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Political Cartoon: 'Now Or Never?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Now Or Never?'" by Clay Bennett, Chattanooga Times Free Press.

Here's today's health policy haiku:

SLASHING THE SAFETY NET

War on Poverty?
Now Republicans show us
What that really means.

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Summaries Of The News:

Health Law

Now That Bill Is Unveiled, Leaders Focus On Drumming Up Support From Reluctant Senators

Senate Majority Leader Mitch McConnell is focused on one number: 50. That's what he needs to get to pass his version of the health law bill.

The New York Times: Senate Leaders Try To Appease Members As Support For Health Bill Slips
Senate Republican leaders scrambled Sunday to rally support for their health care bill as opposition continued to build inside and outside Congress, and as several Republican senators questioned whether it would be approved this week. President Trump expressed confidence that the bill to repeal the guts of the Affordable Care Act would pass. (Pear and Kaplan, 6/25)

The Washington Post: Senate Health-Care Bill Faces Serious Resistance From GOP Moderates
The vast changes the legislation would make to Medicaid, the country’s broadest source of public health insurance, would represent the largest single step the government has ever taken toward conservatives’ long-held goal of reining in federal spending on health-care entitlement programs in favor of a free-market system. That dramatic shift and the bill’s bold redistribution of wealth — the billions of dollars taken from coverage for the poor would help fund tax cuts for the wealthy — is creating substantial anxiety for several Republican moderates whose states have especially benefited from the expansion of Medicaid that the Affordable Care Act has allowed since 2014. (Eilperin and Goldstein, 6/25)

The Washington Post: Senate Republicans Face Key Week As More Lawmakers Waver In Support For Health-Care Bill
The mounting dissatisfaction leaves Senate Republican leaders and the White House in a difficult position. In the coming days, moves to narrow the scope of the overhaul could appeal to moderates but anger conservatives, who believe the legislation does not go far enough to repeal and replace the Affordable Care Act, known as Obamacare. A key moment will arrive early this week when the Congressional Budget Office releases an analysis of the bill that estimates how many people could lose coverage under the Republican plan, as well as what impact it might have on insurance premiums and how much money it could save the government. (Parker, Weigel and Costa, 6/25)

The Washington Post: With Five Holdouts On Health-Care Bill, McConnell Is In For A Final Frenzy Of Negotiation
It sets up a final frenzy of negotiation, as McConnell has determined he will finish with the legislation one way or another by the end of this month. If he’s not careful, the GOP leader could end up being lambasted by conservatives and liberals alike for cutting narrow deals to try to buy off votes from individual senators in a similar manner used for passing the Affordable Care Act. McConnell can afford to lose only two of the 52 Republicans in the Senate, but as the week went on, he had many more holdouts than that. (Kane, 6/24)

Los Angeles Times: Republican Senators Seek Changes In Obamacare Repeal Bill They Can All Agree On. It Won't Be Easy
After being widely panned by Democrats and Republicans alike for crafting the bill with unprecedented secrecy keeping details even from GOP senators — McConnell may now be eager to convey a sense of open debate and negotiation. But if the process that played out in the House last month is any guide, expect the deal-making to only go so far before Republicans quickly unify — preferring to hold hands and jump off the political cliff together rather than risk losing their best opportunity to fulfill the Republican promise to stop Obamacare. (Mascaro, 6/22)

The Wall Street Journal: GOP Senators Lay Out Demands On Health Bill
Demands for getting on board include adding funds for particular areas, such as opioid treatment. But GOP senators are particularly divided over the bill’s cuts to Medicaid, the federal-state health program for the poor that covers one in five Americans. In addition, four conservative senators object to the bill’s retention of requirements for insurers to cover patients at the same price regardless of their medical history and with set benefits packages. Those provisions have created new consumer protections but also driven up premiums for younger, healthier people in particular, which the senators have cited as a primary concern. “It’s going to be a challenge,” Sen. Pat Toomey (R., Pa.) said Sunday on CBS , about ameliorating centrists’ concerns over the Medicaid changes in the bill. (Radnofsky, 6/26)

Modern Healthcare: Race Is On To Pass Senate Healthcare Bill Despite Industry Opposition
Healthcare providers and insurers had differing reactions to the Senate Republican bill unveiled last week to repeal and replace the Affordable Care Act. The "discussion draft" draft bill bombed with healthcare providers, while some insurers reveled at the offering of cost-sharing reduction payments and tens of billions in temporary reinsurance funding. But it may not matter what industry stakeholders think. They say GOP lawmakers didn't ask for their input. "I've never seen anything so rushed or secretive," said Dr. Bruce Siegel, CEO of America's Essential Hospitals, which represents 300 safety-net systems. (Meyer, 6/24)

Modern Healthcare: Will McConnell Succeed In Passing ACA Repeal Bill?
Next week promises to one of the most turbulent, consequential weeks in U.S. healthcare history, as Senate Majority Leader Mitch McConnell tries to quickly pass a far-reaching bill, unveiled only last Thursday, to restructure and cut Medicaid and reshape the individual health insurance market. The Better Care Reconciliation Act of 2017, along with its House-passed cousin, the American Health Care Act, faces intense opposition from Democrats; provider, public health and consumer advocacy groups; and safety-net health plans. It also has elicited skepticism from both conservative and moderate Senate Republicans, whose votes McConnell needs to pass the bill with a bare majority under budget reconciliation rules. (Meyer, 6/23)

The Hill: GOP’s Message On ObamaCare Is Us Versus Them
Do you want to be known as the Republican who killed the repeal of ObamaCare? That’s the question every GOP senator will weigh over the next week, and it’s an integral part of the Republican leadership’s strategy to get the prized legislation a step closer to President Trump. Senate Majority Leader Mitch McConnell (R-Ky.) is expected to force a vote this week, despite complaints from conservatives that his draft bill doesn’t really repeal ObamaCare  —  and deep reservations from centrist Republicans that it goes too far. (Cusack and Swanson, 6/26)

The Hill: McConnell Allies Confident In Healthcare Win 
Republicans close to Senate Majority Leader Mitch McConnell (R-Ky.) are confident he can save the Senate’s teetering healthcare reform bill, the Better Care Reconciliation Act, over the next five days -- though its shaping up to be a daunting task.  Some Republican senators are skeptical that McConnell can stick to his ambitious plan of passing a major overhaul of the nation’s healthcare system before Congress takes off for the July 4 recess. (Bolton, 6/26)

Politico: CBO Score Sure To Add To McConnell’s Headaches
The CBO is poised to tell Senate Republicans this week that their health plan will leave millions more uninsured than Obamacare — with the losses estimated from 15 million to 22 million over a decade, according to a half dozen budget analysts polled by POLITICO. (Cancryn and Diamond, 6/26)

The Nevada Senator In The Eye Of The Health Bill Storm

Sen. Dean Heller, who became the fifth Republican senator to say he was opposed to the GOP's measure, has all eyes on him.

