because this is a new law, we should expect the health care system won't get everything right.

"We need to be active bill readers and ask a lot of questions to our providers and insurance companies if there's a bill we don't think we should be paying," said Patricia Kelmar, the health care director at consumer protection group U.S. PIRG.

Patients can direct complaints online or through a 1-800 number.

Out-of-network doctors also must inform patients about what their care might cost, and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.)

The bottom line: The law will save a lot of patients from financial ruin. But a lot of gaps remain in the health care system.

Have you been hit with a large or unexpected medical bill? Maybe the overall medical billing experience left you feeling puzzled or upset? Email bob@axios.com, so we can dig into what's happening as part of Axios' new series, Billed and Confused.

Out-of-network costs spin out of control (Nov. 16, 2021)

When you're charged a copay you shouldn't owe  (Jan. 20, 2022)

Many surprise medical bills are now illegal

Consumers getting care in the ER can breathe a sigh of financial relief.

A paper with the word "due" torn into shreds.

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Health care costs

The U.S. health system faces critical questions about cost, access and equity. Technological advances and new discoveries about diseases like cancer and Alzheimer’s are transforming patient care and reshaping public health.

Health

Top stories & latest news on the Federal Reserve, real-time data, plus the biggest shifts happening in the U.S. and global economy.

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After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

The pandemic that never seems to end will likely dominate our attention in 2022, along with President Biden's struggling agenda and Donald Trump's continuing hold over the GOP. 

Here’s what else Axios’ newsletter authors and expert reporters will be watching — from interest rates to Big Tech scrutiny to whether last year's climate pledges will lead to meaningful action this year. (Sign up for their newsletters here.)

Politics: One year after Jan. 6, and as redistricting resets the board, Donald Trump’s loyalty tests could fracture or radicalize the GOP. Meanwhile, Democrats’ inability to modify the filibuster or enact voting rights protections — along with their own fractures and President Biden's sinking approval ratings — could exile them from power come November. — Margaret Talev

Business: The big story of the year is going to be interest rates, both nominal and real. How far will the Fed hike rates — and how negative will rates remain once you adjust for inflation? If inflation remains high, even a series of rate hikes will leave real rates deep in negative territory, reinforcing the impression that all central banks are dovish these days. — Felix Salmon

Tech: Big Tech is likely to continue to come under pressure from regulators and lawmakers around the globe, as well as continued internal pressure from workers who want to see their employers do better. Once again, a gridlocked Congress means that states and Europe are likely to take the lead on the legislative front. — Ina Fried

Media: The media and entertainment sectors continued to see a high volume of consolidation in 2021, pegged to the rise of streaming. In 2022, we'll be looking at how those deals will shape the streaming ecosystem. Most notably, we'll be watching the formation of a new media giant through the combination of Discovery and WarnerMedia. — Sara Fischer

Work: Companies spent 2021 trying to figure out what hybrid work would look like after the pandemic, but new variants keep foiling their plans to bring people back into offices. Now, they’re hoping 2022 will be the year we finally settle into our post-COVID working world — and how that shakes out will affect everything from how downtowns recover to the way we get around. — Erica Pandey

Health care: As Omicron spreads worldwide, global vaccination rates will take on new urgency. However, with improving vaccination rates and the development of new anti-viral treatments, it's still possible the pandemic will reach an "endemic" level of disease — meaning the population has gained some immunity, but the virus continues to circulate and cause more localized outbreaks. — Tina Reed

Energy: Be on the lookout for progress, or lack thereof, in turning climate pledges into action. The Glasgow summit capped a year heavy on new emissions-cutting commitments, but big steps to transform them into reality are less certain. We'll also be watching emerging science as crucial new IPCC reports roll out, and will track unrelenting extreme weather and climate events. — Ben Geman and Andrew Freedman

Local: Cities across the U.S. will see continued transformation in response to the pandemic and other crises, such as climate change. Lagging foot traffic in downtowns and lingering staffing shortages could forever change how local business is done. Meanwhile, a greater emphasis on public transit and electric vehicles could reshape how we get from point A to B. — Emma Way

World: 2022 will be a year of seismic elections. In France, President Emmanuel Macron hopes to fend off the far right, while in Brazil, far-right President Jair Bolsonaro is fighting for survival. Term limits mean new presidents will be elected in South Korea, Colombia, the Philippines and Kenya — all before Americans go to the polls for the midterm elections in November. — Dave Lawler

