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Good morning ... Who's ready for another Axios event? Today's the day of our Future Shapers event in Chicago on mental health care. It's hosted by Mike Allen, and it's going to look at the latest in technology and biopharmaceuticals, with important context from advocates. Details here.

And quick reminder that Vitals is on special spring break schedule this week, so we'll be back on Thursday. Now, let's get to it....

The Freedom Caucus wins the Obamacare town halls

Caitlin Owens hit the road to two House Republican events over the recess — a town hall by a moderate Republican in Colorado last week, and a constituent event by a Freedom Caucus member in Florida last night. The takeaway, she writes this morning, was pretty clear: the Freedom Caucus has had a way easier recess than the moderates.

  • Rep. Mike Coffman, the moderate Republican, got scolded by liberals for supporting Trumpcare, while some Republicans thought the bill would just make Obamacare's problems worse.
  • Rep. Ron DeSantis, the Freedom Caucus member, breezed through his event, which was designed to minimize conflict. And some of his constituents figured that by opposing Trumpcare, he saved them from a bad bill.
The bottom line: The town halls show that moderates have the most to lose, and nervous members may become even more reluctant to vote for Trumpcare — but the Freedom Caucus is probably going to get even bolder in challenging GOP leadership.

More trouble ahead for Obamacare insurer payments

If DeSantis is any indication, it may not be easy to get the Freedom Caucus members to sign off on a government funding bill that includes payments to insurers for those Obamacare cost-sharing subsidies — even if Republicans agree to fund them.

Here's what he told Caitlin last night, referring to the ongoing House GOP lawsuit against the payments: "After going to court against it, you're going to then turn around and appropriate it? I just couldn't imagine that the leadership would do that. I mean, absent major concessions from the Democrats."

The consequences: Insurers are trying to get some clarity from Trump administration officials in a meeting today, because they say they can't even price their Obamacare health plans for next year without knowing what's going to happen. Tom Policelli of Minuteman Health, a nonprofit insurer, tells the Wall Street Journal that the signals from Washington are "swerving day by day ... we can't change our pricing model day by day."

Trumpcare isn't helping the GOP

Andrew Witherspoon / Axios

This is from the Pew Research Center poll that came out yesterday: Democrats now have a 19-point advantage over Republicans on who does the best job on health care. They've always had a bit of an advantage, except for the rockiest period right before the full implementation of Obamacare. But this is easily the biggest gap since Obamacare was passed.

Why it matters: Republicans are feeling a lot of pressure to reach an agreement so they can repeal Obamacare — mostly to fulfill their campaign promises — but it's not going to get any easier for them if the polling doesn't get better.

One big thing to watch: hospitals' pay-first policies

This Reuters article from last week caught the eye of Axios contributor Steven Brill — he says it's more important than the next 10 stories you'll read about Trumpcare. It's about something that's real and happening now: Hospitals, facing increasing amounts of unpaid patent debt because deductibles are now so high, are getting more aggressive about getting paid by patients in advance.

Why it matters: Patient debt is not really about Obamacare or its possible replacement. It's about how insurance policies covering tens of millions of Americans now require so much in the way of out of pocket expenses that hospitals (and doctors and labs, too) are increasingly asking patients to pay their shares up front, or to take out bank loans arranged by the hospital to cover the charges.

The good news: At least it forces hospitals to tell patients beforehand how high their bills are going to be. And it is encouraging the most community-minded among them to work with patients in advance to apply for financial aid under the hospitals' charity care policies.

The bad news: The upfront sticker shock is causing lots of patients to defer care, which is no surprise in light of a recent Kaiser Family Foundation poll reporting that 45 percent of Americans would have trouble paying a sudden $500 medical bill.