The New York Times: Health Law Repeal Leaves Nevada Republican Torn Between Lawmakers
Senator Dean Heller, Republican of Nevada, is the man everyone wants. This has not been a good thing for him. Brian Sandoval, the governor of Mr. Heller’s home state, is a Republican, but he is counting on Mr. Heller to provide what could be a crucial vote to maintain President Barack Obama’s health care law, which has been a boon for the working poor in Nevada. Senator Mitch McConnell, the majority leader who this week will be rounding up votes to fulfill his party’s biggest promise of the last decade — repealing the Affordable Care Act — is trying to prevent Mr. Heller from undermining that goal. (Steinhauer, 6/24)

The Associated Press: 5 GOP Senators Now Oppose Health Care Bill As Written
Nevada Republican Dean Heller became the fifth GOP senator to declare his opposition to the party's banner legislation to scuttle much of Barack Obama's health care overhaul on Friday, more than enough to sink the measure and deliver a stinging rebuke to President Donald Trump unless some of them can be brought aboard. (6/24)

The Wall Street Journal: Nevada Senator’s Opposition To Health Bill Highlights Political Pressures
“I cannot support legislation that takes away insurance from millions of Americans and hundreds of thousands of Nevadans,” said Mr. Heller, who is seen by analysts on both sides as the most vulnerable Senate Republican in 2018. “Make no mistake, the Affordable Care Act does need fixing. But the bill in front of us today doesn’t make those fixes.” The announcement was in part a recognition that the ACA, a law that Mr. Heller has spent years disparaging, has grown more popular in Nevada. (Hackman, 6/24)

CQ Roll Call: Top Nevada Republicans Criticize Senate GOP Health Bill
Republican Sen. Dean Heller and GOP Gov. Brian Sandoval on Friday publicly said they could not support Majority Leader Mitch McConnell's draft health care bill, increasing the challenges facing the veteran Kentucky dealmaker. Heller said at a joint press conference with Sandoval that a procedural vote could come as early as Tuesday and indicated he would not vote even to support that motion to proceed. Heller and Sandoval argued the bill would too abruptly end the 2010 health care law’s Medicaid expansion, which helped the state combat the opioid epidemic. Nevada is among the 31 states and the District of Columbia that accepted generous federal aid to expand their Medicaid programs, allowing the working poor to gain coverage. (Young, 6/23)

Politico Pro: Why Nevada's GOP Senator Opposes The New Health Care Bill
Sen. Dean Heller said Friday that he won't support the Senate's Obamacare repeal bill without significant changes to prevent major coverage losses, a potential blow to the GOP efforts to roll back the health care law... Heller is now the fifth Republican to go public with a threat to vote against the bill, which is the culmination of seven years of GOP campaign promises. (Haberkorn and Pradhan, 6/23)

Beyond The Five: Other Republican Senators Have 'Serious Concerns' Over Proposed Bill

Although five Republicans have taken a formal stand against the legislation, there are others who aren't sold on it either. A look at what GOP lawmakers are saying about the plan.

Reuters: Key Republican Collins Has 'Serious Concerns' On Healthcare Bill
Republican Senator Susan Collins of Maine said on Sunday she has extreme reservations about the U.S. Senate's healthcare overhaul and does not think it will be able to pass this week. Collins, a moderate Republican who has not taken a formal stance on the bill, said she was concerned it would cut Medicaid too deeply and said she wants to see an upcoming analysis by the Congressional Budget Office before making a decision. (Dunsmuir and Whitesides, 6/25)

Bloomberg: Cornyn Expects To Move Ahead On Senate Health Bill Wednesday
“I have very serious concerns about the bill,” Senator Susan Collins of Maine said on ABC’s “This Week.” The CBO score “will be so important,” she said. Senate Republican leader Mitch McConnell on Thursday unveiled a long-awaited proposal to replace the health-care reforms enacted by President Barack Obama. (Krasny and McCormick, 6/25)

The Hill: GOP Senator Defends Funding Planned Parenthood 
Republican Sen. Susan Collins (Maine) continued to break with some of her party's priorities on Sunday, speaking out against defunding Planned Parenthood as part of the Senate's recently unveiled healthcare legislation. “It makes absolutely no sense to eliminate federal funding for Planned Parenthood,” Collins told ABC’s George Stephanopoulos on “This Week.” The moderate Republican’s comments come just days after Senate Republicans revealed proposed legislation to repeal and replace ObamaCare, which would defund the nonprofit, which provides women’s health services and abortions.  (Manchester, 6/25)

The Wall Street Journal: GOP Senators Express Misgivings About Health Bill
Sen. Ron Johnson of Wisconsin, who had said last week he couldn’t support the bill, also raised concerns Sunday on the timing. “I don’t have the feedback from constituencies who will not have had enough time to review the Senate bill. We should not be voting on this next week,” Mr. Johnson said on NBC. (Witkowski and Chaney, 6/25)

The Hill: Sasse Has 'Nothing To Announce' On GOP ObamaCare Repeal 
Sen. Ben Sasse (R-Neb.) said Sunday that he is not committed to the GOP’s ObamaCare repeal bill. Sasse, who described the Senate bill as more of a "Medicaid reform package" than a repeal and replace of ObamaCare at a Koch summit this weekend, broke with the majority of his party in telling a group of donors to Charles and David Koch that he wasn’t committed to the bill, according to multiple reports.  (Thomsen, 6/25)

The Hill: Ernst Polls Supporters On Obamacare Repeal Plan
Sen. Joni Ernst (R-Iowa), who has not yet taken a position on Senate Republicans’ ObamaCare repeal and replace plan, is polling her constituents to gauge their feelings on the bill. “Traveling across Iowa on my 99 county tour, I hear from Iowans who are looking for affordable and patient-centered healthcare solutions; your feedback is critical.  I will be closely examining the bill to see how it will affect insurance availability and affordability in 2018 and beyond,” Ernst wrote in an email to constituents. (Manchester, 6/25)

Politico: Freedom Caucus Holds Fire On Senate Obamacare Repeal Bill
The most hard-line conservatives in the House are taking an unusually cautious approach to the Senate's Obamacare replacement, promising to keep an open mind about whatever their colleagues across the Capitol send back. It’s a change in strategy for the House Freedom Caucus. (Cheney and Bade, 6/25)

Meanwhile in Ohio, Gov. John Kasich speaks out against the bill while Sen. Rob Portman remains circumspect —

Boston Globe: On CNN, An Impassioned Kasich Says Neither Party Cares About Poor People
Ohio Governor John Kasich delivered an impassioned defense of those criticizing the Senate’s version of the GOP health care plan on Sunday, telling CNN’s Dana Bash that neither political party “particularly cares about helping poor people.” The declaration came during an interview on CNN’s “State of the Union” in which Bash and Kasich were discussing the recently unveiled plan. (Reiss, 6/26)

