KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Opioid Treatment Funds In Senate Bill Would Fall Far Short Of Needs

The $45 billion for opioid treatment in the Senate bill sounds like a lot of money, but an advocate estimates it would provide $1,000 to $2,000 per year for each person in Pennsylvania who might need treatment. Meanwhile, one year of methadone treatment for opioid addiction costs about $4,700 per year, (Ben Allen, WITF, 7/24)

Political Cartoon: 'Buck The System?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Buck The System?'" by Adam Zyglis, The Buffalo News.

Here's today's health policy haiku:

For GOP, Knowing The Plan Is A ‘Luxury We Don’t Have’

Don't know what's in it?
No problem — find out later
Like Democrats did.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

Senate Parliamentarian Tosses Another Roadblock Onto Already Bumpy Path To Health Vote

Senate parliamentarian Elizabeth MacDonough says Republicans would need 60 votes to maintain abortion-related provisions in their legislation, in addition to others, because they don't relate to the budget.

The New York Times: Senate Parliamentarian Challenges Key Provisions Of Health Bill
The provisions appear to violate Senate rules, the parliamentarian said, giving Democrats grounds to challenge them as the Senate prepares for a battle next week over the future of the Affordable Care Act. One provision questioned by the parliamentarian, Elizabeth MacDonough, and cherished by conservatives would cut off federal funds for Planned Parenthood for one year. Another would prohibit use of federal subsidies to buy insurance that includes coverage for abortions. (Pear and Kaplan, 7/21)

The Wall Street Journal: Parliamentary Rules Likely To Prevent Senate GOP From Defunding Planned Parenthood
Ms. MacDonough’s recommendations were released by Senate Democrats. “The parliamentarian’s decision today proves once again that the process Republicans have undertaken to repeal the Affordable Care Act and throw 22 million Americans off of health insurance is a disaster,” Sen. Bernie Sanders (I., Vt.), the most senior member of the Democratic caucus on the Budget Committee, said in a statement Friday. (Peterson, 7/21)

Politico: Parliamentarian Rules Against Key Provisions In Obamacare Repeal Bill
The parliamentarian's guidance — provided as part of a process known on Capitol Hill as a "Byrd bath" — amounts to a significant win for Democrats, who are aiming to eliminate as much from the health care bill as possible. But Republicans cautioned that the rulings apply to a prior version of the Senate bill, and GOP aides are already reworking some of the provisions flagged by the parliamentarian, according to one source familiar with the effort. GOP lawmakers faced similar obstacles over language eliminating Obamacare's individual and employer mandates when they drafted the 2015 repeal bill but overcame them through rewrites. (Haberkorn and Kim, 7/21)

Kaiser Health News: Senate Parliamentarian Upends GOP Hopes For Health Bill
The official rules keeper in the Senate Friday tossed a bucket of cold water on the Senate Republican health bill by advising that major parts of the bill cannot be passed with a simple majority, but rather would require 60 votes. Republicans hold only 52 seats in the Senate. Senate Parliamentarian Elizabeth MacDonough said that a super-majority is needed for the temporary defunding of Planned Parenthood, abortion coverage restrictions to health plans purchased with tax credits and the requirement that people with breaks in coverage wait six months before they can purchase new plans. (Rovner, 7/21)

Modern Healthcare: Parliamentarian's Rulings Jeopardize Senate GOP Repeal Bill
Senate GOP leaders could overrule the parliamentarian's decisions, a summary of which were posted on Democratic Sen. Bernie Sanders' website. But political observers say [Senate Majority Leader Mitch] McConnell will be reluctant to do so because that would jeopardize the future of the minority party's power to filibuster Senate legislation by denying it 60 votes. Some believe he would be more likely to overrule the parliamentarian if he is within one or two votes of passing the bill with those provisions intact. (Meyer, 7/22)

The Hill: Parliamentarian Deals Setback To GOP Repeal Bill 
In a statement, Planned Parenthood said it was "obvious" that the defunding provision would be a violation of the reconciliation rules. "No amount of legislative sleight of hand will change the fact that the primary motivation here is to pursue a social agenda by targeting Planned Parenthood," the group said. (Weixel, 7/21)

Health Care Efforts Edge Toward Chaos As Senators 'Don't Even Know' What Their Voting On

"I don’t know whether we’re proceeding to the House bill, a new version of the Senate bill, the old version of the Senate bill, the 2015 repeal-and-hope-that-we-come-up-with something-in-two-years bill. I truly don’t," Sen. Susan Collins (R-Maine) said. Senate Majority Leader Mitch McConnell (R-Ky.) is continuing his push for some vote this week.

The Washington Post: Senate Republicans Plan To Plow Ahead With Health-Care Vote This Week
The Senate returns to Washington on Monday with its GOP leaders determined to vote this week on their years-long quest to demolish the Affordable Care Act, even though the goal remains mired in political and substantive uncertainties. Central questions include whether enough Senate Republicans will converge on any version of their leaders’ health-care plan and whether significant aspects of the legislation being considered can fit within arcane parliamentary rules. (Goldstein, 7/23)

The Associated Press: GOP Health Bill Still A Mystery Before Planned Vote
The Senate will move forward with a key vote this week on a Republican health bill but it's not yet known whether the legislation will seek to replace President Barack Obama's health care law or simply repeal it. Sen. John Thune of South Dakota, the third-ranking Republican, said Senate Majority Leader Mitch McConnell will make a decision soon on which bill to bring up for a vote, depending on ongoing discussions with GOP senators. (7/24)

The Wall Street Journal: Senate Republicans Unsure Of What Health-Care Measure They Will Vote On
Some senators said Majority Leader Mitch McConnell (R., Ky.) has told them they would know before the vote whether they would be asked to allow debate on some version of a bill to repeal and replace the Affordable Care Act, or legislation that would repeal the ACA with a two-year expiration date. GOP leaders’ current strategy is to lean heavily on lawmakers to at least vote to allow debate on the bill, in the hopes that amendments and other tweaks could yield an agreement. (Andrews, Armour and Peterson, 7/23)

The Hill: Senate Heads To New Healthcare Vote With No Clear Plan 
The two leading options are a repeal-only bill or an updated version of the Senate’s repeal-and-replacement measure. But there has not been a breakthrough on either, despite senators holding a late-night meeting on Wednesday to try to revive the replacement bill. (Sullivan, 7/21)

Los Angeles Times: 'I Don't Even Know What We're Proceeding To Next Week.' Obamacare Vote Nears With Key Details Still Missing
The uncertainty so close to a major vote is feeding a growing sense of chaos on Capitol Hill, where GOP senators are openly fretting about the lack of information about legislation that could leave anywhere from 22 million to 32 million more Americans without health insurance. "I don’t even know what we’re proceeding to next week," said Maine Sen. Susan Collins, a centrist Republican who has called on her party’s leaders to take a more measured approach to fixing the current healthcare law. (Levey, 7/21)

Politico: McConnell's Last-Ditch Obamacare Strategy
Talking is no longer working. It's time to vote. Senate Majority Leader Mitch McConnell is taking the rare step of forcing his members to take a tough vote on an Obamacare repeal bill, H.R. 1628 (115), that is on track to fail, making them own their votes. (Haberkorn and Kim, 7/21)

Meanwhile, in other health care legislation news —

CQ Roll Call: Repeal Debate Clouds Next Important Health Bill
The day-to-day uncertainty over the Republican health care effort is causing angst among the supporters of the next high-priority health policy item on the Senate’s agenda: a bill to renew crucial Food and Drug Administration funding authorizations before they expire in September. The bill would give the FDA the ability to collect about $1.4 billion in fees from the prescription drug and medical device industries, money which pays the salaries of employees who review product applications. If the fee collection authority is not renewed before Sept. 30, those employees could be furloughed. In the meantime, the FDA would start making plans for reducing staff and would begin notifying affected employees. (Siddons, 7/21)

GOP Will Go Back To Drawing Board On Repeal If This Week's Vote Fails, Top Senator Promises

"It’s not a question of if, it’s a question of when," said Senate GOP Conference chairman John Thune (R-S.D.). Media outlets also look at where other lawmakers stand on the issue.