Why the Chamber cares about those Obamacare payments

You expect to see health insurers pushing President Trump and Congress to pay for those Obamacare cost-sharing subsidies — but the U.S. Chamber of Commerce has been beating that drum too, in a big way. It co-signed the insurers' letter to Trump and congressional leaders last week, and it reinforced the message in a blog post under the headline: "Don't Let the Individual Health Insurance Market Implode."

So what is the Chamber's stake in the fight? Stability, according to spokeswoman Blair Latoff Holmes. That's "critical" to Chamber members, she says — and besides, the payments are "legitimately expected by the insurers."

Artificial Intelligence is really good at predicting heart attacks

Better than the guidelines doctors use, in fact. That's the conclusion of a new study written up in Science magazine. Here's how they tested it: A UK epidemiologist and his colleagues tested four machine-learning algorithms against the doctors' guidelines, to see how well they could predict which patients would have heart troubles based on 2005 medical records. Sure enough, the artificial intelligence programs did a better job of predicting who actually had heart attacks and other problems within the next 10 years.

What it means: If computers can teach themselves, they may be able to account for a lot of random factors with people's health, more than doctors can keep track of themselves. If these programs had actually been used, the study's authors said, 355 people's lives could have been saved.

Yes, but: Given how much trouble doctors have had with electronic medical records, are they really going to be enthusiastic about adding even more technology to their practices?

A quiet victory for the ankle industry

That's right, the ankle industry. Don't thank me — thank Bob Herman. He found a big policy change buried on page 155 of Friday's Medicare payment rule — one that benefits providers and medical device companies that are involved with ankle replacement surgeries.

What Big Ankle wins: A lot more Medicare money. The federal government proposed moving all ankle replacements from a broad, lower-paying joint category into a higher-paying Medicare code (MS-DRG 469 for all you wonks out there) based on comments from unnamed "requestors." That would bump up average baseline Medicare payments for ankle replacements by more than 60 percent, to almost $20,000, based on this 2015 document from Wright Medical Group, a medical device manufacturer.

The winners: Stryker, Wright Medical Group, Zimmer Biomet and other companies that make the screws, implants and other components of ankle replacement surgeries. The doctors who perform the procedures also would get more money.

What we're watching today: Our mental health event, of course. It starts at 3 p.m. Central. Livestream here. Also, Centers for Medicare and Medicaid Services chief Seema Verma meets with insurance executives. And UnitedHealth Group and Johnson & Johnson report their first-quarter earnings before the market opens.

What we're watching this week: More GOP town halls.

Thanks, and if you see any other weird industry victories hidden in that Medicare rule, let me know: david@axios.com.

Featured

Sneak Peek: Pence to the pyramids

Pence listens as Trump announces his Jerusalem move. Photo: Alex Brandon / AP

With President Trump's announcement on Jerusalem lighting up the Middle East, Vice President Mike Pence embarks Saturday on his first trip to Israel since taking national office.

The vice president will be gone for a week, with stops in Egypt and Germany:

  • Pence takes off from Washington, lands in Tel Aviv and goes straight to Jerusalem for a bilateral meeting with Israeli President Benjamin Netanyahu.
  • Pence then will light a menorah at the Western Wall.
  • An aide said that Pence's message in Israel will be that Trump, as he said in his speech recognizing Jerusalem as the capital, is committed to working for peace between Israelis and Palestinians.
  • Pence will use his meetings with leaders in the region to reaffirm the administration's commitment to work with partners throughout the Middle East and to "defeat radicalism."
  • On Monday, Pence will give the signature speech at the Knesset, the Israeli Parliament. The speech will be aimed at the region overall. Pence will emphasize that he is there on behalf of the president, and detail why Israel is a most cherished ally of the United States.
  • Pence will then fly to Cairo for a bilat with President Abdel Fattah el-Sisi. The two will discuss security and joint efforts to fight ISIS.
  • Pence will visit the pyramids and will talk with media with the ancient wonders as a backdrop.
  • Pence will fly home through Ramstein Air Base in Germany, and will do a meet-and-greet with troops.