Cleveland Plain Dealer: Ohio Republican Candidates For Governor, U.S. Senate Quiet On Obamacare Repeal Bill
Senate Republicans unveiled their plan to alter Obamacare on Thursday, including a three-year phase out of the Medicaid expansion beginning in 2021. That Medicaid rollback will likely play a massive role in the 2018 governor and Senate races as Republicans wrestle with how to balance six years of calling for Obamacare's repeal while trying to maintain the extra funding the state received because of the law. (Richardson and Tobias, 6/23)

Cincinnati Enquirer: Rob Portman Asked Twitter For Its Thoughts On The Senate Health Care Bill. Guess What Happened.
Thursday afternoon, in the hours after Senate Republicans unveiled their health care bill, Ohio Sen. Rob Portman posted a simple request on Twitter:"Here is the full text of the draft Senate health care bill. Let me know what you think"... So far he's gotten at least 2,300 replies, virtually all of them urging him to vote 'no' - plus a few thanking him for at least asking. (Weiser, 6/23)

GOP's Politically Volatile Move To Cut Medicaid Spending Would Impact Consumers, States

The Associated Press and New York Times offer analyses of how the fundamental changes in the Medicaid program being considered by Congress could impact average Americans. The Wall Street Journal also delves into a new controversy about the disparity in Medicaid funding for hospitals in the Senate plan. Kaiser Health News takes note of the large number of seniors that use Medicaid to help pay for their long-term care services. And other outlets explore state-specific concerns.

The Associated Press: Medicaid Is Biggest Consumer Story In 'Obamacare' Rollback
Republicans in full control of government are on the brink of history-making changes to the nation's health care system. The impact for consumers would go well beyond "Obamacare." Former President Barack Obama's signature law is usually associated with subsidized insurance markets like HealthCare.gov. But the Affordable Care Act also expanded Medicaid. (Alonso-Zaldivar, 6/23)

The Wall Street Journal: Health Bill Provision Favors States That Didn’t Expand Medicaid
As health-care companies parse Senate Republicans’ bill to undo the Affordable Care Act, a rift is emerging in the hospital industry over a provision that would award additional funds in states that didn’t expand Medicaid. The split centers around cuts the Affordable Care Act made to Medicaid subsidies known as “disproportionate share” payments, for hospitals that care for a large share of uninsured patients. Hospitals wouldn’t need the subsidies as more Americans gained insurance coverage, ACA policymakers believed. (Evans, 6/25)

The Washington Post: In Health-Care Bill, Two Prized Republican Goals Converge
The Senate Republican health-care bill would achieve a historic convergence of GOP priorities, placing major, permanent caps on Medicaid spending and providing a significant tax cut for wealthy Americans. President Trump and congressional Republicans describe the legislation as fulfilling their promise to repeal the Affordable Care Act, or Obamacare, but key provisions are also aimed at making progress on the GOP’s long-held goal of cutting entitlement spending. (Paletta, 6/23)

Politico: Republican Governors Could Be Secret Weapon Against Health Care Bill
A handful of GOP governors opposed to their party’s proposals to overhaul Medicaid could potentially kill Mitch McConnell’s effort to repeal Obamacare. Nevada Gov. Brian Sandoval, a Republican moderate who has hammered the repeal efforts for months, helped to deliver Sen. Dean Heller to the “no” column Friday. He stood next to Heller in the governor’s conference room in Las Vegas as the Nevada Republican announced he could not vote for the Senate repeal plan as written. (Pradhan, 6/24)

Bloomberg: Health Insurers Concerned By ‘Dramatic’ Medicaid Cuts In Bill 
Health insurers criticized the steep cuts to Medicaid proposed in the Senate bill to repeal and replace the Affordable Care Act as “too much, too fast. ”After hospital, doctors and advocacy groups lambasted the proposal released Thursday, the health insurance industry’s main Washington lobby said it’s concerned about its impact on states’ finances and low-income Americans. The end to funding for Obamacare’s expansion of Medicaid and a move to cap how much the federal government spends on the state-federal health program for the poor could harm state budgets and program beneficiaries, according to America’s Health Insurance Plans. (Tracer, 6/23)

CQ HealthBeat: Repeal Talks Cloud Health Care Safety Net Hearing
Lingering resentment over the health care replacement legislation dominated conversation at the House Energy and Commerce Health Subcommittee hearing on funding the Children's Health Insurance Program and community health centers. ... While CHIP has traditionally been a bipartisan effort, Democrats and Republicans exchanged jabs over how funding for the program could proceed without addressing funding for Medicaid, the federal and state program that pays for half of the births in the United States as part of its broad mission. Both the House health care bill (HR 1628) and Senate draft bill propose capping Medicaid funding for the first time since its creation in 1965. (Raman, 6/23)

Kaiser Health News: In The End, Even The Middle Class Would Feel GOP Cuts To Nursing Home Care
Alice Jacobs, 90, once owned a factory and horses. She raised four children and buried two husbands. But years in an assisted living facility drained her savings, and now she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home here. “You think you’ve got enough money to last all your life, and here I am,” Jacobs said. (Rau, 6/26)

Minneapolis Star Tribune: Medicaid Cuts In GOP Health Care Bill Could Take Toll On Minnesota Seniors
The Senate GOP health care bill could lead to cuts in programs that help frail Minnesota seniors and jeopardize many cost-saving services that support caregivers and help seniors stay in their homes. ... “There’s a lack of awareness that Medicaid is really the safety net in Minnesota for so many of our seniors,” said Minnesota Department of Human Services Commissioner Emily Piper, whose agency manages the $11 billion program. (Crosby, 6/24)

The CT Mirror: Malloy Stands By Pledge To Aid Planned Parenthood Despite Cost
Gov. Dannel P. Malloy is maintaining his commitment to fully fund Medicaid reimbursements to Planned Parenthood in Connecticut if the federal government ends its financial support as part of the Republican plan to dramatically reshape the Affordable Care Act, a spokeswoman said. Numbers provided by the governor’s budget office indicate picking up the federal share of Planned Parenthood’s funding in Connecticut would cost the state several million dollars each year at current levels. (Constable, 6/23)

Meanwhile, Ohio state legislators are moving to make changes to Medicaid, too --

Cincinnati Enquirer: Ohio GOP Preps For Showdown Over Drug Treatment, Medicaid Expansion
Ohio's GOP lawmakers say they are devoting millions to the fight against heroin and opioids, even as they propose stripping away insurance that helps Ohioans receive drug treatment. With one hand, GOP lawmakers in the Ohio Senate have offered $176 million to tackle the state's drug problem. With the other, they've proposed crippling Gov. John Kasich's Medicaid expansion by ending new enrollment after July 1, 2018. (Balmert, 6/24)

Republicans Say Costs Will Be 'Much Lower' Under Their Bill -- But Experts Disagree

They say millions of Americans will pay more for an insurance policy that comes with a much steeper deductible, and it could also make it much harder to find a comprehensive plan covering various conditions ranging from heart disease to depression that would not be prohibitively expensive. Media outlets look at what else is in the measure, and how it will affect consumers and the industry.