China: 2021 saw the entrenchment of deep animosity between the U.S. and China — and a growing chill in relations between China and European nations. In 2022, will Beijing and Washington be able to find a sustainable, peaceful way to manage their differences, or will the world become locked into another great power struggle? — Bethany Allen-Ebrahimian

Race and justice: The 2022 midterms are expected to focus on rising crime in cities, ongoing criminal justice reform and voting rights. Conservatives have signaled they'll use diversity lessons in classrooms and the quest for police reforms as wedge issues. But newly energized voters of color, a growing electorate in the U.S., may stop this backlash — if they get to the ballot box. — Russell Contreras

Space: The launch of the James Webb Space Telescope marks a new era for space science. We'll be watching for early results from the mission along with findings from several other new probes headed to the Moon, asteroids, Jupiter and more. — Miriam Kramer and Alison Snyder

Gaming: Big console and PC game publishers face a pivotal 2022, as the industry’s ocean liners try to tack in a direction that can offset the swelling cost of making blockbuster games. We’ll see more famous game franchises pop up on mobile, and we just might learn whether the $2 billion + invested in the controversial and unproven NFT gaming sector is a boom leading to a bust. — Stephen Totilo

Sports: This year's most important story will be the evolution of the college sports model. Last year brought the long-awaited change that allows student athletes to earn money on their name, image and likeness. How that industry grows and impacts recruiting, particularly as the NCAA hands over more governing responsibility to its conferences, will be fascinating to watch. — Jeff Tracy

What we're watching in 2022

The pandemic, President Biden's struggling agenda, Big Tech and other stories to watch.

Illustration of the year 2022 with an eye in a magnifying glass in place of the zero.

2022 elections

Emerging Tech

2024 will be an election year like no other, as President Biden seeks re-election amid economic uncertainty, two wars and questions about his age. His likely foe, former President Trump, faces felony charges and vows revenge on his political enemies. Meanwhile, Americans generally are dissatisfied with those choices and are divided over immigration, race, education and more.

Politics & Policy

Conflicts, policies and powers are intersecting and shaping the world. Breaking news and analysis of national security, foreign policy and global crises.

World

From the Valley to D.C., Big Tech players like Facebook, Google and Amazon are under more scrutiny than ever as new technology develops and privacy and antitrust concerns grow in lockstep with companies’ ambitions.

Technology

News and analysis of the scientific advances fueling AI and quantum computing, revolutionizing biology and medicine, and tackling climate change. Science is changing the world and colliding with the global politics that shape it.

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Breaking climate science and policy coverage as extreme weather events reshape communities. Keep tabs on the race to a low carbon economy, which may be bumpy as governments, climate tech startups and major oil and gas companies race to find their niche amid the changing energy landscape.

Energy & Climate

Shifts in technology and media are changing the way we play, watch and understand sports. Business models are adapting and social change is forcing those in charge of teams and leagues to reconsider decades-old practices.

Sports

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The organizers of CES said Friday that next week's giant consumer electronics show in Las Vegas will go forward in person, but will end one day early.

Why it matters: The event is a major revenue source for the Consumer Technology Association, but many large tech companies and media outlets are choosing not to attend in person amid the fast-spreading Omicron variant of Covid-19.

The latest: CTA said in a statement that it was shortening the show to run Jan. 5-7 "as an additional safety measure." The organization did not immediately respond to a question from Axios as to how ending a day early would increase safety.

Since last week, many key companies including Amazon, Meta, Microsoft, Google, Twitter, AT&T have announced they were scrapping in-person attendance.

T-Mobile, a major sponsor, said it would not appear in person and that CEO Mike Sievert would not deliver a keynote as scheduled.

Most large tech media organizations are also covering the event remotely, including CNET, Engadget, The Verge, TechCrunch, IGN and TechRadar.

Yes, but: CTA noted on Friday that more than 2,200 companies will be there in person, including 143 added in just the last two weeks.

Attendees will required to be vaccinated and to do a self-test before entering the event.

Go deeper: CES organizers press on despite Omicron threat

CES to end a day early amid Omicron, cancellations

The Las Vegas consumer electronics show will now run from Jan. 5-7

The shadow of a hand and smartphone are seen in front of the CES logo

Photo Illustration: Rafael Henrique/SOPA Images/LightRocket via Getty Images

Denver

Axios Denver

The wind-fueled flames of the Marshall Fire dashed from house to house yesterday, torching entire neighborhoods and skipping others, indiscriminately destroying lives and capping a difficult year in Colorado.