The takeaway: A key theme for Pence's remarks and interviews will be U.S. efforts to stop persecution of Christians and other religious minorities in the region.

Go deeper: Palestinians won't meet with Pence.

Featured

Exclusive: Policy official leaving White House

The White House South Portico is adorned with Christmas lights. Photo: Manuel Balce Ceneta / AP

Paul Winfree is leaving the White House, according to a senior administration official with knowledge of the decision. Winfree, who declined to comment, has resigned from his position as Deputy Director of the White House Domestic Policy Council and Director of Budget Policy.

  • Why this matters: Winfree's departure is part of what we've been forecasting will be a wave of White House staff departures after year one of the Trump presidency. His last day in the White House will be Friday.

Winfree, a respected policy wonk with strong ties to the conservative movement, is the second senior official to announce a departure in three days. Deputy National Security Adviser Dina Powell told colleagues she's leaving to return to her family in New York.

What Winfree has been telling friends and colleagues:

  • He and his wife are expecting a second baby boy in a few weeks.
  • He'll return to the Heritage Foundation, where he will run economic policy.
  • He also plans to start his own policy consulting business. -
  • Starting in February, he will teach a seminar on policymaking at a top university, where he will draw on his experiences working in the White House, the U.S. Senate, and with think tanks.
Featured

NYPD adjusts interview techniques for sexual assault victims

New York police officers march. Photo: Andres Kudacki / AP

Amid a flood of sexual misconduct allegations — some of which have turned into police investigations — the New York Police Department has taken a new approach to questioning victims, the Wall Street Journal reports.

The bottom line: "The focus that’s occurring on sexual criminal conduct coming out of the Hollywood celebrities and members of Congress may be a watershed moment,” NYPD Deputy Chief Michael Osgood told the Journal. He says more sensitive and open-ended questioning techniques may lead to breakthroughs in cold cases that have been abandoned for years.

The backdrop: Police tactics in dealing with victims of sexual assault have long been controversial, with critics saying harsh questioning puts undue scrutiny on victims and pushes them to silence. These critcisms were thrown into the spotlight when ProPublica, in conjunction with the Marshall Project, published "An Unbelievable Story of Rape" — an investigative project which showed how a police department in Washington state coerced a woman into retracting a rape allegation.

NYPD detectives in the Special Victims division received training in Forensic Experiential Trauma Interview (FETI) techniques this year. The methods include asking victims of sexual assault open-ended questions such as, "Tell me about your experience," instead of specifics about the perpetrators appearance and the time and place of the incident.

How it works: Such specific details are "stored in the prefrontal cortex of the brain, which shuts down during traumatic events. In FETI training, the detectives are instructed to ask broad questions that tap into a victim’s primitive brain, which maintains sensory information of those events. Channeling this part of the brain can result in a more substantial narrative," per Osgood.

Featured

White House: "Unfortunate" that Palestinians won't meet with Pence

Vice President Pence's office has called the decision by Palestinian officials not to meet with Pence on his visit to the region "unfortunate. The Palestinians are refusing to meet with Pence over President Trump's decision to recognize Jerusalem as Israel's capital. The statement:

"The Vice President very much looks forward to traveling to the region to meet with Prime Minister Netanyahu and President el-Sisi. It’s unfortunate that the Palestinian Authority is walking away again from an opportunity to discuss the future of the region, but the Administration remains undeterred in its efforts to help achieve peace between Israelis and Palestinians and our peace team remains hard at work putting together a plan."
Featured

The mental health crisis among young Americans, by the numbers

Illustration: Sam Jayne / Axios

One in five American young adults under the age of 25 lives with a mental illness or behavioral disorder, NBC reports, citing the Centers for Disease Control and Prevention.

The big picture: Per the CDC's research, the state of young adult mental health in the U.S. is only worsening, with the suicide rate among teenage girls reaching a 40-year high in 2015. Here's a look at the numbers that tell the story of this crisis.

