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Good morning ... Know what Obamacare is getting for its 7th birthday on Thursday? A repeal vote in the House, that's what! Happy birthday, Obamacare. Gonna be the worst birthday party ever. Brings back bad memories of when I lost at miniature golf on my 7th birthday, and then got repealed.

This is going to be one of those weeks where you really need help de-cluttering your news, and that's what we, on the Axios health care team, are trying to do. But if you think we're missing important stuff, please let us know. And keep checking the Axios health care news stream for all the latest, and sign up for our newsletters and breaking news alerts here.

The three big things to know for repeal week

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Here's what you need to know as we head into the week of the House vote:

  • Republican leaders may be within striking distance of the 216 votes they need for Trumpcare to pass the House.
  • They're nowhere close to the votes they need in the Senate, thanks to conservatives and moderates turning against it for different reasons.
  • The one new change that seems almost certain to happen: The tax credits will be reworked to give more help to the low-income elderly.
There's still a long way to go in the House, but GOP leaders are a lot closer to nailing down the votes after President Trump struck a deal with the Republican Study Committee on Friday morning to win their support. (Caitlin Owens and Jonathan Swan give a rundown here of the Medicaid changes they've been promised.) Here's who to keep your eye on now:
  • Freedom Caucus members: Even after the Republican Study Committee got on board on Friday, the Freedom Caucus tweeted that it "still opposes the GOP replacement bill in its current form." CNN reports that the group's chairman, Rep. Mark Meadows, and Sens. Ted Cruz and Mike Lee met with top Trump aides at Mar-a-Lago this weekend to try to push the bill farther to the right.
  • Reality check: The Freedom Caucus is certainly capable of causing trouble for House Speaker Paul Ryan — they made life miserable for John Boehner. But how many would actually vote against a repeal bill when the time comes? You'll know the tide has turned if you start hearing "I don't like it but won't stand in the way" speeches.
  • Moderates: The Washington Post has a good look at what it calls the "sleeping giants," or the moderates who are appalled by the estimated coverage losses. Many are from states that expanded Medicaid, and don't like how the bill handles the end of the expansion.
  • Reality check: The GOP leaders are trying to win them over, as Jonathan Swan reported yesterday — but when was the last time a bill failed in the House because moderate Republicans all stood their ground against the leadership? It's not impossible, but it doesn't happen very often.
The bigger problem is in the Senate, where senators are more independent and less likely to fall in line than in the House. Sens. Ted Cruz and Susan Collins were on separate Sunday talk shows discussing how they can't support the bill, but from opposite ends of the spectrum: Cruz wants to knock out the Obamacare insurance regulations, while Collins is worried about lost coverage and Medicaid cuts. Try to figure out the formula that makes both happy.

Hospitals have a big labor problem coming up

Obamacare was good for health care jobs around the country, but especially for hospitals. Now, Bob Herman reports that they're going to have a problem on their hands if repeal happens: What are they going to do with all of those expensive new hires if millions of people lose health coverage? The hiring has already slowed down because of all of the uncertainty, and if they have fewer patients who can pay for their medical care, they might have to reduce their staffs through attrition — or layoffs. Read Bob's story here.

Don't spend a ton of time learning about "Phase 3"

I was all set to give you an in-depth look at all of the health care bills Republicans are lining up for "Phase 3" of Obamacare replacement — all the proposals they can't put in the budget "reconciliation" bill. Here's the list so far:

  • Competitive Health Insurance Reform Act of 2017 — eliminating the antitrust protection for insurance providers (House voting this week)
  • Small Business Health Fairness Act of 2017 — association health plans (House voting this week)
  • Medical malpractice reform (later this month)
  • Protecting self-insurance (later this month)
  • Selling health insurance across state lines (House Energy and Commerce subcommittee hearing coming soon)

There are substantive reasons to learn about the pros and cons and all of them. But here's the problem: All of them might be able to pass the House pretty easily, but then they'd all need Democratic votes to pass the Senate, since they'd need 60 votes.

So I asked around about whether any of them could get enough Democratic votes, and here's what a Senate Democratic leadership aide told me: "No they will not. We are happy to work with Republicans to improve health care but they have to drop repeal first. If they manage to pass a repeal bill, they're on their own. There won't be a phase 3."

Cruz actually laughed at the idea on CBS's "Face the Nation" yesterday when John Dickerson asked him about it. "That ain't going to happen," Cruz said, calling it "the sucker's bucket." So, moving along ....