CQ Roll Call: Cruz And Lee: The Best Friends Who Sometimes Quarrel
When Utah Republican Mike Lee announced on July 17 that he could not support the latest version of the Senate health care bill, he parted ways with Ted Cruz, the Texas Republican with whom he’d worked on an amendment to allow health insurers to offer bare-bones health plans. Senate Majority Leader Mitch McConnell worked out a deal with Cruz, winning his support, but Lee said he wasn’t satisfied with the language. (Zeller, 7/24)

Milwaukee Journal Sentinel: Sen. Johnson Optimistic That Senate GOP Can Pass Health Care Reform
U.S. Sen. Ron Johnson said Friday he remains optimistic that Republicans will be able to pass health care reform legislation, arguing that leadership from President Donald Trump has kick-started the effort. ...Johnson also was one of the biggest advocates for delaying the vote in June, saying senators and their constituents needed more time to understand the effects of the bill before it went to a vote. (Guerra Luz, 7/21)

Denver Post: Cory Gardner Doubles Down On Promise To Address Health Care Reform
Over the shouts of protesters who sought to disrupt his speech, U.S. Sen. Cory Gardner on Friday told a conservative gathering that he would “address the issue of health care” in the coming week, doubling down on Republican promises to repeal Obamacare, even as the effort’s success is increasingly in doubt. Gardner’s comments at the Colorado Convention Center came on the opening night of the Western Conservative Summit — the second major conservative political conference in downtown Denver this week, as the American Legislative Exchange Council wrapped up its own annual meeting at a hotel across the street. (Eason, 7/21)

Cleveland Plain Dealer: Pence Puts Subtle Squeeze On Portman Over Healthcare At Columbus Fundraiser
Vice President Mike Pence on Saturday doubled down on his promise to repeal and replace the Affordable Care Act and tried to put some pressure on U.S. Sen. Rob Portman in the process. Appearing for the fifth time in one of the most contentious states over the healthcare debate, Pence guaranteed during his speech at the Ohio Republican Party state dinner that the healthcare bill currently stalled in the Senate was going up for a vote next week. (Richardson, 7/22)

And in more news on the Republicans' health care efforts —

The Hill: GOP Wrestles With Soaring Deductibles In Healthcare Bill
Senate Republicans have run into another problem in passing their ObamaCare replacement bill: It could increase deductibles by thousands of dollars, potentially alienating moderates who are already skeptical of the bill. An analysis released Thursday by the nonpartisan Congressional Budget Office (CBO) concluded that a single policyholder purchasing a standard benchmark plan under the GOP bill could face a deductible of $13,000 in 2026. (Hellmann, 7/22)

Modern Healthcare: Healthcare Groups Seek Alternatives To Kill ACA Taxes If GOP Repeal Effort Fails
With GOP efforts to gut the Affordable Care Act on the verge of derailing, healthcare industry groups seeking repeal of ACA taxes on their members are looking to hitch a ride on a new legislative train. ... But healthcare lobbyists say if those bills fail, industry groups will try to attach the tax repeals to other legislative vehicles, such as the bipartisan Food and Drug Administration user fee legislation, reauthorization of funding for the Children's Health Insurance Program, the 2018 omnibus budget bill, the Medicare extenders package or broader tax reform legislation. (Meyer, 7/20)

Kaiser Health News: Opioid Treatment Funds In Senate Bill Would Fall Far Short Of Needs
At a lunch last week, President Trump tried to persuade some reluctant senators to endorse repealing the Affordable Care Act. During the meeting, he mentioned a provision in the Senate Republican proposal that allocates funding for opioid treatment, saying, “We’re committing $45 billion to help combat the opioid epidemic, and some states in particular like that. ”But addiction treatment specialists warn that sum of money is far from enough to address a crisis that has escalated across the United States in recent years, killing tens of thousands of people. (Allen, 7/24)

Former CBO Chiefs Fire Back At Republicans' Attacks On Agency's Integrity, Professionalism

The directors wrote to congressional leaders to urge them to "maintain and respect the Congress’s decades-long reliance on Congressional Budget Office’s estimates in developing and scoring bills."

Politico: Former CBO Directors Hit Back At GOP Criticism Of Agency
All eight former directors of the Congressional Budget Office fired back Friday at Republican attacks on the nonpartisan scorekeeping agency over its projections that Obamacare repeal would leave millions more uninsured. In a letter to congressional leaders, the former chiefs wrote that the CBO has a long track record of producing high-quality and nonpartisan reports. (Cancryn, 7/21)

AMA Speaks Out Against Republicans' Health Care Plan

"Each bill results in millions more Americans without health insurance coverage, weakened markets, less access to affordable coverage and care, and the undermining of funding for state Medicaid programs," Dr. James L. Madara, the group's CEO, said in a letter to Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Chuck Schumer (D-N.Y.). Media outlets look at how small businesses and others are reacting to the proposed legislation, as well.

The Associated Press: Doctors' Group Tells Senate To Fix, Not Repeal 'Obamacare'
The nation's largest doctors' group urged senators on Friday to stop trying to repeal or replace Barack Obama's Affordable Care Act and instead begin a bipartisan effort to stabilize the insurance marketplace. The American Medical Association said proposed Republican bills — one to repeal and replace the 2010 health law, the other to repeal only — would cause too many people to lose coverage. (Johnson, 7/21)

The New York Times: Small Businesses Split Over Republican Health Plans
Small-business owners have been some of the most vocal opponents of the Affordable Care Act. One trade group fought the overhaul all the way to the Supreme Court. But for many solo entrepreneurs and freelancers, the seeming collapse of the Senate’s efforts to repeal and replace the law came as a relief. (Cowley, 7/23)

As Congress Tarries On Health Law Debate, Concerns Grow Among Medicaid Beneficiaries

Among the groups worried about future Medicaid payments are rural hospitals and schools with large numbers of students with special needs. Meanwhile, the friction among Kansas Republicans' priorities mirrors what's developing on the national scene, and Hawaii's Democratic congressional delegation seeks Medicaid help for other Pacific Islanders.