The latest: The orange flames that lit up the skies around Boulder County left behind a black-and-white scene Friday, as snow fell on charred homes and piles of gray ash.

Emergency officials are beginning the grim task of assessing the damage as evacuated residents are eager to know whether their homes are still standing.

Two thousand homes are in the burn area, and Gov. Jared Polis said that nearly 1,000 homes and businesses were decimated in Superior, Louisville and other Denver and Boulder suburbs. Local authorities put the estimate closer to 500.

The cause of the fire is still under investigation, but emergency officials reported downed power lines in the area where the blaze began.

Displaced residents are still not allowed to return to their homes because of dangerous conditions and smoldering flames in some areas, Boulder County Sheriff Joe Pelle said at a briefing this morning.

Xcel Energy is working to restore power to 15,000 customers in the area, and Louisville and Superior residents are advised to boil water.

There are no known casualties and only a few people suffered burns — an outcome the sheriff called "miraculous."

What they're saying: "It feels like we've experienced enough loss and tragedy these last two years," Polis said.

"This is our community, and to watch it burn so quickly, so unexpectedly, is something that I think we are all just struggling to believe and understand."

Why it matters: The Marshall Fire is expected to rank as the most destructive blaze in state history in terms of homes destroyed, and the fact that it struck in dense suburbs in late December is remarkable.

Between the lines: The conditions that helped make the fire so devastating bear the imprint of climate change, including a record dry and unusually warm six months, Axios' Andrew Freedman and Ben Geman write.

This dry period was preceded by a wet spring, which prompted grasses to grow, only to see them dry out, adding to the combustible situation.

What you can do: Several nonprofits are collecting money and supplies to help those who suffered losses in the fire, including the Community Foundation Boulder County, the American Red Cross Colorado Chapter and the Salvation Army.

Coloradans who can offer shelter to displaced residents can sign up online to host through the Airbnb Open Homes Program, according to the Boulder Office of Emergency Management.

Of note: Boulder's emergency operation center has urged people to donate online, and not call the facility, to help keep the phone lines clear.

The big picture: The fire concludes a horrible holiday week in the Denver area, as violence and the coronavirus interrupted the season of hope.

A suspected gunman killed five people and shot a police officer Monday in an attack that began in Denver and ended in downtown Lakewood.

Colorado set a new pandemic record Wednesday for single-day COVID-19 cases, fueled by the rapid spread of the Omicron variant, and the governor activated the National Guard to help with testing.

What's next: One pressing question moving forward is where the people whose homes were destroyed will live.

Affordable housing was already hard to come by in Boulder County.

Emergency shelters are open, and the state has asked federal authorities for help with temporary housing, but the long-term outlook remains uncertain.

The impact: A neighbor helped Doris and Richard Channel evacuate Thursday with their half-poodle mix, Trina. Doris has lived in Louisville her entire 85 years.

"I've never, ever seen anything like this," she told the Colorado Sun. "I just want to go home to my bed. I just hope it's still there."

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The latest on Colorado’s Marshall Fire

Only a few people suffered burns and there are no known casualties so far — an outcome the sheriff called "miraculous.

An Arvada firefighter walks back to the firetruck as a fast moving wildfire swept through a Louisville neighborhood, destroying cars and homes. Photo: Marc Piscotty/Getty Images

Wildfires

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The Boulder, Colorado-area wildfires — the most destructive in state history —  were likely made worse by the effects of climate change, including extremely dry conditions and long stretches of record warm weather in recent months.

Why it matters: The Marshall Fire that consumed at least 1,600 acres on Thursday destroyed nearly 600 homes, Boulder County Sheriff Joe Pelle said at a Thursday news conference.

Climate factors provided the fuel for the devastating fires, while an extreme weather event, in the form of powerful downslope winds coming off the Rocky Mountains, provided the spark and fanned the flames. 

Wind gusts peaked as high as 110-115 miles per hour -- equivalent to a Category 2 or 3 hurricane. 

Catch up fast: The rapidly-moving flames led to evacuation orders covering more than 30,000 people in Superior, Louisville and portions of other communities.

Officials say downed power lines were the likely cause of the fire, per the Denver Post.