Price is still a fan of Medicare balance billing

Steven Brill points out something for your radar: Price's long fight to let doctors charge more to Medicare patients could now be a big deal. Modern Healthcare reported that in his written responses to questions from the Senate Finance Committee considering his nomination for Health and Human Services secretary, Price didn't back down from his support for a change in the Medicare law that would allow doctors participating in the program to "balance bill" Medicare beneficiaries — meaning they could charge them more than the amount Medicare pays. (You can read the exchange here — it starts on page 8.)

Balance bills are often given to patients with private insurance, usually because they are using a doctor out of the insurance company's network. But the practice has always been banned for doctors treating Medicare patients. Under the change long advocated by Price, a former orthopedic surgeon, the doctors could have their cake and eat it, too: be in the Medicare network, but charge as much extra as they can to as many patients as they can.

Why it matters: Medicare, with about 55 million enrollees, protects about twice the number of Americans who are enrolled through the Obamacare exchanges and the expansion of Medicaid.

While you were weekending ...

  • House Rules Committee chairman Pete Sessions faced chants of "Vote him out!" at a town hall meeting in Richardson, Texas, as he talked about the Obamacare repeal effort.
  • Sen. Rand Paul, on ABC's "This Week," predicting the House GOP bill won't pass: "I believe that the real negotiation begins when we stop them."
  • Ryan, on Fox News Sunday, on Trump's proposed cuts to the National Institutes of Health: "NIH is something that's particularly popular in Congress. We just passed the Cures Act just this last December to increase spending in the NIH."
  • Collins on NBC's "Meet the Press," on Trump's NIH cuts: "If we're serious about reducing health care costs, the last thing that we should be doing is cutting the budget for biomedical research."
  • Price, on ABC's "This Week," on ProPublica's bombshell report that U.S. Attorney Preet Bharara was investigating Price's stock trades before he was fired: "I have -- know nothing about that whatsoever."
  • The New York Times looks at how the GOP is confronting the reality that a lot of blue-collar Trump voters depend on government medical care.
  • The Center for American Progress has a district-by-district breakdown of how many people would lose coverage under the GOP bill, based on the Congressional Budget Office estimates.
  • Avik Roy writes that the GOP bill's premium increases for the elderly could be eliminated by means testing the tax credits and adding a standard deduction.
New on Twitter: Centers for Medicare and Medicaid Services administrator Seema Verma (@SeemaCMS). And if you're not following Tom Price's official account yet, it's @SecPriceMD.

Why Medicaid work requirements won't work

Some think tank is apparently warning that work requirements for Medicaid — the latest thing Republicans are about to add to the Obamacare replacement bill — won't work because "making cash assistance or food stamps contingent on work participation is one issue, denying medical care to sick, poor people is another matter."

Just gonna check and see who wrote that — guessing it's the Center for American Progress or some other lefty think tank that would never...OMG IT'S THE HERITAGE FOUNDATION. Here's what senior research fellow Robert Rector wrote: It's likely to be optional, so most governors would ignore it; the rule would be "almost impossible to administer and enforce;" and, no one's really going to deny medical care to someone who didn't do their work assignments.

Rector isn't really against work requirements in principle — he just thinks they should be applied to food stamps, which would be easier to enforce and covers a lot of the same population. But it will be interesting to see if any Republicans grapple with the practical problems when the Medicaid part of the bill is being rewritten.

What we're watching today: Trump rally in Louisville, Kentucky to build support for the GOP bill, 7:40 p.m. Eastern. Also, Trump meets with Ryan, Price, and Zeke Emanuel, 11:30 a.m. Eastern.

What we're watching this week: House Rules Committee takes up the Obamacare replacement package, probably Wednesday ... and the big House vote, Thursday. The House also votes on bills to eliminate the antitrust protection for insurance providers and to create association health plans. Also, Senate HELP Committee will hold a hearing on reauthorizing the Food and Drug Administration's user fee agreements, Tuesday.

Thanks, and let me know what you'll be drinking on repeal night: david@axios.com.

Featured

Sessions vows to take travel ban appeal to Supreme Court

Ted S. Warren / AP

Attorney General Jeff Sessions has announced the DOJ will ask the Supreme Court to review Thursday's ruling from a federal appeals court keeping the block on President Trump's travel ban in place:

"President Trump's executive order is well within his lawful authority to keep the Nation safe…The Department of Justice strongly disagrees with the decision of the divided court..."