Modern Healthcare: No Signs Of Relief: Rural Providers Remain On Edge Over ACA's Uncertain Future 
The latest Republican effort to replace the ACA failed to garner enough vote to pass the Senate, leaving Medicaid programs as they are, for now. But rural healthcare providers such as [Fairview (Okla.) Regional Medical Center] remain concerned that the partisan wrangling over the healthcare law's future will just perpetuate the inertia over addressing the financial problems most rural hospitals now face. (Johnson, 7/22)

The Washington Post: Fear Of Medicaid Cuts Looms At School That Serves Students With Disabilities
At [St. Coletta Special Education Public Charter School in Southeast Washington], where all students have special needs, tiny pieces of progress can add up to life-changing trajectories. The school relies on funding from Medicaid to employ a cadre of therapists. But with each twist in the health-care debate on Capitol Hill, staff members wonder whether their Medicaid dollars could be at risk. (McLaren, 7/22)

Kansas City Star: Kansas Republican Rift Over Medicaid Expansion Now Stymies Obamacare
For years a small but growing group of Kansas Republicans have pushed to accept the ACA’s federal money to expand Medicaid eligibility to everyone who makes up to 138 percent of the federal poverty line. For years more conservative Kansas Republicans have successfully pushed back, arguing the state’s program should remain largely restricted to children, pregnant women, the elderly and people with disabilities. (Marso, 7/21)

CQ Magazine: Amidst Effort To Preserve Medicaid Funding, Hawaii Democrats Seek More Of It
As part of their failed effort, thus far, to repeal and replace the 2010 health care law, Republicans in Congress tried to cap spending on Medicaid, the state-federal program that provides health care to the poor and near-poor. Defenders of the Affordable Care Act are trying just to defend the status quo. So it runs against the grain that Hawaii Democrats are taking time to make a case that Medicaid spending should be expanded. The state’s two senators, Mazie K. Hirono and Brian Schatz, and its two representatives, Colleen Hanabusa and Tulsi Gabbard, have introduced legislation (S 1391 and HR 2982) to reinstate Medicaid coverage for citizens of three island nations in the Pacific Ocean that saw fighting between U.S. and Japanese forces during World War II — the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau — who are living in the United States. (Mauff, 7/24)

And in state Medicaid news —

Tampa Bay Times: Paralyzed Patients In Florida Fear Losing Health Care At Home
[Albert] Hort is one of about 500 Floridians with brain or spinal cord injuries who fear that a change in Florida health care law will force them out of their own homes and into nursing homes. That change — dropping a Medicaid waiver program and putting patients who were using it on managed care — also affects cystic fibrosis and AIDS patients who receive medical care at home. (Morgan, 7/24)

The Associated Press: DHS Won't Name Commenters On Plan To Drug Test Medicaid Applicants
The Wisconsin Department of Health Services is wrong to keep secret the names of people who publicly commented about Gov. Scott Walker’s proposal to drug-test Medicaid applicants, open records advocates and a former head attorney for the agency said. The department insisted it is doing what is required to protect health information under the federal Health Insurance Portability and Accountability Act, or HIPAA, as well as under state laws protecting the identity of Medicaid applicants. (Bauer, 7/24)

The CT Mirror: Report: Medicaid-Expansion States, Led By CT, Reduce Per-Person Costs
Per-person Medicaid spending in Connecticut dropped an average of 5.7 percent per year from 2010 to 2014, compared with an increase of 2.5 percent for private health insurance and an increase of 1.6 percent for Medicare, according to a analysis of federal data by Center for Medicare and Medicaid Services researchers published in the journal Health Affairs. The article cites the implementation of the Affordable Care Act as having the most widespread impact on the health sector nationwide in the 2010-2014 period. ... An influx of healthier Medicaid enrollees under the expansion is credited with helping to bring down costs. (Kara, 7/24)

Former Senator Who Faced Political Consequences Of ACA Vote Speaks Of Lessons Learned

“I believe that you have to be very cautious on promises, and very consistent on keeping your promises when you make them," former Sen. Ben Nelson of Nebraska says. In other news, former Rep. Bart Stupak shares the experience he had when Congress was moving to pass the Affordable Care Act.

Omaha World-Herald: Ex-Nebraska Sen. Ben Nelson, Whose Obamacare Vote Caused Controversy, Says Odds Are Against GOP On Health Care
Nearly eight years ago, Ben Nelson cast a U.S. Senate vote in favor of a version of the Affordable Care Act, and he’s still catching heat. The latest critic: President Donald Trump, who said this week that Democrats “ended up giving away the state of Nebraska” to win passage of the law in 2010. In an interview with The World-Herald on Thursday, Nelson said Trump and other critics misunderstand what actually happened, but he agreed with the president’s broader point: Passing a health care law was difficult for him and his fellow Democrats and is politically challenging for today’s Republicans. (Jordan, 7/21)

Roll Call: Stupak Shares Insider Look At Obamacare Debate In New Book
The former congressman opposed the House Democrats’ original health care bill because of provisions to pay for abortions, until he was able to add the Stupak-Pitts Amendment, which he wrote with former GOP Rep. Joe Pitts of Pennsylvania. It prohibited the use of federal funds to pay for an abortion or parts of the cost except in the case rape, incest or danger to life. It was adopted by the House in November 2009, but not included in the Senate’s version of the bill. During the arm-twisting and agonizing over the bill, Stupak said he spoke directly with President Barack Obama twice. They made a deal that Obama would issue an executive order to not allow abortion funding. (Gangitano, 7/24)


Trump Accused Of Deliberately Causing Confusion To Destabilize Marketplace

Democrats say all the competing messages coming from the White House over health care are part of a larger strategy to hurt the Affordable Care Act marketplaces. Meanwhile, President Donald Trump is planning to speak about health care on Monday.

The Associated Press: Mixed Signals From Trump White House On Health Care Strategy
Repeal and replace "Obamacare." Just repeal. Or let it fail — maybe with a little nudge. President Donald Trump has sent a flurry of mixed messages, raising questions about the White House strategy on health care. Democrats say Trump's confusing signals are part of a strategy to destabilize the Affordable Care Act, as a way to force recalcitrant Republicans in Congress to repeal former President Barack Obama's signature law. (Alonso-Zaldivar and Thomas, 7/22)

USA Today: Trump To Speak Monday On Health Care
President Trump on Monday will speak to the press at the White House about health care, minutes after meeting with what he calls “victims of Obamacare. ”The statement, announced late Sunday by the White House, comes nearly a week after Trump pressed Republican senators to agree to an alternative to the Affordable Care Act, otherwise known as Obamacare, before taking an August recess. (Toppo, 7/23)

Politico: GOP Despairs At Inability To Deliver
The Republican Party is more powerful than it’s been in more than a decade — and yet it has never seemed so weak. Continuing chaos in the White House has been punctuated by the failure to deliver on the GOP’s seven-year pledge to overhaul Obamacare, and has many asking whether the party can capitalize on the sweeping victories it has achieved at the federal, state, and local levels. (Johnson and Dawsey, 7/23)

Beyond Insurer Subsidies: What Else Trump Can Do To Nudge ACA Toward Collapse

The Hill and KHN look at the steps the administration can take to undermine the Affordable Care Act. Meanwhile, a group of Democrats wants to investigate the Department of Health and Human Service's efforts to push out anti-Obamacare messaging.