The New York Times: Senate Health Plan Falls Short Of Promise For Cheaper Care, Experts Say
President Trump and the Republicans have promised that their plan to overhaul the federal health care law will make medical coverage much more affordable. Premiums and deductibles will be “much lower,” Mr. Trump tweeted in April. He also assured Americans that the plan to replace the Affordable Care Act would protect people with potentially expensive medical conditions. ... But millions of Americans will pay more for an insurance policy that comes with a much steeper deductible under the new Senate plan, according to some health economists and insurance experts. It could also make it much harder to find a comprehensive plan covering various conditions ranging from heart disease to depression that would not be prohibitively expensive. (Abelson, 6/23)

The Associated Press: Consumer Issues Stemming From The GOP Health Care Initiative
Republicans in full control of government are on the brink of history-making changes to the nation's health care system. The impact for consumers would go well beyond "Obamacare." Former President Barack Obama's signature law is usually associated with subsidized insurance markets like HealthCare.gov. But the Affordable Care Act also expanded Medicaid. (6/24)

Los Angeles Times: What The Senate Healthcare Bill Could Mean For Californians
The Affordable Care Act has had a huge impact on California, where roughly 4 million people have gained insurance and the percentage of uninsured residents has dropped more than half. [Here] is a breakdown of some of the ways the Senate bill could affect healthcare coverage in California if it becomes law. (Karlamangla, 6/23)

Kaiser Health News: ‘Coverage Gap’ For Poor May End, But Many Will Still Have Trouble Affording Plans
Having long decried the failings of the Affordable Care Act, Senate Republicans are purporting to fix one of its loopholes with their newly unveiled health plan. The so-called coverage gap left more than 2.5 million people living below the poverty line of $11,880 for an individual ineligible for Medicaid or financial assistance to buy insurance — even as higher earners got subsidy checks to buy theirs. But experts say the fix, which looks fine on paper, is a mirage. (Galewitz, 6/23)

WBUR: How The Senate Health Care Bill Could Disrupt The Insurance Market
Senate Republicans have little margin for error as they prepare for a vote this coming week on a bill to repeal and replace the Affordable Care Act. Some lawmakers are already raising concerns that the bill could aggravate the problem of healthy people going without insurance, driving up costs for everyone else. (Horsley, 6/24)

Politico Pro: Senate Repeal Bill Could Free Health Insurers To Sell Plans Across State Lines
An under-the-radar provision in the Senate's Obamacare repeal bill would take a step toward the longtime GOP goal of allowing health insurance sales across state lines. Section 139 of the bill released Thursday would take away state regulators' ability to approve the participation of plans in their small-group health insurance market, paving the way to speed new plan offerings across the country. (Diamond, 6/23)

WBUR: What The Senate Health Bill Means For The Drug Industry
The pharmaceutical industry has not taken a position on the Senate's health care bill released Thursday. The bill would eliminate a tax on drug companies, but provisions of the bill that are expected to leave millions more uninsured could hurt sales for drug companies. (Hobson, 6/23)

Modern Healthcare: Public Health Funding Slashed In Senate's Proposed ACA Repeal Bill 
Senate Republicans' bill to repeal and replace the Affordable Care Act deals a heavy blow to public health efforts by eliminating key funding created by the landmark healthcare reform bill. The Better Care Reconciliation Act revealed Thursday proposed eliminating the ACA's Prevention and Public Health Fund in 2018, which makes up 12%, or nearly $900 million, of the Centers for Disease Control and Prevention's budget. (Johnson, 6/23)

Trump Dips Toes Into Senate Negotiations After Weeks Of Sitting On Sidelines

“I cannot imagine that these very fine Republican Senators would allow the American people to suffer a broken ObamaCare any longer," President Donald Trump tweeted.

The Associated Press: Trump: Not 'That Far Off' From Passing Health Overhaul
Making a final push, President Donald Trump said he doesn't think congressional Republicans are "that far off" on a health overhaul to replace "the dead carcass of Obamacare." Expressing frustration, he complained about "the level of hostility" in government and wondered why both parties can't work together on the Senate bill as GOP critics expressed doubt over a successful vote this week. It was the latest signs of high-stakes maneuvering over a key campaign promise, and the president signaled a willingness to deal. (6/25)

USA Today: Trump, Obama Clash Over Health Care Bill Amid Uncertainty For Senate Republicans
In addition to disputes over costs and insurance rates for Americans, the health care debate also features the most public duel yet between President Trump and predecessor Barack Obama — including an argument over the use of the word "mean." "Well, he (Obama) used my term, 'mean,'" Trump said in an interview broadcast Sunday on Fox & Friends, adding that "I want to see a (health care) bill with heart." (Jackson and Schouten, 6/25)

Meanwhile, a look at the promises the president has made on health care —

The Washington Post: Trump Likely To Break Many Of His Health-Care Promises — No Matter What Happens
Donald Trump set himself apart from other Republican presidential candidates when it came to health care. Before taking office, he vowed “insurance for everybody” that would be “much less expensive and much better” and explicitly promised not to touch Medicaid, which millions of his working-class supporters rely upon to cover doctor’s visits and medication. But as Republicans in the Senate press ahead with legislation that would dramatically cut Medicaid and scale back the Affordable Care Act marketplaces, it is increasingly clear that President Trump is almost certain to fall well short of fulfilling those promises. (Wagner, Phillip and Johnson, 6/26)

The Associated Press: Promises, Promises: What Trump Has Pledged On Health Care
President Donald Trump is not known for plunging into the details of complex policy issues, and health care is no exception. Since his campaign days, Trump has addressed health care in broad, aspirational strokes. Nonetheless he made some clear promises along the way. Those promises come under two big headings. First, what Trump would do about the Affordable Care Act, his predecessor's health care law, often called "Obamacare." Second, the kind of health care system that Trump envisions for Americans. (6/26)

HHS Secretary Says Goal Of GOP Health Plan Is To Make Sure 'Nobody Falls Through Cracks'

Health and Human Services Secretary Tom Price talked about the plan this week and what can be done to woe the Republican hold-outs.

Politico: Price Invites GOP Foes Of Obamacare Overhaul To Keep Talking
A top Trump administration official leading Obamacare overhaul efforts sought Sunday to placate members of his own party in the Senate who are opposing legislation unveiled last week. Tom Price, secretary of Health and Human Services, said on "Fox News Sunday" that President Donald Trump and others are talking with the five Senate Republicans who have said they do not support the Senate version of an Obamacare overhaul. They are Sens. Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah, Ron Johnson of Wisconsin and Dean Heller of Nevada. (Temple-West, 6/25)

The Hill: Price: 'No Guarantees' People Won't Fall Through Cracks Of Healthcare Bill
“That is the goal of the plan, to make certain that any transition from Medicaid to the individual market, from Medicaid to the employer-sponsored market, from Medicaid to Medicare, and the other ways that nobody falls through those cracks, that that is a seamless transition. That doesn’t occur right now, but that’s the goal of the plan,” Price said at the Aspen Ideas Festival. (Manchester, 6/25)

In other news, White House adviser Kellyanne Conway also talked about the legislation —

Secrecy, Juicy Scandals And Money, Money, Money: Why Efforts Against GOP Health Bill Have Foundered

The Democrats have been trying to get their message across, but they haven't been able to gain as much traction as the efforts against the Affordable Care Act seemed to. Meanwhile, a look at what one of the top officials involved in running the ACA thinks about the Republicans' plans.