The dissenters: Sessions is right, the court was split 10-3. The dissenters said that the law does not permit judges to second-guess a president's ability to make decisions about national security.

The majority: Chief Judge Roger Gregory, however, wrote the ban "drips with religious intolerance, animus, and discrimination."

Featured

Ford veteran returns after brief stint at Uber

Alan Diaz / AP

Sherif Marakby, an automotive executive who left Uber in April after one year, has re-joined Ford, where he previously spent 25 years, according to the Wall Street Journal. Marakby will be a vice president overseeing the company's self-driving and electric-car businesses.

The news comes a few days after Ford abruptly named James Hackett as its new CEO, replacing Mark Fields. Hackett was previously heading the company's Smart Mobility division.

Between the lines: Marakby's departure from Uber was only the latest amid a slew of controversies around the company, including an ongoing lawsuit from Alphabet's self-driving car unit, Waymo. And with Detroit's increasing focus on keeping up in the autonomous driving race and rethinking car ownership models, it's no surprise to see Marakby being wooed back by Ford, which has been heavily investing in those areas over the past year.

Featured

U.K. resumes sharing intel with U.S.

Matt Dunham / AP

The U.K. has resumed sharing intel with the U.S. according to the U.K. Home Secretary, Reuters and BBC report. This comes after the U.K. halted sharing intel with U.S. officials due to undesired leaks to the media about the Manchester bombings and photos of the crime scene.

Why now? U.K. counter-terrorism officers reportedly received assurances today about the U.S. Earlier today Trump said he had asked the DOJ to launch review of the leaks and threatened prosecution.

Featured

Millennials want to buy houses, but not save for them

Keith Srakocic / AP

Avocados aside, almost 80% of millennials plan to buy a home at some point, but aren't prepared for it, according to a study by Apartment List. The study also found that many millennials, especially those in metropolitan areas, significantly underestimate how much a down payment will cost them.

  • Almost 70% of 18- to 34-year-olds have saved less than $1K for a down payment.
  • 40% don't save at all on a monthly basis — even among 25-34 year olds who historically have owned or would be soon owning a home already.
  • Millennials making less than $24K typically save about 10% in general, while those who make more than $72K only save 3.5%.
  • Less than 30% of 25- to 34-year-olds can save enough for a 10% down payment in the next three years.

Why: In the survey, not being able to afford to buy a home was the biggest determent, followed by not being ready to settle down or waiting to get married. Student debt, rent and delayed careers due to the recession could all attribute to the affordability problem, as well as trends in urban areas to spend more on food and entertainment, Wall Street Journal points.out.


Featured

Zuckerberg: We need more purpose

Steven Senne / AP

Mark Zuckerberg told Harvard's graduating Class of 2017 Thursday that strong projects creating a sense of purpose for everyone involved. He said his hardest times at Facebook came about when he didn't take the time to explain the purpose of the project.

His call to action: Let''s "do big things not just to create progress, but to create purpose...You are graduating into a world that needs purpose. It's up to you."

His advice to those with big ideas: "Be prepared to be misunderstood."

What pop culture gets wrong about tech and innovation: "The idea of a single eureka moment is a lie," which he says is detrimental to future innovators who tend to think, "we feel like we just haven't had ours yet." Also, "no one writes math formulas on glass."

Here's everything Zuckerberg says our society needs right now:

  • "How about stopping climate change before we destroy the planet and getting millions of people involved installing solar panels?"
  • Track health data and share genomes
  • "Invest in cures so people don't get sick"
  • "How about modernizing democracy so everyone can vote online?"
  • "And how about personalizing education so everyone can learn… continuous education through our lives"
  • "Let's do it in a way that gives everyone" a role
  • "We need affordable child care"
  • "Healthcare that's not tied to just one employer"
  • "We need a society that's less focused on locking us up and [that] stigmatizes us when they do"
  • Eliminate income inequality
  • Deal with automation and self-driving trucks
His take on globalization: "There are people left behind by globalization…It's tough to care about other people when we don't feel good about our lives at home. There's pressure to turn inward."
Zuckerberg was accepted into Harvard as a member of the Class of 2006 and today received a Doctor of Laws with the Class of 2017.
Featured

OPEC down for "whatever is necessary" to raise oil prices

Ronald Zak / AP

Following a series of meetings between OPEC and non-OPEC countries in Vienna Thursday, Saudi Arabia's energy and oil minister, Khalid Al-Falih announced that all members will do "whatever is necessary to balance the markets," even if that means further extending cuts in oil output past March 2018.