The Hill: What Trump Can Do To Cripple ObamaCare
If Congress isn’t able to repeal ObamaCare, it’s likely that the Trump administration will follow through on the president's vow to let the law fail. President Trump regularly asserts that ObamaCare is dead or dying, and the administration has already taken steps to undermine the law while congressional Republicans struggle to enact healthcare legislation. (Weixel, 7/23)

Kaiser Health News: 5 Ways White House Can Use Its Muscle To Undercut Obamacare
President Donald Trump has vowed to “let Obamacare fail,” after legislative efforts to undo the Affordable Care Act have stalled. He and congressional Republicans have repeatedly portrayed the Affordable Care Act insurance marketplaces, also known as exchanges, as being in a “death spiral.” But independent analyses have concluded that such spontaneous disintegration isn’t happening. (Luthra, 7/24)

The Hill: Senate Dems Question Admin Over Funding Anti-ObamaCare Effort
A group of Senate Democrats is raising concerns to the Department of Health and Human Service (HHS) about its role in a public relations campaign aimed at effectively undermining ObamaCare. Democratic Sens. Cory Booker (N.J.), Chris Murphy (Conn.) and Brian Schatz (Hawaii) raised the concerns in a letter to HHS, The Daily Beast reported. ( Manchester, 7/22)

And in other news on the ACA and its marketplaces —

WBUR: Even Talking About Weakening Obamacare Provisions Weakens The Exchanges
Every month, the Trump administration faces a deadline to pay what are called "cost-sharing reduction" (or CSR) subsidies to insurers. ... Trump reportedly wants to end the payments, as Politico reported, but the White House chose this week to continue the payments once again. Still, the ongoing ambiguity about the future of the payments is apparently causing premiums to rise and insurers to pull out of markets. (Kurtzleben, 7/21)

Cleveland Plain Dealer: Obamacare: Dead, Alive Or In Limbo? 5 Things To Know
New ideas are being considered, but no one -- including lawmakers -- seems to know what will happen if a vote is called next week to either kill the Affordable Care Act or amend it. ...So if you worry that you'll lose health coverage, or hope you'll be free of the ACA's mandates to get coverage, here's what to know. (Koff, 7/22)

PolitiFact California/Capital Public Radio: Kevin McCarthy's False Claim On Obamacare Sign-Ups
Congressman Kevin McCarthy claimed almost twice as many people have paid a penalty or taken a waiver as signed up for Obamacare. By focusing only on enrollment through the Obamacare exchanges, McCarthy’s claim presents a narrow and misleading look at total insurance sign-ups under the federal health law. Even under the limited view, those foregoing insurance do not amount to "almost twice" the exchange sign-ups. Most notably, the congressman’s claim ignores the huge category of Medicaid expansion under Obamacare. (Nichols, 7/21)

Coverage And Access

Free Clinic Shines Light On Reality Of Health Care In America

More than a thousand patients flocked to the Remote Area Medical clinic in Virginia over the weekend.

The New York Times: When Health Law Isn’t Enough, The Desperate Line Up At Tents
Anthony Marino, 54, reached into his car trunk to show a pair of needle-nosed pliers like the ones he used to yank out a rotting tooth. Shirley Akers, 58, clutched a list of 20 medications she takes, before settling down to a sleepless night in the cab of a pickup truck. Robin Neal, 40, tried to inject herself with a used-up insulin pen, but it broke, and her blood sugar began to skyrocket. (Gabriel, 7/23)

The Washington Post: To Get Treatment At A Free Clinic, The Crowds Come Early — Sometimes The Night Before
Parked at the edge of the field, they covered the windows so the little girls could sleep inside the car. The grown-ups slept on blankets outside on the grass. Before 5 a.m. Saturday, the family joined the sleepy crowds drifting toward the fence of the Wise County fairgrounds. Soon day two of the Remote Area Medical clinic would begin letting people in. Some had camped overnight, others were just arriving in the dark. The day before, more than 1,250 people from all over Appalachia showed up for free medical, dental and vision care. (Schneider, 7/22)

Administration News

Pence, Verma and Others From Indiana Setting Key Health Policies, Despite State's Poor Record

Vice President Mike Pence has been a leader of the Trump administration’s efforts to seek a repeal of the Affordable Care Act, including phasing out its Medicaid expansion. And he's brought along other Hoosiers: Seema Verma, who heads the Centers for Medicare & Medicaid Services, Jerome Adams, the nominee to be surgeon general, and Matt Lloyd, the top spokesman at the Department of Health and Human Services.

USA Today: Many Of Key Players On Trump Health Care Reform Team Are Hoosiers
Several Hoosiers in key positions in the Trump administration, led by Vice President Mike Pence, are negotiating the future of federal health policy despite the state’s mixed reputation on health care. Indiana spends less on public health funding than any other except Nevada, a handicap when Indiana was home to the nation’s first HIV outbreak linked to the injection of oral painkillers in 2015. In addition, the state for years has ranked among the least healthy. Hoosiers smoke more, are less active and die sooner than most Americans. (Groppe, 7/23)

The New York Times: New C.D.C. Chief Saw Coca-Cola As Ally In Obesity Fight
When she was health commissioner of Georgia, the state with one of the highest rates of child obesity, Dr. Brenda Fitzgerald faced two enormous challenges: How to get children to slim down and how to pay for it. Her answer to the first was Power Up for 30, a program pushing schools to give children 30 minutes more exercise each day, part of a statewide initiative called Georgia Shape. The answer to the second was Coca-Cola, the soft drink company and philanthropic powerhouse, which has paid for almost the entire Power Up program. (Kaplan, 7/22)


Pharma Cracked Open Massive War Chest To Lobby Congress On Pricing, Importation, Drug Approvals

The industry spent $14 million so far this year.

Stat: Drug Industry Is Lobbying The U.S. Government At Record-Setting Pace
The drug industry’s war chest is going a long way. The two big trade groups for drug makers, the Pharmaceutical Research and Manufacturers of America and the Biotechnology Innovation Organization, spent more lobbying the federal government in the first six months of this year than they have in that period since at least 1999, according to lobbying disclosure filings updated this week. (Robbins and Mershon, 7/21)

Kaiser Health News: Follow The Money: Drugmakers Deploy Political Cash As Prices And Anger Mount
Two federal investigations — one examining opioid sales, another about a multiple sclerosis drug whose price had soared to $34,000 a vial — were only part of the troubles Mallinckrodt faced as the year began. The stock of the drugmaker, whose United States headquarters are in St. Louis, was tanking. Wall Street worried that Medicare might reduce the half-billion dollars it was spending yearly on a Mallinckrodt drug with limited evidence of effectiveness. (Hancock, Lucas and Lupkin, 7/24)

CQ HealthBeat: CQ.Com - Health Care, Tax Overhauls Drive Lobbying In Trump Era
During the turbulent first six months of the Trump administration, some of the biggest lobbying groups scaled back their spending as his signature initiatives collapsed. But major agenda items, including a tax overhaul, will continue to fuel K Street work. ...The drug industry lobby Pharmaceutical Research and Manufacturers of America increased its federal lobbying tab to $14 million during the first half of the year as lawmakers debated dismantling the 2010 health care law. Its lobbying spending is up from $10.6 million during the first six months of 2016. (Ackley, 7/21)

Veterans' Health Care

Committee's Plan To Shift Money To Veterans' Choice Program Draws Immediate Backlash

Eight major organizations spoke out against the proposal, saying it was unacceptable privatization of veterans' health care.