Politico: Obamacare Repeal: Why Democrats Can’t Break Through
Even before Senate Republicans released their Obamacare repeal plan last week, a call went out from liberal activists: Head to the airport and greet departing senators with a furious protest. About five dozen demonstrators showed up at Reagan National Airport, chanting loudly and hoisting signs that read “Don’t Take Away Our Health Care” and “Resist.” Organizers hailed the turnout given the short notice, but the contrast with the thousands of people who flocked to the last airport protests — against President Donald Trump’s travel ban — was inescapable. (Schor, 6/26)

The Wall Street Journal: What The Health-Care Vote Means For The Midterm Elections
This week’s expected Senate vote on the GOP health-care bill will showcase a sharp partisan divide on the issue in states where Democrats are poised to play defense in next year’s midterm elections. All Senate Democrats are expected this week to oppose Republican legislation that would dismantle and replace much of the Affordable Care Act. Many of their potential challengers in next year’s elections are House Republicans, who supported a similar bill when it passed their chamber in May. (Peterson, 6/26)

NPR: What The Man Who Ran Obamacare Thinks About The GOP Health Care Plan
Andy Slavitt understands the inner workings of the U.S. health care system better than most. From 2015 to 2017, he ran the Affordable Care Act, sometimes called Obamacare, as head of the Centers for Medicare and Medicaid Services. Since leaving that post in January, he's been an outspoken critic of the Republican proposals to dismantle it. Yesterday, shortly after the release of the Senate bill, he tweeted, "It's the ugly step-sibling of the House bill." And this morning his message was, "We must start over. It's too important." (Deahl and Hsu, 6/23)

And Independent and Democratic senators are vowing to fight bill —

The Hill: Sanders Tries To Sway GOP Colleague On Obamacare Repeal
Sen. Bernie Sanders (I-Vt.) was in Charleston, W.Va., Sunday for a Protect Our Health Care Rally where he urged GOP Sen. Shelley Moore Capito to vote against what he called a “barbaric and immoral” bill, The Charleston Gazette-Mail reported. “It turns out that the legislation that is coming before the Senate in a few days, the so-called health care bill, will be the most devastating attack on the working class of this country in the modern history of the United States of America,” Sanders said to a crowd of about 2,000, according to the Gazette-Mail. (Master, 6/25)

Roll Call: Opponents, Led By Sanders, Mobilize To Fight Health Care Bill
Opponents of the GOP bill are calling on constituents to register disapproval with their Republican lawmakers as well, by calling and visiting offices, and holding organized protests like the one outside Majority Leader Mitch McConnell’s office Thursday. ... [Sen. Bernie] Sanders and MoveOn will host rallies in Pennsylvania, Ohio, and West Virginia to try and sway Republican Sens. Pat Toomey, Rob Portman, and Shelley Moore Capito, who are seen as possible holdouts on their party’s bill. (Breiner, 6/23)

Seattle Times: Sen. Maria Cantwell Vows To Use ‘Every Tool We Have’ To Stop GOP Health-Care Plan 
U.S. Sen. Maria Cantwell joined doctors and patients at Virginia Mason Medical Center on Friday to blast the newly unveiled Senate Republican health-care bill’s steep cuts to Medicaid. The Senate plan, like the bill passed earlier this year by the U.S. House, would roll back the expansion of Medicaid, the federal-state health insurance program for poor and disabled people, while cutting taxes for the wealthy...In Washington state, 600,000 people have received medical coverage under the Medicaid expansion, as part of the 2009 Affordable Care Act (ACA), or Obamacare. The Senate Republican plan would end federal money to fund that expansion by 2020, leaving states to pick up the cost or end coverage for millions. (Brunner, 6/23)

The Philadelphia Inquirer: Casey Urges Action Against GOP Health-Care Plan
At a morning rally in the state Capitol, Sen. Bob Casey urged voters to help him and other Democrats defeat the Republican Senate plan to replace the Affordable Care Act...He spoke a day after Senate Republicans unveiled their long-awaited proposal to replace Obamacare, a bill their leaders hope to bring to a vote next week. With Republicans clinging to a two-seat majority in the chamber and Democrats unified against the plan, every vote will count. (Langley, 6/23)

Richmond Times-Dispatch: Parents, Stakeholders Tell Kaine They're Concerned About Potential Virginia Medicaid Cuts
U.S. Sen. Tim Kaine, D-Va., met with stakeholders in Richmond on Friday for a roundtable discussion on the potential effect of Medicaid cuts in Senate Republicans’ health care proposal... Kaine spent much of the hour listening to stories from Virginians who said that without Medicaid assistance they would not have the means to care for children who are seriously ill, or who deal with mental health problems or developmental disabilities. (Cain, 6/23)

Koch-Backed Group Disappointed By GOP Plan: 'We Were Caught Flat-Footed' Over Lack Of Full Repeal

The conservative group, Americans for Prosperity, says the proposed measure doesn't go far enough.

Reuters: Conservative Koch Network Criticizes U.S. Senate Healthcare Bill
Officials with the conservative U.S. political network overseen by the Koch brothers say they are unhappy with the healthcare bill that may be voted on by the Senate this week and will lobby for changes to it. At a weekend event with conservative donors, top aides to Charles Koch, the billionaire energy magnate, said the Senate bill does not go far enough to dismantle former President Barack Obama's signature healthcare law, also known as Obamacare. (Oliphant, 6/25)

Politico: Koch-Backed Group Calls Health Fight In Congress 'Humbling'
The head of the the Koch brothers-backed Americans for Prosperity admitted to donors on Sunday that the group was caught “flat-footed" by the fight in Congress to replace Obamacare, as the group seeks to influence Republican proposals it says do not go far enough to repeal the 2010 law. “We fully expected a repeal vote,” Americans for Prosperity President Tim Phillips told hundreds of donors at the Koch network’s annual seminar at the Broadmoor Resort. “We were caught flat-footed when it didn’t happen." (Robillard, 6/25)

'It’s Too Important Not To Get Right': Trump Supporters Decry Cuts They Say Will Exacerbate Opioid Crisis

There are fears that the Medicaid cuts proposed in the GOP bill will make the already raging opioid epidemic worse.