Threat level: The conditions that helped make the fire so devastating bear the imprint of climate change.

They include a record dry and unusually warm July 1 to Dec. 29 in the region, according to Colorado State University meteorologist Russ Schumacher. 

This dry and warm period was preceded by a wet spring, which prompted grasses to grow, only to have them dry out, adding to the combustible situation on Thursday. 

Context: Late December is downslope wind season along Colorado's Front Range, Boulder meteorologist Matthew Kelsch told Axios. However, this event was unusually intense, he said, and overlapped with the tinderbox dry conditions. 

This enabled any spark to fuel an inferno, whereas in previous years, such winds came after snowstorms had already occurred. 

This year, Denver had its least snowy September through November period on record and latest first snow on record. Fall finished without measurable snow for the first time since records began in 1882, the Weather Service stated. 

Heavy snow finally arrived Friday, one day too late to prevent the disaster.

As is occurring in California and other western states, Colorado has seen an uptick in large wildfires and wildfire severity in recent years, which studies have tied to human-caused climate change. 

Sixteen of the top 20 largest wildfires on record have occurred since 2008, according to the Colorado Division of Fire Prevention and Control. 

What they're saying: With universities and government research labs located there, the Boulder region is home to some of the top authorities on climate change and extreme weather events. 

University of Colorado ecologist Merritt R. Turetsky, an expert in wildfire behavior, said via Twitter that extremely dry conditions and high winds together create "hot, flashy, and very dangerous grass fires."

 "This is the human and health cost of the #ClimateCrisis," she tweeted.

Daniel Swain, a climate scientist at UCLA and researcher at the National Center for Atmospheric Research in Boulder, described the fires as "climate enabled and weather-driven." On Friday, he tweeted that he woke up to the "overwhelmingly acrid smell of burnt homes."

According to data Swain cited, the past 90 days were the warmest and driest on the Front Range of Colorado since at least 1979. Additionally, the "vapor pressure deficit," a key wildfire risk indicator that measures how quickly the air robs plants of moisture, was at a record high on Thursday. 

"Climate change is clearly increasing both temperatures [and] vapor pressure deficits across [the] Western U.S.," Swain tweeted.

The bottom line: The urban firestorm in Colorado caps off a year of jarring and devastating extreme weather events across the U.S., with scientists increasingly wondering if the pace and severity of climate impacts is proceeding faster than previously thought.

Go deeper: Fast-moving wildfires burn at least 580 homes near Denver

Climate changes linked to Colorado's fire disaster

The urban firestorm could not have happened without a unique combination of climate factors.

Picture of a building burning in a Colorado wildfire on Dec. 30, 2021.

Fire takes over a business in Louisville, Colorado. on Dec. 30. Photo: Helen H. Richardson/MediaNews Group/The Denver Post via Getty Images

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Extreme weather

Percent who say they were/are more fearful about the upcoming year

Data: Momentive/SurveyMonkey; Chart: Baidi Wang/Axios

Americans are less optimistic and more nervous about what 2022 has in store for the world than they were heading into 2021, according to a new Axios/Momentive poll.

And this year, democracy ranked second among the issues survey respondents said matter most to them, behind jobs and the economy and just ahead of health care.

"COVID" and "Trump" were the top two words people said they'd like to hear less in 2022. The top word people said they'd like to do more of: Travel.

A word cloud shows the things Americans say they'd like to hear less of in 2022, including COVID and Trump

The big picture: The overall findings are comparable to recent pre-pandemic, year-ahead polls conducted by Momentive (formerly SurveyMonkey). But compared with last year's poll, they show a souring of the national mood after an unusually optimistic view of what 2021 could be.

"The end of last year was a particularly hopeful time," partly because there was a change in the presidency but also because we'd just been through the first year of COVID and everyone thought things could only get better after 2020, said Laura Wronski, senior manager for research science at Momentive.

"I think after this year we realized it's not going to magically get better, that we're going to have to live with COVID for a while."

By the numbers: More than half of the people in our survey — 54% — said they're more fearful than hopeful about what's in store for the world in 2022, while 44% said they're more hopeful.

That's a sharp turnaround from last year's survey, when 63% said they were more hopeful about the world in 2021 and 36% said they were more fearful.

While Republicans were more pessimistic than Democrats and independents both years, all three groups turned more negative in this year's survey, with 69% of Republicans, 45% of Democrats and 47% of independents saying they were more fearful than hopeful.