The Associated Press: House Unveils Plan To Fix VA’s Budget Gap As Deadline Looms
A House committee unveiled a disputed plan Friday to allow the Department of Veterans Affairs to shift $2 billion from other programs to cover a sudden budget shortfall that could threaten medical care for thousands of patients in the coming weeks. The proposal by the House Veterans Affairs Committee would provide a six-month funding fix to the department’s Choice program, which offers veterans federally paid medical care outside the VA and is a priority of President Donald Trump. To offset spending, the VA would trim pensions for some veterans and collect fees for housing loans. (Yen, 7/21)

Women’s Health

Both Sides Rack Up Wins On Battlefield Over Women's Health In The States

While some states are stripping Planned Parenthood of funds, others are passing laws to protect contraception for women. Outlets report on other women's health news out of Kentucky, Texas, Tennessee, Georgia and Texas.

Stateline: Flurry Of Laws Enacted On Women’s Access To Health Care
As Washington moved to reduce federal funding for women’s health this year, adversaries in the war over affordable birth control and other women’s health services shifted the battleground to state capitals — resulting in a spate of new laws that both expand and contract women’s access to care. ... Medicaid pays for three-quarters of all publicly supported women’s health programs. So when Iowa abruptly cut off Medicaid dollars to Planned Parenthood, it was game over, said Jodi Tomlonovik, executive director of the Family Planning Counsel of Iowa, which oversees distribution of federal and state money to women’s health clinics. (Vestal, 7/24)

Reuters: U.S. Abortion Support Groups Put On More Public Face
Patricia Canon drives poor rural Kentucky women to distant abortion clinics each week, part of a national army of volunteers who are growing bolder even as abortion foes ratchet up opposition to the activists they have branded as "accomplices to murder." The Kentucky Health Justice Network, where she volunteers, is one of dozens of non-profit U.S. abortion funds providing money for procedures or covering travel costs to help women obtain abortions, particularly in states where Republican-backed laws have narrowed options. (Kenning, 7/22)

The Washington Post: Dying After Childbirth: Women In Texas Are At High Risk, Especially If They’re Black
Black women in Texas are dying with frightening frequency after childbirth — at a rate up to nearly three times higher than that of white women. And no one has figured out why. In a state with the worst overall maternal mortality in the nation, the Texas legislature opened a special session this week that will address the issue as one of 20 items that Gov. Gregg Abbott (R) listed in calling lawmakers back to work. The most they may do, however, is extend and expand the scope of a task force that started studying the problem a few years ago. (Murgia, 7/21)

The Associated Press: Tennessee Inmates Get Reduced Sentences For Birth Control
A program in a Tennessee county reduces inmates’ jail time if they voluntarily undergo birth control procedures, in a move that has drawn criticism from the local district attorney and the American Civil Liberties Union. WTVF-TV reports General Sessions Judge Sam Benninfield signed a standing order in May that provides 30 days’ credit toward jail time for men who agree to free vasectomies in White County and women who agree to receive free Nexplanon implants, which prevent pregnancies for up to four years. (7/21)

Atlanta Journal-Constitution: Fed Cuts In Teen Pregnancy Grants Hamstrings Georgia Recipients
Quest for Change, a youth and family development-focused nonprofit run out of tiny Dawson, Ga., trained Jackson and other teenagers in how to discuss pregnancy, sexually transmitted diseases and healthy relationships with their peers. ... [Shaunae] Motley’s organization and 80 others across the country were recently notified by the federal Department of Health and Human Services that the five-year grants they applied for and won in 2015 would be cut off two years ahead of schedule. (Hallerman and Hart, 7/21)

Austin American-Statesman: Abortion-Related Bills Sent To Full Senate For A Vote
The state Senate Health and Human Services Committee approved five bills Friday, the first of the legislative session to be sent to a full chamber for a vote since Gov. Greg Abbott expanded the scope of the agenda early Thursday. Three of the bills dealt with abortion and passed on a party-line 6-3 vote. (Chang and Silver, 7/21)

Public Health And Education

States Urged To Sue Drug Companies Over Painkiller Epidemic By Lawyers Who Drove Tobacco Litigation

The Wall Street Journal reports on a one-time attorney general who is aiding in lawsuits filed by Mississippi and Ohio against pharmaceutical makers. In another story on the business front of the drug crisis, McKesson's board will be greeted by picketing teamsters organized by the father of an overdose victim.

The Wall Street Journal: Lawyers Hope To Do To Opioid Makers What They Did To Big Tobacco
The legal front widening against makers of opioid painkillers has something in common with landmark tobacco litigation of the 1990s: attorney Mike Moore. As Mississippi’s attorney general in 1994, Mr. Moore filed the first state lawsuit against tobacco companies, saying they harmed public-health systems by misrepresenting smoking’s dangers. He helped marshal the subsequent spate of state litigation and then the talks that led to a $246 billion settlement. (Whalen, 7/23)

Bloomberg: Overdose Victim's Dad Rallies Teamsters In Fight With McKesson 
When McKesson’s board and executives gather near Dallas for their annual shareholders meeting on July 26, they’ll be greeted by a throng of picketing Teamsters. Representatives of the union, which owns more than $30 million of McKesson shares, will call on investors to reject the company’s executive-pay plan and for the board to claw back some of Chief Executive Officer John Hammergren’s compensation. (Melin, 7/21)

State efforts to combat the epidemic are reported from Massachusetts, New Jersey, Virginia, Colorado and Connecticut —

Boston Globe: Key Part Of Opioid Legislation Is Not Working
As originally proposed by Governor Charlie Baker, the law would have required those taken to the emergency room after an overdose to be held involuntarily for up to 72 hours to receive treatment. But the final version approved by the Legislature excised that requirement, dictating instead that hospitals must simply offer substance abuse treatment to these patients after a voluntary assessment. (Edmondson, 7/23)

Denver Post: Colorado Medicaid Program Reduces Opioid Dosages To Combat Addiction
Colorado’s Medicaid program is reducing the amount of opioid painkillers it allows its recipients to receive, part of a growing campaign to restrict how many of the highly addictive drugs are in circulation. The new policy, announced this month, will roll out in two phases. The first, which goes into place in August, applies to Medicaid recipients who are prescribed opioids for the first time in at least a year. The policy will limit those patients to receiving only a seven-day supply to start, with two additional one-week refills possible if the patient requests them. Another refill request beyond that will require additional scrutiny. (Ingold, 7/24)

A Cure For HIV? One Child May Give The World Hope

Scientists presented the case study of a boy who has remained HIV-free since his early treatment as an infant. But Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, struck notes of both optimism and caution when speaking about him. In other public health news: gene therapy, vaccinations, arrest in old age, concussions, inflammation and a flesh-eating bacteria.