Stat: She Hoped Trump Would Curb The Opioid Crisis. The Results So Far Worry Her
[Leigh Anne] Wilson lost her daughter, 21-year-old Taylor, to an opioid overdose last year. Weeks later, she voted for Trump, won over by his pledge to fight the opioid crisis by building a wall to keep out drugs — and by reforming health care. She is not impressed with how things are going so far....Like Trump, Wilson thinks Obamacare is broken. But she doesn’t believe that rushing through the GOP health care plan is the answer. The bill now before the Senate would make deep cuts in Medicaid spending and phase out the extra federal funds that Obamacare gave states to expand Medicaid. That funding accounts for nearly half of all spending on substance abuse treatment in West Virginia, according to an analysis by the Associated Press. (Blau, 6/26)

The Hill: Opioid Crisis Threatens GOP ObamaCare Repeal
Fears that cuts to Medicaid could exacerbate a national opioid epidemic that took more American lives last year than the Vietnam War have emerged as a huge threat to the Senate GOP's ObamaCare repeal-and-replace bill. The legislation includes a $2 billion fund to help people with substance use disorders, but critics say that's not enough to make up for the deep cuts to Medicaid that would come if the bill becomes law. (Toubein, 6/24)

In other news on the crisis —

Stat: 51 Percent Of Opioid Prescriptions Go To People With Depression And Anxiety
More than half of all opioid prescriptions in the United States are written for people with anxiety, depression, and other mood disorders, according to a new study that questions how pain is treated in this vulnerable population. People with mood disorders are at increased risk of abusing opioids, and yet they received many more prescriptions than the general population, according to an analysis of data from 2011 and 2013. (Caruso, 6/26)

The Washington Post: Greater Opioid Use And Mental Health Disorders Are Linked In A New Study
A new study suggests that people with anxiety and depression are consuming a disproportionate share of prescription painkillers, a finding that could add a new wrinkle to the epidemic of opioid use in the United States. Researchers at Dartmouth College and the University of Michigan found that nearly 19 percent of the estimated 38.6 million people with those two most common mental health disorders received at least two prescriptions for opioids during a year. And more than half the prescriptions for the powerful, highly addictive painkillers went to individuals in that group, the researchers asserted. (Bernstein, 6/26)

Arizona Republic: Former Insys Executives Face Probes Over Opioid Spray, Deaths
Limiting pain pill fills, distributing overdose antidotes and declaring a public-health emergency are pillars of the state’s effort to attack an opioid epidemic that has killed an average of two Arizonans every day. But Arizona so far has not joined the growing number of states that have filed lawsuits or pursued investigations against pharmaceutical companies that market opioid drugs. (Alltucker, 6/23)

Washington Examiner: Naloxone For Opioid Overdoses Still Faces Hurdles In Schools
States are increasingly turning to schools as they work to stave off the devastating opioid epidemic, which is claiming a growing number of lives and ravaging the lifespans of middle-aged white people. Yet local laws prevent some districts from stocking a life-saving antidote, and critics worry it won't discourage drug use. A 2015 law in Rhode Island took the most aggressive approach by requiring all public middle, junior and high schools be equipped with naloxone, which reverses the effects of an overdose when someone passes out. (Leonard, 6/26)

The Washington Post: Oklahoma Doctor Charged With Murder After Patients Overdose On Opioids
On Nov.  21, 2012, Sheila Bartels walked out of the Sunshine Medical Center in Oklahoma with a prescription for a "horrifyingly excessive" cocktail of drugs capable of killing her several times over. A short time later, she was at a pharmacy, receiving what drug addicts call “the holy trinity” of prescription drugs: the powerful painkiller Hydrocodone, the anti-anxiety medication Xanax and a muscle relaxant known as Soma. (Wootson, 6/24)

Anger Over GOP Plan Reverberates In States

Media outlets report on reactions to the newly unveiled legislation.

The Philadelphia Inquirer/Philly.com: In Philly Area, Advocates See 'Devastating Impact' Of GOP Health Plans
Anger over proposed cuts was loud and sharp across the deep-blue Philadelphia region Thursday as Senate Republicans unveiled their health-care plan. New Jersey Hospital Association CEO Betsy Ryan denounced the proposal as having “callous disregard.” Across the river, 18 people lay on the sidewalk outside Republican Sen. Pat Toomey’s Philadelphia office — “Every one of you represents someone who is going to die if they pass this bill,” a speaker said — as hundreds rallied against the measure. (Sapatkin, 6/23)

Arizona Republic: Protesters Call On Sen. Flake To Vote Against American Health Care Act
A group of protesters marched into U.S. Sen. Jeff Flake's Phoenix office Friday morning and started shouting at staff members, demanding they call Flake and have him specify his position on the American Health Care Act and whether he's going to vote against it. ... More than half the protesters were escorted out of the building by two security guards about 15 minutes into the protest. (Na, 6/23)

Cincinnati Enquirer: Cincinnati Faith Leaders Speak Out On Health Care Repeal, Deliver Letter To Sen. Portman
The Interfaith Healthcare Coalition's letter, which has more than 340 signatures from faith leaders across Ohio, urged Portman "to protect Medicaid" and states that "access to affordable, quality healthcare should not and cannot be a privilege" .... Nearly 40 percent of all children in Ohio are on Medicaid; it also covers low-income children, seniors and people with disabilities, according to the letter. (Padilla, 6/23)

Coverage And Access

California Pumps Brakes On 'Woefully Incomplete' Single-Payer Legislation

Assembly Speaker Anthony Rendon cited the fact that the bill doesn't address issues such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration.

The Associated Press: California Assembly Leader Shelves Single-Payer Health Plan
The prospects of a government-run health care system in California dimmed Friday when the leader of the state Assembly announced he doesn't plan to take up the single-payer bill this year. Speaker Anthony Rendon called the bill "woefully incomplete." "Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill," the Los Angeles-area Democrat said in a statement. (6/23)

Sacramento Bee: California Assembly Stalls Universal Health Care Bill
Democratic Sens. Ricardo Lara and Toni Atkins, who introduced the proposal, acknowledged the bill was dead for the year. Lara and Atkins had described the bill as a work in progress when it passed the Senate earlier this month without a funding plan. A legislative analysis pegged the cost at $400 billion. 6/23)

Sacramento Bee: Bernie Sanders Unhappy With Parking Of California Universal Health Care Bill
Having recently urged California to be the nation’s leader in instituting universal health care policy, Sanders has been a strong supporter of Senate Bill 562, which would create a universal, publicly funded health care system for the state... In parking the bill, Rendon called the legislation fatally flawed, noting “serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters to make SB 562 a genuine piece of legislation.” (McGough, 6/24)

Administration News

Congressional HIV Panel Sends Trump Bipartisan Request For Explanation Of Policies

The letter from the Congressional HIV/AIDS Caucus follows the resignation of the six members of a presidential advisory group and concerns about administration policies to fight the disease and help people with it. Also in the news, President Donald Trump signed a law to make it easier to remove employees at the Department of Veterans Affairs.