Why March? Earlier today, the group agreed to extend its November deal to cut oil output by nine months. Al-Falih said that although they believe they will hit their desired target by the end of the year, the three-month extension should help with any buildup of stocks.

Conformity to deal: "The conformity level from the members is exceptional. We have reached 102% of overall conformity, so we are even exceeding our commitment," said Al-Falih. Russia's minster of energy, Alexander Novak, also noted that his country reached full conformity at the end of April.

The caveat: Despite Al-Falih's boasting of such high conformity, not all OPEC and non-OPEC members who agreed to cut oil output by 1.8 million barrels a day are keeping up their end of the bargain. Iraq is just one example of cheating the agreement. According to Bloomberg, Iraq produced roughly 80,000 more barrels of oil a day than permitted.

Next meeting: All OPEC and non-OPEC members will meet again on November 30, 2017. Al-Falih said that the two groups are considering extending their close alliance and continuing to work together beyond 2017 and the nine-month extension.

  • 14 OPEC countries, as of January 2017: Algeria, Angola, Ecuador, Equatorial GuineaGabon, Iran, Iraq, Kuwait, Libya, Nigeria, Qatar, Saudi Arabia (the de facto leader), United Arab Emirates, and Venezuela.
  • 10 non-OPEC countries: Azerbaijan, Bahrain, Brunei, Kazakhstan, Malaysia, Mexico, Oman, Russia, Sudan and South Sudan.
Facts Matter Featured

What is NATO Article V and where does Trump stand on it?

Matt Dunham / AP

The issue

At a NATO leaders meeting May 25 President Trump did not explicitly endorse the collective defense article, Article V, of the North Atlantic Treaty, which binds member nations to defend one another if one comes under attack.

The facts

Trump was expected to make a commitment to Article V in the speech, but then stopped short of doing so. He did discuss shared "commitments," using the example of the September 11 attacks (the only time Article V has been invoked):

"We will never forsake the friends who stood by our side. And we will never waver in our determination to defeat terrorism and to achieve lasting prosperity and peace."

Why it matters

Article V is the cornerstone of NATO, and NATO member countries have been waiting to hear Trump confirm the U.S. will honor it, especially as he has repeatedly stressed that not all members are paying their fair share of defense spending and once called the alliance "obsolete." After the backlash to the omission, Sean Spicer stepped in to explain they're "not playing cutsie" and that Trump is "fully committed" to Article V.

Featured

Ryan says Congress will move up deadline on debt ceiling

Andrew Harnik / AP

House Speaker Paul Ryan told investors Thursday that Congress will move up its deadline to raise the debt ceiling to avoid an economic default, reports AP. Congress was initially expected to vote on the debt limit this fall.
"The debt ceiling issue will get resolved."
—Paul Ryan
Timing: His reassurance comes a day after Treasury Secretary Mnuchin warned that Congress needs to vote to raise the nearly $20 trillion ceiling before their August recess.
Featured

Trump to Macron: "You were my guy"

Peter Dejong / AP

French officials said today that President Trump denied having supported far-right nationalist Marine Le Pen in the recent French presidential election while meeting with French President Emmanuel Macron today. Instead, Trump told Macron:

You were my guy.

Worth noting: While it certainly seems like Le Pen's nationalist positions would have endeared her to Trump, he stopped short of endorsing her in an April interview with the AP: "No, I have no comment on [endorsing Le Pen], but I think that [the April 20 shooting of Paris police officers] will probably help her because she is the strongest on borders and she is the strongest on what's been going on in France."

Featured

Senate will start putting together draft health care bill next week

(Jacquelyn Martin / AP)

After three weeks of working group meetings, Senate Republicans will begin drafting their version of a health care bill over next week's recess.

"Over the break, initial legislation will be drafted, and then we'll have more time — we'll actually have a basis to discuss on these things," Sen. Ron Johnson told reporters, saying leadership and committee staff will write the bill.

What to watch: While we expect the Senate bill to take on some the same basic policy structure as the House bill, some pieces are subject to change — particularly after the release of the Congressional Budget Office score yesterday. There's a lot of hesitation to include state waivers that allow states to opt out of the Affordable Care Act ban on charging sick people higher premiums, and the Medicaid per-person funding growth rate debate is still unresolved.