The Washington Post: New Hope For HIV Cure As Child Remains Virus-Free Years After Final Treatment
A South African boy, believed to have been infected with HIV around the time of his birth, has remained free of the virus for 8½ years after early treatment — renewing hope among scientists that such outliers may hold clues to help end the decades-old epidemic. The case study, described by researchers before a presentation Monday at an international AIDS conference in Paris, suggests a paradigm shift in the treatment of those infected. It establishes that HIV may be controllable in some way other than a daily and lifelong regimen of antiretroviral drugs. (Cha, 7/24)

The New York Times: Companies Rush To Develop ‘Utterly Transformative’ Gene Therapies
The approval of gene therapy for leukemia, expected in the next few months, will open the door to a radically new class of cancer treatments. Companies and universities are racing to develop these new therapies, which re-engineer and turbocharge millions of a patient’s own immune cells, turning them into cancer killers that researchers call a “living drug.” One of the big goals now is to get them to work for many other cancers, including those of the breast, prostate, ovary, lung and pancreas. (Grady, 7/23)

NPR: Alternatives To Vaccination Shots Are In Development
News this summer of a flu vaccine patch sparked a lot of chatter. Could getting vaccinated be as easy as putting on a bandage? Could there be fewer, or at least smaller, needles in our future? Some companies and academic labs are working to make those things happen. (Columbus, 7/23)

The New York Times: Another Possible Indignity Of Age: Arrest
It was the sort of incident that happens at facilities that care for people with dementia. At a residence for older adults in San Francisco last summer, Carol King momentarily left a common sitting area. When Ms. King returned, she found that another resident had taken her chair, a nurse who witnessed the episode later reported. She grabbed the usurper’s wrist. (Span, 7/21)

NPR: Concussions May Hit Female Brains Harder, Research Suggests
Thanks to research on boxers and football players, both athletes and the public are becoming more aware of the dangers of sports-related head injuries. Yet there is little data on participants like Mazany. That's because, unlike the vast majority of athletes studied, she is a woman. "We classically have always known the male response to brain injury," says Mark Burns, at Georgetown University. But there have been remarkably few studies of females. The bias runs throughout the scientific literature, even in studies of mice. (Hamilton, 7/24)

NPR: Inflammation Can Be Bad For Your Health, Or Good
Chronic, low-level inflammation seems to play a role in a host of diseases, including type 2 diabetes, heart disease, Alzheimer's, cancer and even depression. And even though the science on inflammation and disease is far from settled, tests and treatments are being promoted that claim to reduce that risk. (Hobson, 7/21)

The Washington Post: He Thought He Just Had Blisters From A Hike. He Had Flesh-Eating Bacteria And Nearly Died.
Wayne Atkins thought little of the blisters he had gotten while hiking. He was trekking up and down the 4,500-foot-high Mount Garfield in New Hampshire — 10-miles round-trip — and blisters were no surprise. He was in the Granite State for a family member's early June wedding, which went off without a hitch, even with the blisters. But things soured when he returned to Miami, according to Manchester, N.H., ABC affiliate WMUR-TV. (Wootson, 7/23)

State Watch

State Highlights: N.J. Raises Smoking Age To 21; Fall Out From Scandal Involving USC's Former Med School Dean Continues

Media outlets report on news from California, Iowa, New Jersey, Tennessee, Florida, Ohio, Wisconsin, Minnesota and Georgia.

Los Angeles Times: USC Received More Than A Year Of Questions About Former Medical School Dean's Conduct Before Scandal Broke
Four days after The Times published a story about drug use by the then-dean of USC’s medical school, the university announced it was moving to fire Dr. Carmen A. Puliafito and said it was “outraged and disgusted” by his conduct. USC Provost Michael Quick said the university decided to act because it had been shown “extremely troubling” information that same day about Puliafito’s behavior. Quick provided no details. But he said it was “the first time we saw such information firsthand.” (Pringle, Elmahrek, Hamilton and Parvini, 7/23)

Reveal: Lawmakers Call On Acosta To Address Latino Workplace Deaths
From meatpacking to agricultural fields, Latino immigrants often work the most menial jobs in America and their on-the-job death rate is 18 percent higher than the average worker, recent statistics show. The troubling trend has prompted a group of Democratic senators to call on the Labor Department to protect these workers. (Gollan, 7/23)

Kaiser Health News: In Appalachia, Two Hospital Giants Seek State-Sanctioned Monopoly
Looking out a fourth-floor window of his hospital system’s headquarters, Alan Levine can see the Appalachian Mountains that have defined this hardscrabble region for generations. What gets the CEO’s attention, though, is neither the steep hills in the distance nor one of his Mountain States Health Alliance hospitals across the parking lot. Rather, it’s a nearby shopping center where his main rival ­— Wellmont Health System, which owns seven area hospitals — runs an urgent care and outpatient cancer center. Mountain States offers the same services just up the road. (Galewitz, 7/24)

California Healthline: California Valley Fever Cases Highest On Record
The number of Valley Fever cases in California rose to a record level in 2016, with 5,372 reported — a jump of 71 percent from the previous year. Historically, about three-quarters of cases have been in the state’s heavily agricultural San Joaquin Valley. The fungal infection, known as coccidioidomycosis, or “cocci,” is most common in the southern portion of the Valley and along the Central Coast of California. (Bartolone, 7/24)

San Francisco Chronicle: Under-Radar Bill Focuses On Polluters In Poverty Areas
AB617 by Assemblywoman Cristina Garcia, D-Bell Gardens (Los Angeles County), was touted as the less-grandiose partner to cap and trade, whose expansive reach allows California polluters to offset their emissions by reducing them in another state. Garcia’s measure is aimed closer to home, attempting to “address air pollution in the most burdened communities,” she said. (Cart, 7/23)

Cleveland Plain Dealer: Law Would Require Nearly All Older Cleveland Homes To Be 'Lead Safe'
Cleveland homes, childcare centers and schools built before 1978 would have to be certified as safe from lead hazards by 2021 under legislation City Councilman Jeff Johnson will introduce next month. Johnson, along with Cleveland Lead Safe Network (CLSN), created the proposed ordinance as part of a sweeping Lead Safe Cleveland Initiative that would first tackle lead paint hazards in homes and then go after reducing the risk from the toxin in soil and water. (Dissell and Zeltner, 7/23)

San Jose Mercury News: Former Oakland Army Base: Feds Probe Civil Rights Complaint
For years, advocates at the West Oakland Environmental Indicators Project (WOEIP) have lamented the soot on their blinds and the hacking coughs that result from breathing in toxic diesel fumes spewing out of trucks as they enter and exit the Port of Oakland. Now, two federal agencies — the Department of Transportation and Environmental Protection Agency — are launching a formal investigation into whether the city and the Port of Oakland are doing enough to mitigate air pollution in the neighborhood, which has historically been burdened by elevated levels of black carbon, nitric oxide and other toxic particles. (Baldassari, 7/22)

Atlanta Journal-Constitution: Drug Screening Lab Under Federal Investigation Heads For Auction
A drug testing lab in Gwinnett County that had been in the center of a campaign donation bundling scandal is up for auction amid a federal investigation. ...In 2014, employees and executives with the company came under federal scrutiny when they combined to give more than $80,000 to U.S. Rep. Jack Kingston, who was seeking the Republican nomination to the U.S. Senate. (Joyner, 7/21)

San Francisco Chronicle: State Bill Aimed At “Big Weed” Marketing Hits Small Businesses Too
State Sen. Ben Allen, D-Santa Monica, is the sponsor of SB162, which would prohibit licensed cannabis businesses from selling or giving away promotional hats, T-shirts or any branded merchandise that bears the name or logo of a cannabis company or product. Allen and his allies say the bill, which in May passed the Senate in a 40-0 vote, is meant to protect children from potentially harmful marketing practices. But for some whose businesses would be affected, the bill is seen as quashing free speech. (Mitchell, 7/23)

Editorials And Opinions

Perspectives: Despite Senate Difficulties, ACA Is Still At Risk; The Paths Forward For The GOP's BCRA

Editorial pages analyze the current state of play in Republicans' push to replace Obamacare.