Stat: HIV Panel Resignations Spur Lawmakers To Seek Answers From White House
The leaders of the Congressional HIV/AIDS Caucus are demanding answers from the White House after a mass exodus from a presidential advisory group. Reps. Barbara Lee (D-Calif.) and Ileana Ros-Lehtinen (R-Fla.), the co-chairs of that group, delivered a letter last week to President Trump that called for the White House to back off proposed budget cuts to HIV/AIDS programs, revamp the currently blank website it scrubbed in January, and to appoint a national AIDS policy director, all after six council members jointly resigned. Those members slammed Trump for not caring about the issue in a public letter of resignation earlier this month. (Facher, 6/26)

The New York Times: Trump Signs Bill Meant To Restore Trust In V.A.
President Trump signed a bill into law on Friday that will make it easier for the Department of Veterans Affairs to remove bad employees and promote whistle-blowing. It is the first step toward fulfilling a campaign pledge by Mr. Trump to make sweeping changes at the beleaguered agency. (Haberman and Fandos, 6/23)

CQ Roll Call: The Trump Budget: Health And Human Services
The Trump administration quickly drew harsh criticism for its plans to strip billions from medical research and public health agencies, with a top GOP House appropriator among the most vocal skeptics of the proposal. House Labor-HHS-Education Appropriations Chairman Tom Cole, R-Okla., in May said the budget request disappointed him, especially since Congress worked in a bipartisan way to boost the National Institutes of Health funding by $2 billion in each of the previous two years. President Donald Trump is seeking to cut $7 billion in fiscal 2018 from the NIH’s current $34 billion budget. (Young, 6/26)

Marketplace

As More Rely On Gig Economy, The Idea Of Employee Benefits May Be Facing An Overhaul

"I think we also want to start imagining the next era of a safety net, where people can do the work they enjoy and need to do, and can get the benefits that they need," says Sara Horowitz, executive director of the Freelancers Union.

NPR: 'Gig Economy' Workers Push For Employee-Style Benefits
The list of perks Dan Teran's company offers sounds pretty dreamy. Anyone working 120 hours a month gets employer-sponsored medical, dental and vision insurance. His company, Managed by Q, also offers a matching 401(k) retirement program, paid time off, a stock option program for all employees, and 12 weeks of paid parental leave. (Noguchi, 6/23)

In other workplace news —

The Washington Post: Why Are Female Doctors Introduced By First Name While Men Are Called ‘Doctor’?
Julia Files and Anita Mayer, physicians at the Mayo Clinic, started seeing a pattern: When their male colleagues were introduced at conferences, they were usually called “Doctor.” But the men introduced them and other female doctors by their first names. The pair quickly realized they weren’t alone. Sharonne Hayes, another Mayo doctor, had noticed the same thing. While a male colleague would be introduced as “Dr. Joe Smith,” for example, the women were often simply called “Julia,” “Anita” and “Sharonne.” (Neumann, 6/24)

Quality

Despite Efforts To Curb Problem, Inappropriate Social Media Postings Continue To Plague Nursing Homes

While the problem isn’t new, the pace of reported incidents has certainly picked up — and it’s not clear why.

ProPublica: Nursing Home Workers Still Posting Nude And Vulgar Photos Of Residents On Snapchat
In the last year alone, employees of at least 18 nursing homes and assisted living facilities have posted unauthorized — and in some cases, vulgar and stomach-turning — photos and videos of residents on Snapchat and other social media platforms, a ProPublica analysis has found. Six incidents were in Iowa, which has put a greater focus on identifying such cases. (Ornstein, 6/23)

Public Health And Education

For Those With Alzheimer's, Coping With Other Symptoms Can Be Worse Than Memory Loss

"You don't die of Alzheimer's," Greg O'Brien says. "You die of everything else. But first, you live with it all." In other public health news: strokes, racial disparity in transplants, managing chronic diseases, toilet-training newborns, obesity and more.

NPR: Alzheimer's Bring Other Health Problems With It
The first problem with the airplane bathroom was its location.It was March. Greg O'Brien and his wife, Mary Catherine, were flying back to Boston from Los Angeles, sitting in economy seats in the middle of the plane. "We're halfway, probably over Chicago," Greg remembers, "and Mary Catherine said, 'Go to the bathroom.' " (Hersher, 6/24)

NPR: How Forgetting Might Make Us Smarter
Intuitively, we tend to think of forgetting as failure, as something gone wrong in our ability to remember. Now, Canadian neuroscientists with the University of Toronto are challenging that notion. In a paper published Wednesday in the journal Neuron, they review the current research into the neurobiology of forgetting and hypothesize that our brains purposefully work to forget information in order to help us live our lives. (Hsu, 6/23)

The Star Tribune: Reaching Deep Into The Brain To Treat Strokes
The market for minimally invasive tools and equipment to treat brain problems like strokes and aneurysms is worth more than $500 million in the United States today and is likely to surpass $1 billion by 2025, according to estimates from analyst Beata Blachuta with Decision Resources Group. Those estimates were considered conservative by another source.Industry analysts say the dominant player in the neurovascular-device market is Minnesota-run Medtronic PLC, by virtue of its 2015 acquisition of industry forerunner Covidien, which had neurointerventional devices once owned by Plymouth-based firm ev3. (Carlson, 6/24)

NPR: Doctor Tells A Personal Tale Of Racial Disparity In Organ Transplants
While she was a primary care doctor in Oakland, Calif., Dr. Vanessa Grubbs fell in love with a man who had been living with kidney disease since he was a teenager. Their relationship brought Grubbs face to face with the dilemmas of kidney transplantation — and the racial biases she found to be embedded in the way donated kidneys are allocated. Robert Phillips, who eventually became her husband, had waited years for a transplant; Grubbs ended up donating one of her own kidneys to him. And along the way she found a new calling as a nephrologist — a kidney doctor. (Martin, 6/24)

The Wall Street Journal: How Apps Can Help Manage Chronic Diseases
Technology is offering a new fix for one of the most confounding health-care challenges: getting patients with chronic disease to take better care of themselves. About half of all adults suffer from one or more chronic diseases, which account for seven of 10 deaths and 86% of U.S. health-care costs. But preventing and treating such ailments requires time that doctors don’t have in brief office visits, and a degree of daily self-management that many patients have been unable to handle. They often become overwhelmed by the demands of their daily regimens, slip back into poor health habits, fail to take their medications correctly—and end up in the emergency room. (Landro, 6/25)

The Washington Post: Physician Couple Toilet-Trains Newborn, Skips Diapers
When two California doctors were expecting their third child, they wanted to stop contributing to the more than 27 billion disposable diapers dumped yearly into U.S. landfills. But washing cloth diapers wasn’t an environment-friendly alternative, either. Then Rosemary She read about a way to skip diapers altogether. Called elimination communication, the method has parents and caregivers tune in to a baby’s cues and natural rhythms and bring the child to a toilet when it seems like the right time. (Cohen, 6/24)