The numbers:

  • 15 million, or 1 in 5, American children and young adults battle mental illnesses or learning disorders.
  • 10 million, or two-thirds of them, are undiagnosed or aren't receiving treatment.
  • Among children ages 3 to 17: 6.8% are diagnosed with ADHD, 3.0% suffer from anxiety, 2.1% suffer from depression
Featured

The case that bitcoin is a bubble

A man uses a Bitcoin ATM in Hong Kong. Photo: Kin Cheung / AP

The case against bitcoin, stated concisely by the Economist:

"It seems that every day, Bitcoin seems to hit a new high. But the reported price can move up and down by $1,000 or so within a few hours. This might have made it a great investment for those who got in at the right price and are nimble enough to get out in time. But it doesn't make it a useful means of exchange. When the price is rising fast, those who use bitcoin will be reluctant to part with it; when the price falls, those who sell goods will be reluctant to accept it."

Bitcoin as bubble: "This blogger remains convinced it is a bubble. Indeed its exponential rise only reinforces the argument. The beauty of bitcoin is that its intrinsic value is impossible to determine and that makes any value plausible to true believers. This is not the same as saying there is no merit in electronic currencies or blockchain technology; of course there is. But the range of prices which can be found on cryptocompare shows this is a narrow, illiquid market."

Go deeper: Read the whole article for an excellent Monty Python reference.

Featured

The state of racial inequality in 12 major U.S. cities

The March Against Racism in Boston Common in 1974. Photo: Frank C. Curtin / AP

A deep-dive into racial inequities from the Boston Globe's Spotlight team reveals the cities where gaps between white and black residents are closing and the cities where little has changed since the 1970s.

The big picture: A survey commissioned by the Globe found that 54% of African-Americans feel Boston isn't welcoming to people of color, the highest of the cities surveyed. That percentage is 34% for Chicago and 28% for New York. Atlanta fares best, at 16%.

Boston

  • 7% of residents are black; 73% are white
  • 54% of African-Americans believe the city is unwelcoming to people of color
  • 4 neighborhoods have visible black middle class populations meaning, per the Globe's analysis, "At least 15 percent of the residents are black; and among the black residents, at least 30 percent had a four-year college degree and their household income was at or above the median for their metro area."

New York

  • 16% of residents are black; 48% are white
  • 28% of African-Americans believe the city is unwelcoming to people of color
  • 150 neighborhoods have visible black middle class populations

Washington, D.C.

  • 25% of residents are black; 47% are white
  • 119 neighborhoods have visible black middle class populations

Philadelphia

  • 20% of residents are black; 63% are white
  • 34% of African-Americans believe the city is unwelcoming to people of color
  • 36 neighborhoods have visible black middle class populations

Chicago

  • 17% of residents are black, 54% are white
  • 34% of African-Americans believe the city is unwelcoming to people of color
  • 33 neighborhoods have visible black middle class populations

Atlanta

  • 33% of residents are black; 49% are white
  • 16% of African-Americans believe the city is unwelcoming to people of color
  • 110 neighborhoods have visible black middle class populations

Dallas

  • 15% of residents are black; 49% are white
  • 50 neighborhoods have visible black middle class populations

Houston

  • 17% of residents are black; 38% are white
  • 57 neighborhoods have visible black middle class populations

Miami

  • 20% of residents are black, 33% are white
  • 24% of African-Americans believe the city is unwelcoming to people of color
  • 38 neighborhoods have visible black middle class populations

Los Angeles

  • 6% of residents are black; 31% are white
  • 24 neighborhoods have visible black middle class populations

Charlotte

  • 35% of residents are black, 45% are white
  • 38% of African-Americans believe the city is unwelcoming to people of color

San Francisco

  • 6% of residents are black, 54% are white
  • 34% of African-Americans believe the city is unwelcoming to people of color
  • 9 neighborhoods have visible black middle class populations

Go Deeper: The full piece from the Globe is well worth the click.