The New York Times: Health Care Is Still in Danger
Will Senate Republicans try to destroy health care under cover of a constitutional crisis? That’s a serious question, based in part on what happened in the House earlier this year. As you may remember, back in March attempts to repeal and replace the Affordable Care Act seemed dead after the Congressional Budget Office released a devastating assessment, concluding that the House Republican bill would lead to 23 million more uninsured Americans. Faced with intense media scrutiny and an outpouring of public opposition, House leaders pulled their bill, and the debate seemed over. (Paul Krugman, 7/24)

RealClear Health: A Narrow Path Forward For The BCRA
Following a week of high-level negotiations among GOP senators, Republican leadership is planning a Tuesday vote on the motion to proceed to the House-passed American Health Care Act (AHCA) — the vehicle for their health care reform efforts. The process has been shrouded in confusion and uncertainty, as it still remains unclear what legislation Senate leaders ultimately hope to move forward. And while knowing what’s in the Senate bill may be, as Senate Whip John Cornyn said, a “luxury we don’t have,” it’s worth acknowledging that there’s still a narrow path towards passage. (Shea McCarthy, 7/24)

Boston Globe: Republicans Must Challenge Trump On Health Care
But though he [Donald Trump] has browbeaten Republican senators for failing to follow through on repealing the Affordable Care Act, abandoning his own campaign commitments doesn’t seem to bother him at all. Months into the GOP’s repeal-and-replace effort, not one piece of legislation Trump has backed, in either the House or the Senate, would keep all of those promises. (7/23)

The Wall Street Journal: Force Congress’s Hand On Health Care
If President Trump is serious about repealing ObamaCare—about delivering a better policy with more choice and lower costs—there’s a simple move he could make that wouldn’t require congressional approval. It would align the interests of lawmakers and their staffers with the interests of voters. (Heather R. Higgins, 7/23)

The Wall Street Journal: Congress Won’t End ObamaCare, So Here’s How To Mend It
Having so far failed to repeal and replace the Affordable Care Act, the best way forward for Republicans would be to work with Democrats to improve the marketplaces set up by the 2010 law. While legislation could help, all that really is needed for the marketplaces to succeed is for the Trump administration to do no harm. This means continuing to implement the law without actively undermining it. (Jason Furman, 7/23)

Los Angeles Times: Under Senate's Obamacare Repeal, Some Americans Would Have To Pay More Than Their Total Income For Health Coverage
One of the ostensibly brilliant ideas in Senate Republicans’ plan to repeal the Affordable Care Act is to move low-income families from Medicaid to the private insurance marketplace, allowing them to use the premium subsidies provided by the ACA. But there’s a catch, according to a new analysis of the proposal. For many low-income families, the marketplace premiums and deductibles combined would amount to more than their total income, even after subsidies. Moreover, despite shifting more of these costs to enrollees, the change would cost the federal government more than Medicaid.  (Michael Hiltzik, 7/21)

The Kansas City Star: Sens. Moran And Roberts: Don’t Endanger My Daughter’s Health
My beautiful daughter Hannah turns 26 this Saturday. Her birthdays are particularly special because she was diagnosed with stage 4 cancer at age 13. After successful treatment, her cancer returned when she was 14 and she had a less than 10 percent chance of survival. She wasn’t expected to be alive for her 15th birthday. Burkitt’s Lymphoma is a very aggressive cancer that doubles in size every two hours. We were fortunate to receive amazing care at Children’s Mercy Hosptital. Hannah endured dozens of surgeries, 69 days of intense chemotherapy and spent over 300 days in the hospital. She received hundreds of units of blood and platelets, had 38 spinal taps, 18 bone marrow biopsies, a stem cell transplant and countless other treatments and procedures. (Deedra Miller, 7/22)

Lincoln Journal-Star: Nebraska Needs Health Care Reform
Obamacare is failing in Nebraska. Proponents of the law argued that it would increase choice and lower costs, but the exact opposite has taken place. For instance, earlier this year, Blue Cross Blue Shield announced it would be leaving the state’s Obamacare exchange market. The last remaining Obamacare insurer -- Medica Health -- also announced it might pull out of the market by the end of the year, which would leave thousands of Nebraskans without health coverage. (Jarrett Stepman, 7/24)

The Big Picture: The Health Issues We Should Be Discussing; How To Move The Debate Forward

Even as the heated discourse over the future of the Affordable Care Act continues, some people offer their thoughts on the serious issues that are being overlooked and on how bad manners have soured the process.

Boston Globe: The Health Care Debate We Should Be Having
Most of the life expectancy gains of the last century can be chalked up to what we call public health, a catch-all term for those interventions aimed not at a single patient, but at a whole community or the entire population. ...Which helps explain the great riddle of American health care: How come we spend more than everyone else, yet generally have worse outcomes? We overspend on medical care and underinvest in public health. (Horowitz, 7/22)

St. Louis Post-Dispatch: Collapse To Compromise: A Better Way To Health Care Reform
Republicans and Democrats disagree about the role of government; the trade-off between individual freedom and societal good; and about money and taxes. These long-standing disagreements play out repeatedly on the national stage, and today, health care is front and center. On our present course, these disagreements will turn our health care system upside down every time we vote to change party control of the White House and the Congress. (Steven H. Lipstein, 7/23)

The Washington Post: The GOP Cannot Fix Itself — Let Alone American Health Care
The inability of a Republican Congress and a Republican president to repeal Obamacare, or even just dial it back, is yet the latest demonstration that Republicans simply aren’t ready to govern. The facile explanation for this is the unresolved division, within the party, between its radical tea party populist wing and its more moderate, business-friendly establishment wing. But the bigger issue is that the party’s elected politicians are unwilling to make the trade-offs that are the essence of what governing is about. (Steven Pearlstein, 7/23)

The Washington Post: How Health Care Controls Us
If we learned anything from the bitter debate over the Affordable Care Act (Obamacare) — which seems doubtful — it is that we cannot discuss health care in a way that is at once compassionate and rational. This is a significant failure, because providing and financing health care have become, over the past half-century, the principal activity of the federal government. (Robert J. Samuelson, 7/23)