In addition, 51% said they were more fearful than hopeful about what's in store for the U.S. in 2022, including 66% of Republicans, 41% of Democrats and 46% of independents.

Yes, but: Even with the Omicron variant spreading across the country, 61% of Americans said they're more hopeful than fearful about what's ahead for the pandemic in 2022, with 37% saying they're more fearful.

That optimism was consistent across the board, with little variation by party, age, race or gender. It's down from last year, however, when 76% said they were more hopeful than fearful about COVID.

And despite their worries about the U.S. and the world, 68% said they're more hopeful than fearful about what 2022 has in store for them personally, with 30% saying they're more fearful.

What to watch: This year, 17% of the people in our survey said democracy was the issue that matters most to them right now, second only to jobs and the economy, at 31%.

That urgency was driven largely by Democrats — who ranked it as their highest priority, at 24% — and people with a college degree or higher, also at 24%.

Republicans also ranked democracy as a high priority, at 15%, while it was basically a non-issue for independents 7%.

Between the lines: Americans' pandemic fatigue was obvious from people's answers when asked what they'd like to hear less about in 2022: COVID and former President Donald Trump. (President Biden was a top choice among Republicans, too.)

Their choices of the best words to describe 2021 suggested fatigue as well: "exhausting" (43%), "worrisome" (43%) and "chaotic" (31%).

That's similar to the words people used to describe 2017 and 2018 as well, but that was more because of politics than COVID, Wronski said. "All of these factors are just multiplying right now, and it's hard to know what a normal year is because we haven't had that in a long time."

People's embrace of "travel" as what they want to do more of in 2022 is one sign that Americans still have hope for the future.

Methodology: This Momentive online poll was conducted Dec. 14-16 among a national sample of 2,602 adults. Respondents for this survey were selected from the more than 2 million people who take surveys on the SurveyMonkey platform each day. The modeled error estimate for this survey is plus or minus 2 percentage points.

Data have been weighted for age, race, sex, education, and geography using the Census Bureau’s American Community Survey to reflect the demographic composition of the United States age 18 and over. 

Exclusive poll: America's fears rise for 2022

Americans are less optimistic and more nervous about 2022 than they were heading into 2021.

Polls

President Biden and Russian President Vladimir Putin spoke for 50 minutes on Thursday, in what a senior U.S. official characterized as a "serious and substantive" phone call setting the parameters for high-stakes security talks in Europe next month.

Why it matters: Russia has amassed more than 100,000 troops on its border with Ukraine, raising fears of a large-scale invasion with devastating consequences for Europe. 

The Biden-Putin phone call sets the stage for U.S.-Russia security talks on Jan. 10, followed by meetings of the Russia-NATO Council on Jan. 12 and the Organization for Security and Cooperation in Europe (OSCE) on Jan. 13.

The talks come as Putin has demanded that the U.S. and NATO provide legal guarantees ruling out eastward expansion or military cooperation with former Soviet states, including Ukraine.

What they're saying: Speaking to Putin from his home in Delaware, Biden laid out "two paths" that will "really depend on Russia's actions in the period ahead," according to a senior administration official who briefed reporters on the condition of anonymity.

One is a "path of diplomacy" leading to de-escalation, while the other was a "path more focused on deterrence" — including massive sanctions and an increase of NATO activity in eastern member states if Russia invades Ukraine, the official said.

"Both leaders acknowledged there will likely be areas where we could make meaningful progress, as well as areas where agreement may be impossible," the official said. "The upcoming talks will determine more precisely the contours of each of those categories."

The other side: The Kremlin said in its own readout that Putin was "satisfied" with the "constructive" conversation, but warned Biden that major sanctions would be a "colossal mistake" that could lead to a complete breakdown in relations.

"Our president emphasized that in this rather difficult situation we will behave the way the United States would behave if offensive weapons were deployed near American borders," the Kremlin said, according to a translation.

The Kremlin emphasized that Putin is seeking "concrete" guarantees for Russia's security in the upcoming talks and that success in these negotiations could lead to the normalization of U.S.-Russia relations.

What's next: The senior Biden official said that the U.S. will continue to consult with European allies ahead of next month's talks, stressing that no decision on Ukraine will be made without Ukraine at the table.

Biden lays out "two paths" for Ukraine crisis in call with Putin

The two leaders spoke for 50 minutes ahead of next month's security talks.

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