Featured

Nikki Haley: Trump's accusers deserve to be heard

Diverging from the White House line, UN Ambassador Nikki Haley said on CBS' "Face the Nation" that the women accusing President Trump of sexual harassment and assault "should be heard."

"I know that he was elected, but, women should always feel comfortable coming forward and we should all be willing to listen to them," she said. Press Secretary Sarah Sanders has denied all of the dozen-plus claims and said Thursday that "the people of this country addressed" the allegations when they elected Trump.

Featured

Sen. Shelby says Alabama "deserves better" than Roy Moore

Shelby. Photo: Alex Brandon / AP

Richard Shelby, Alabama's senior senator, told Jake Tapper on CNN's "State of the Union" Sunday that the Ethics Committee will have to investigate Roy Moore should he be elected on Tuesday, and the Senate will have to make a decision as to whether he's fit to serve.

Why it matters: As the NY Times' Jonathan Martin notes, "The most senior Ala R goes on nat’l TV to torpedo his would-be colleague!... Shelby has been in Cong for 40 years. He knew exactly what he was doing accepting this Sunday show invite."

  • "I'd rather see the Republican win, but I'd rather see a Republican write-in. I couldn't vote for Roy Moore. I didn't vote for Roy Moore."
  • "There's a tipping point.... When it got to the 14-year-old's story, that was enough for me."
Featured

Trump: View each day as TV episode

A TV is on in the West Wing of the White House. Photo: Susan Walsh / AP

Read this sentence twice to understand this year and Trump: "Before taking office, Mr. Trump told top aides to think of each presidential day as an episode in a television show in which he vanquishes rivals."

  • That's from a juicy N.Y. Times tour de force on the president's style and habits, "The President vs. the Presidency ... Inside Trump's Hour-by-Hour Battle for Self-Preservation," by Maggie Haberman, Glenn Thrush and Peter Baker.

It's been one helluva season for this Trump show:

  • "Around 5:30 each morning, President Trump wakes and tunes into ... CNN for news, moves to 'Fox & Friends' for comfort and messaging ideas, and sometimes watches MSNBC's 'Morning Joe' because, friends suspect, it fires him up for the day."
  • "Trump spends at least four hours a day, and sometimes as much as twice that, in front of a television, sometimes with the volume muted."
  • "Watching cable, he shares thoughts with anyone in the room, even the household staff he summons via a button for lunch or for one of the dozen Diet Cokes he consumes each day."
  • "Trump is an avid newspaper reader who still marks up a half-dozen papers with comments in black Sharpie pen ... [Steve] Bannon has told allies that Mr. Trump only 'reads to reinforce.'"
  • "As he ends his first year in office, Mr. Trump is redefining what it means to be president. He sees the highest office in the land ... as a prize he must fight to protect every waking moment, and Twitter is his Excalibur. Despite all his bluster, he views himself less as a titan dominating the world stage than a maligned outsider engaged in a struggle to be taken seriously."
  • "Trump still takes shots at Mark Cuban, a fellow rich-guy reality star, and expresses disappointment that Tom Brady ... has distanced himself."
  • After dinner, he "sometimes 'hate-watches' CNN to get worked up, especially Don Lemon."
  • "In between, it is time for phone calls ... In recent weeks, Mr. Trump's friends have noticed a different pitch, acknowledging that many aides and even his own relatives could be hurt by Mr. Mueller's investigation. As for himself, he has adopted a surprisingly fatalistic attitude ... 'It's life,' he said of the investigation."
  • "From there it is off to bed for what usually amounts to five or six hours of sleep."
  • Get your Sharpie out.

P.S. The article has this footnote: "Glenn Thrush contributed to this article before he was suspended pending the result of an investigation into allegations of inappropriate behavior. Matt Apuzzo also contributed reporting."