Huffington Post: Former CBO Directors Express ‘Strong Objection’ To GOP Attacks On Agency
Every economist who has previously served as director of the Congressional Budget Office has signed a letter registering “strong objection to recent attacks” on the agency. The letter, sent Friday morning and addressed to congressional leaders, does not specify who has been making those attacks. But only one political party is attacking the CBO right now ― and only one party has so brazenly questioned the agency’s methods to draw this kind of response from such a distinguished, bipartisan group of economists. It’s the Republicans, because they don’t like what the CBO has been saying about GOP proposals to repeal the Affordable Care Act. (Jonathan Cohn, 7/21)

Roll Call: How Bad Political Manners Fomented The Health Care Mess
[I]t’s not surprising that a secretive, churlish and entirely-outside-the-normal-channels approach has, from the start, distinguished [Senate Majority Leader Mitch McConnell's] balky and now repudiated tackling of the defining legislative battle of Trump’s first year. Straightforward legislative etiquette would have required at least a few hearings and legislative markups on health care where Democrats could have gone on record in opposition and Republican skeptics, on the hard right and in the center, could have vented concerns and offered mollifying language — long before spreading anxieties at both ends of the GOP ideological spectrum crippled the bill. (David Hawkings, 7/24)

Parsing The Policies: What's To Become Of Medicaid And Medicare?

Opinion writers offer their thoughts on how the current Affordable Care Act replacement debate impacts Medicaid and how governors should proceed in pursuing Medicaid waivers as well as current Medicare funding issues.

Daily Beast: Medicaid Delivers As Obamacare Survives
Medicaid got a reprieve from the budget axe with the GOP’s failure so far to repeal, let alone replace, Obamacare. Suddenly, the program for the poor that began in 1965 seems less like a scapegoat for politicians looking to score rhetorical points and to shore up state budgets, and like it may join Medicare and Social Security on the third rail in American politics—touch it and you die. (Eleanor Clift, 7/24)

RealClear Health: Republicans Are Tackling Medicaid Wrongly
The high decibel fight in the Senate over Medicaid is one more example--did we need more?--of why lasting changes in social programs require thoughtful legislative deliberation leading to bipartisan consensus. There should be hearings to gather input from all sides and serious debate in committees as well as on the floor. If one party rams through big changes in any program as important as Medicaid, the other party will demonize the result. In the case of Medicaid cuts, arousing public outrage won't be hard. Individuals and families, state governments, rural hospitals and other health providers will all be vocal about their plight. One wonders why either party would seek such opprobrium when they could be working together on sensible Medicaid reform. (Alice M. Rivlin, 7/24)

Morning Consult: Governors: Avoid Harmful Insurance Practices In Medicaid Waivers
While our nation’s governors recently gathered in Rhode Island for the summer meeting of the National Governors Association, most of the country’s political attention remained focused on the debate in Washington, D.C. over the fate of the Affordable Care Act. Less noticed, but also critically important, is that fact that each governor holds in their hands today the ability to radically reshape Medicaid for their state’s most vulnerable citizens regardless of the outcome of that debate. (Donna Christensen, Scott Mulhauser and Jason Resendez, 7/24)

CBS News: Medicare Funding: Problems And Solutions
Medicare's funding problems often get overlooked when the Social Security trustees issue their annual report on the funded status of the Social Security and Medicare programs. Yet together they form the twin pillars of financial security for retirees. That's why it's important to understand Medicare's financial situation, so you can be an informed health care planner -- and voter. (Steve Vernon, 7/24)

Viewpoints: Is Silicon Valley Losing The Lead In Medical Technology?; Doctors And Hand Writing

Here's a review of editorials and opinions on a range of public health issues.

The Wall Street Journal: Silicon Valley Trails In Medical Tech
People who develop medical technology have long assumed that Silicon Valley would pioneer smartphone-based devices to make Americans fitter and healthier than ever. To some degree, that forecast is coming true: Tech giants are working with doctors and hospitals on highly sophisticated devices — automated radiology, supercomputer-based oncology, fitness-tracker-based analytics — to monitor the sick, provide better automated care, and keep people out of hospitals in the first place. But it turns out the biggest gains from mobile medicine will come from deploying it in poor countries across Africa and Asia. (Michael S. Malone, 7/23)

KevinMD: Doctor, We Can’t Read Your Writing
So to future pharmacists who will read my prescriptions, and other health care professionals who will read my notes: I pledge from here on in to write as neatly as possible within the time constraints allowed, for the safety of my patients, the posterity of cursive writing, and for the sake of my grandfather (who likes reading my blog on his iPad). (Sarah Fraser, 7/23)

USA Today: Veterans Affairs Secretary: VA Health Care Will Not Be Privatized On Our Watch
As a physician, my professional assessment is that the Department of Veterans Affairs has made significant progress over the past six months — but it still requires intensive care. In order to restore the VA’s health, we must strengthen its ability to provide timely and high quality medical care while improving experiences and outcomes for veterans. (David Shulkin, 7/24)

Lexington Herald Leader: A Woman’s Death, Kentucky’s Opioid Crisis
Jenny Fulton’s brief life and brutal death hold important lessons, especially for Kentuckians in positions of public trust. The 27-year-old woman died in 2014 in the Mason County jail where she was sent because she had relapsed into heroin use, violating her parole. Despite widespread recognition that incarceration is not the solution, Kentucky still spends millions of dollars jailing people who have drug use disorders when that money could be better spent on evidence-based treatment. (7/23)

St. Louis Post-Dispatch: Trump Takes A 'Just Say No' Approach To Sex Education
In today’s version of “Just Say No,” first lady Nancy Reagan’s approach to drug use in the 1980s, President Donald Trump’s administration is cutting more than $213 million in funding to help prevent teen pregnancy. The move eliminates evidence-based pregnancy prevention and research programs, and family planning services, but leaves money for abstinence-only education. In addition, Trump appointed a prominent abstinence-only advocate as assistant secretary of Health and Human Services. (7/22)

San Jose Mercury News: Reject Climate Change Skeptic For Top Science Post
President Trump’s disdain for science apparently knows no bounds. He has now nominated climate change skeptic Sam Clovis, a talk radio host, to serve as the Department of Agriculture’s chief scientist — a slap in the face of the scientific community and a disservice to those responsible for the integrity of the USDA’s research. (7/23)

Sacramento Bee: California Workers' Comp System Remains Nation's Most Expensive
Obviously, working in California is not inherently more dangerous than in other states, and cash benefits to disabled California workers are not out of line, so the enormous cost differential must be rooted in the system itself, which explains why its rules are the subject of constant political infighting. One factor in those costs is what officials say is an enormous amount of fraud, concentrated in Southern California. (Dan Walters,  7/23)

Los Angeles Times: Don't Believe The American Heart Assn. — Butter, Steak And Coconut Oil Aren't Likely To Kill You
Last month, the American Heart Assn. once again went after butter, steak and especially coconut oil with this familiar warning: The saturated fats in these foods cause heart disease. The organization’s “presidential advisory” was a fresh look at the science and came in response to a growing number of researchers, including myself, who have pored over this same data in recent years and beg to differ. A rigorous review of the evidence shows that when it comes to heart attacks or mortality, saturated fats are not guilty. (Nina Teicholz, 7/23)