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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 Brings back bad memories of when I lost at miniature golf on my 7th birthday, and then got repealed.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.

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Graham-Cassidy could delay tax reform rollout

Sen. Lindsey Graham speaks at the Capitol last week. Photo: Andrew Harnik / AP

Administration officials have been debating whether to delay the tax rollout until the first week of October to clear space for the Graham-Cassidy health care bill. Sources with direct knowledge tell me no final decisions have been made as of Wednesday afternoon, but Trump has been impatient for tax reform to begin so he may not tolerate any more delays.

Why it matters: Sources involved say the plan is still to roll out tax reform next week, but some officials are wringing their hands about the health care bill — the Senate could vote as early as Wednesday — ruining tax reform's launch week by sucking all of the attention away from tax.

Why it's happening: Trump wants tax reform on schedule, but the Senate is running out of days to use reconciliation to change elements of the Affordable Care Act. Meanwhile, there is concern of potential leaks from the upcoming House Ways and Means Committee retreat, and the "Big Six" that's negotiating the plan has yet to decide what to put in the document that will guide tax reform.

  • An administration official told me the White House invited Big Six communications and coalitions teams to the Roosevelt Room on Wednesday afternoon to discuss what a rollout of tax reform would look like.
  • The group is still operating under the assumption that the rollout will happen next week as originally planned.
The "Big Six": House Ways and Means Committee chairman Kevin Brady, House Speaker Paul Ryan, Senate Majority Leader Mitch McConnell, Senate Finance Committee chairman Orrin Hatch, Treasury secretary Steven Mnuchin and White House economic adviser Gary Cohn.
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Mueller's probe shifts to Trump's presidency

Robert Mueller testifies on Capitol Hill in 2013. Photo: J. Scott Applewhite / AP

Special Counsel Robert Mueller has sent the White House a request for documents pertaining to some of President Trump's most controversial moves in office, per a report from The New York Times. The news suggests that at least part of the Russia probe is focused directly on Trump's time as president.

What Mueller wants: Trump's meeting with high-ranking Russian officials in the Oval Office the day after Comey's firing; the events leading to the firing of Michael Flynn; and the White House's response to questions from NYT about Donald Trump Jr.'s Trump Tower meeting with Russian officials.

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Artificial intelligence pioneer calls for the breakup of Big Tech

Illustration: Lazaro Gamio / Axios

Yoshua Bengio, the artificial intelligence pioneer, says the centralization of wealth, power and capability in Big Tech is "dangerous for democracy" and that the companies should be broken up.

Why it matters: Bengio is a professor at the University of Montreal and a member of the three-man "Canadian Mafia" that pioneered machine learning, the leading method used in AI. His remarks are notable because of his influence in the AI community and because he or his peers all either directly lead or consult for Big Tech's AI programs. Says Bengio: "Concentration of wealth leads to concentration of power. That's one reason why monopoly is dangerous. It's dangerous for democracy."

The AI pioneers: Bengio consults for IBM and his colleagues Geoffrey Hinton consults for Google and Yann LeCun for Facebook. Ruslan Salakhutdinov, a protege of Hinton's, runs Apple's AI research effort.

Benigo said the concentration of resources, talent and knowledge among giant tech companies is only increasing and governments must act. "We need to create a more level playing field for people and companies," Bengio told Axios at an AI conference in Toronto last week.

In recent years, Apple, Facebook, Google and Microsoft have amassed a towering lead in AI research. But now, they are subject to growing scrutiny because of their outsized influence on society, politics and the economy. I asked Bengio if the companies should be broken up. He harrumphed and responded that anti-trust laws should be enforced. "Governments have become so meek in front of companies," he said.

"AI is a technology that naturally lends itself to a winner take all," Bengio said. "The country and company that dominates the technology will gain more power with time. More data and a larger customer base gives you an advantage that is hard to dislodge. Scientists want to go to the best places. The company with the best research labs will attract the best talent. It becomes a concentration of wealth and power."

When some of the young people gathered around him looked a bit dejected, Bengio responded, "Don't despair — fight."

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After summer of historic lows, Trump's popularity improves

Photo: Carolyn Kaster / AP

After several months of reaching record-lows in approval, new polls are showing President Trump's ratings beginning to climb upwards, according to Politico.

  • POLITICO/Morning Consult: 39% last month vs. 43% this week
  • Gallup: 35% last month vs. 38% last week
  • RealClearPolitics average: 37.4% August 14 vs. 39.9% September 20

How it happened: Politico reports Trump's responses to hurricanes Irma and Harvey helped his approval, after his ratings taking a over Charlottesville. Also, while his decision to end DACA was unpopular, he gained momentum from his negotiation with Sen. Schumer and Rep. Pelosi. But, his "popularity still remains historically low for a first-year president."

Other findings: Trump's upward trend over the past month is bigger with independents (+5%) than Republicans or Democrats (both +2%).

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Howard Schultz: Companies need to balance profit and conscience

AP

Howard Schultz, who rose from the projects in Brooklyn to create Starbucks, is making it a personal mission to find jobs for some of the least-advantaged and, in his view, most deserving in the United States: veterans and their families, refugees, and, with a job fair today, young people who are neither going to school nor working.

Why it matters: Schultz and his partners are attempting to pull a much-overlooked segment of U.S. society into the work force at a time that public hostility is driven in large part by low and stagnant salaries, and deep pockets of joblessness in inner cities and rust belts.

We caught up with Schultz at the Convention Center in downtown Washington, DC, where Starbucks and about a dozen other companies were conducting interviews with some 1,800 job-seekers aged 16 to 24 years old, seeking to hire as many as possible on the spot, and others over the coming months.

The background: The official national unemployment rate is just 4.4%, but we all know that statistic camouflages a world of misery: Among it is an 11.7% jobless rate for people 16 to 24 — those trying to just get started — and worse for black youths (14.6%) and Latinos (11.9%). Between the lines are young people who have dropped out of school, are jobless, have a criminal record, or are a parent.

Schultz's organization is attempting to attack the whole crippling system. Downstairs from where we spoke, there was a place for job applicants to leave their child while they were interviewed; a place to type up a quick resume; a place to put on a tie and jacket; and one for makeup. For those hired on the spot, there was advice for finding a place to stay, for public transportation, and child care. Companies, Schultz said, need to find "a balance between profit and conscience."

A need for "truthfulness": Regardless of what I asked in our quick, 15-minute chat, Schultz kept returning to what he said the country sorely needs — civility and respect toward one another. "There is a need for more truth and more transparency, not only because of Donald Trump becoming president," he said. "We've needed that for some time. There is a great need for servant leadership and truthfulness."

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Fed to begin reversing its huge stimulus program

Federal Reserve Chair Janet Yellen testifies before Congress. Photo: Pablo Martinez / AP

The Federal Reserve will begin selling off the government debt and mortgage bonds it amassed to help drive down interest rates and stabilize the housing market in the aftermath of the financial crisis, a move that signals the central bank's growing confidence in the U.S. economy.

Steady as she goes: The Fed will shrink the value of its portfolio of bonds by just $10 billion per month, a fraction of its $4.5 trillion stockpile. The modest nature of the move reflects the Fed's recognition that despite historically low unemployment rates, wage growth has been tame and inflation remains below the bank's 2% annual target.

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Obama: ACA is the reason "people are alive today"

Barack Obama delivers his speech during the 4th Congress of Indonesian Diaspora Network in Jakarta, Indonesia this July. Achmad Ibrahim / AP

While speaking at an event sponsored by the Bill and Melinda Gates Foundation today, former President Barack Obama said "people are alive today because of" the Affordable Care Act, "and when I see people trying to undo that hard-won progress…it is aggravating."

Obama ripped into the Graham-Cassidy bill, which proposes block grant funding to be distributed among the states. Obama said it would "raise costs, reduce coverage and roll back protections for older Americans, and people with pre-existing conditions." Based on current projections from consulting firm Avalere Health, health care cuts could top $4 trillion under this bill.

Other key quotes:

  • "Nationalist thought, xenophobic sentiment ... a politics that threatens to turn good people away from the kind of collective action that has always driven human progress."
  • On climate change: It's the "threat that may define the contours of this century more than any other."
  • On the future of the internet: "I don't think we can count on conventional media to spread the word [of progress]. This is where the power of the internet has not been harnessed the way it needs to be, particularly when you think of young people and young audiences.
Watch Obama speak:

Obama is speaking across town from Trump's UN appearance.

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Trump tells leaders his friends are going to Africa "to get rich"

President Trump addressed African leaders at a UN luncheon, and discussed the "tremendous potential" of Africa, particularly economically. He also said he was disturbed by violence in South Sudan and the Congo, and planned to send UN Ambassador Nikki Haley to Africa.

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Amazon reportedly talking to pharmacy benefit managers

Amazon may be trying to start building pharmacy contracts. Photo: Richard Drew / AP

Amazon may be talking with some middle-market pharmacy benefit managers "in an effort to get into various contract arrangements," according to analysts at investment bank Leerink Partners who spoke with pharmacy executives. Amazon may pursue a mail-order pharmacy that initially targets uninsured customers or people who have high deductibles and pay cash for most of their prescription drugs.

Reality check: The country is still a long way from Amazon handling people's prescriptions, if that time even comes. But conservations with prescription drug middlemen make it appear "that this is the direction Amazon is moving in," Leerink said in a report. Pharmacy executives who spoke with Leerink said it would take at least 18 to 24 months for Amazon to get proper drug licenses in 50 states. Amazon didn't immediately respond.

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Ransomware hack targeting 2 million an hour

This photo shows fingers on a laptop keyboard in North Andover, Mass. Elise Amendola / AP

A ransomware attack sweeping the globe right now is launching about 8,000 different versions of the virus script at Barracuda's customers, Eugene Weiss, lead platform architect at Barracuda, told Axios, and it's hitting at a steady rate of about 2 million attacks per hour.

Weiss' gut reaction on this hack: "What's remarkable about this one is just the sheer volume of it."

Here's what you need to know on the latest:

  • Automated hacking: "Nobody actually sat there and made 8,000 digital modifications," Weiss said. The way they do it is by using a kit that essentially automates code variations.
  • What to watch out for: An incoming email spoofing the destination host, with a subject about "Herbalife" or a "copier" file delivery. Two of the latest variants Barracuda has detected include a paragraph about legalese to make it seem official, or a line about how a "payment is attached," which tricks you to click since, as Weiss puts it, "everyone wants a payment."
  • The hackers are using social engineering to get people to click. That's increasingly becoming a trend, per Weiss. It's "less pure technical hacks" and instead using psychological tactics "get someone to click on something they shouldn't be."
  • If you remember one thing: "Don't click the link that is absolutely the most essential thing."
  • The targets: Email addresses at businesses or institutional groups in the U.S. or Canada.
  • It's likely not a nation-state perpetrating the hack, since the hackers' motives are financial. Instead it's a small, sophisticated group of criminals. The attacks are originating in Vietnam for the most part, as well as India, Colombia, Turkey, Greece, and a few other countries.
  • The future of global hacks: "At some point in the future you may see multilingual internationalized" hacks, Weiss said. In other words, they could be language-targeted. While the messages from these particular hackers are all in English so far, the virus programs are assessing the target computers' language settings.