The Washington Post: Some Scientists Have Been Their Own Guinea Pigs In The Lab
Werner Forssmann had a plan — a plan he knew his superiors would never approve. The 24-year-old German surgeon was frustrated by how difficult it was to access the human heart, but he doubted he’d get permission to perform a risky new procedure. And so, in 1929, he tried it on himself, thereby joining an age-old club: scientists who use themselves as guinea pigs. Forssmann’s plan was rudimentary and extremely dangerous. With the help of a nurse who hadn’t realized what was about to happen, he pushed an oiled urinary catheter through a vein in his arm and almost all the way to his heart, then rushed to another floor of his clinic to X-ray the results. An appalled colleague fought to remove the catheter but was unable to do so before Forssmann pushed the catheter all the way into his heart and proved the procedure wouldn’t kill a patient. (Blakemore, 6/24)

Reuters: More Playtime With Dad Linked To Lower Obesity Risk For Young Kids
Fathers who get increasingly involved in raising their children may be helping to lower the youngsters’ risk of obesity, a new study suggests. Researchers examined how often fathers participated in parenting activities such as caregiving, making meals and playing outside, and how much they participated in decisions related to nutrition, health and discipline when the children were 2 and 4 years old. (6/24)

The Washington Post: How Safe And Sanitary Is ‘Body Art’? Laws Regulating Tattoos, Piercing Vary Widely.
Anyone who goes into a tattoo parlor in North Carolina can be assured that it has a permit from the state health department and that inspectors have checked the premises for safe and sanitary conditions. But go for a body piercing in the state and there’s no such protection. A state law, approved in the 1990s, regulates tattoos but doesn’t apply to other forms of body art. “Most people think it’s all regulated,” said state Rep. Kevin Corbin, a Republican. “But we found out there’s no law on the books.” (Mercer, 6/25)

The New York Times: Antibiotic Eye Drops Often Unhelpful For Pinkeye
Doctors often prescribe antibiotic eye drops to people with conjunctivitis, or pinkeye, even though they are almost always ineffective, a new study found. About 80 percent of cases of pinkeye are caused by a virus, and there is no treatment for viral conjunctivitis. Most bacterial conjunctivitis is mild and will get better in a week or two without treatment. Antibiotics are effective only in the much smaller number of cases that involve the bacteria that cause gonorrhea or chlamydia. (Bakalar, 6/22)

Kaiser Health News: ‘No One Wants To Be Old’: How To Put The ‘Non-Age’ In Nonagenerian
Wilhelmina Delco learned to swim at 80. Harold Berman is in his 67th year practicing law. Mildred Walston spent 76 years on the job at a candy company. And brothers Joe and Warren Barger are finding new spots in their respective homes for the gold medals they’ve just earned in track-and-field events at the National Senior Games. These octogenarians and nonagenarians may not be widely known outside their local communities, but just as their more famous peers — think Carl Reiner, Betty White, Dr. Ruth (Westheimer) or Tony Bennett — the thread that binds them is not the year on their birth certificate but the way they live. (Jayson, 6/26)

The Baltimore Sun: Heart Healthy Diet As Effective As Statins, American Heart Association Says 
Replacing foods high in saturated fats with those that have unsaturated fats can reduce a person's chance of developing heart disease as much as cholesterol lowering drugs known as statins, according to new advice from the American Heart Association. This would mean, for instance, swapping that steak for a healthier avocado, using canola oil instead of butter, and not eating carb-filled junk food. (Cohn, 6/23)

State Watch

State Highlights: Bill Would Make Volunteer Medical Work Across State Lines Easier; Texans' Health Data Exposed For Months

Media outlets report on news from Tennessee, California, Massachusetts, Texas, Connecticut, Virginia, Ohio, Florida, Wisconsin and Colorado.

Nashville Tennessean: Bill Would Ease Rules On Charity Health-Care Providers
In 1985, [Stan] Brock founded a charitable organization that hosts free medical clinics for people who live in underserved, isolated or impoverished communities. Then he discovered another problem: Many states have laws that prohibit medical personnel from crossing state lines and working at his clinics...Rep. John J. Duncan Jr., R-Knoxville, has filed legislation that would provide $1 million to any state that allows licensed medical professionals to travel from other states and offer their services to those in need. The money would be a one-time allocation and, while the bill does not say how it would be used, the intent is to help states pay any costs associated with allowing outside doctors to volunteer within their borders. (Collins, 6/23)

California Healthline: You Are Now Protected From Nasty Surprise Bills
Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica, Calif., hospital and surgeon were in his health plan’s network. They were. Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork. Her diligence was for naught. (Bazar, 6/26)

Boston Globe: Minuteman Health Shifting To For-Profit Status
Minuteman Health Inc., an insurer launched with millions of taxpayer dollars, said Friday it is seeking to ditch its nonprofit structure next year and sell plans under a new for-profit entity. Executives of the Boston-based company said the change is necessary because the company faces regulations that are too burdensome. (Dayal McCluskey, 6/23)

The CT Mirror: Prolonged CT Budget Standoff Will Hurt Towns, Disabled, Needy
Connecticut spends another $1.3 billion each year hiring community-based nonprofit agencies to provide the majority of social services offered to the disabled, the mentally ill, abused children, the poor and others... And while the administration won’t order layoffs while the concessions deal is pending, it will freeze vacant state jobs of all types and reduce consulting, legal and service contracts. (Phaneuf, 6/26)

California Healthline: Kaiser Permanente Fined — Again — For Mental Health Access Problems
Despite three warnings and a multimillion-dollar fine, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to a recent survey of the HMO by the state of California. The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees with “timely access” to behavioral health treatment, in violation of state law. (Gold, 6/26)

Richmond Times-Dispatch: "I've Seen Way Too Many Fatalities": Providers Urge Parents To Talk About Gun Safety
Last week, the children’s hospital educated parents at its Children’s Pavilion downtown about not only gun safety but also how to ask other parents if they have a gun in the home in recognition of ASK — or Asking Saves Kids — Day, which is a collaboration of the Brady Center to Prevent Gun Violence and the American Academy of Pediatrics... Children in the U.S. die by gun 11 times as often as children in other high-income countries, according to the Brady Campaign. (O'Connor, 6/25)

Columbus Dispatch: ERs Adding Palliative Care To Treat Seniors' Chronic Conditions
Historically, emergency departments have treated victims of gunshots, crashes and other traumatic injuries, plus people who have heart attacks, strokes and other medical emergencies. But as the nation’s elderly population has swelled, emergency departments have been flooded by seniors and others with chronic and, sometimes, fatal illnesses who often need more or different things than just the traditional “life-extending” care provided there. (Pyle, 6/26)

Miami Herald: Gables Cop Shot Him With A Taser. Six Months Later, There's No Cause Of Death.
But the revelation of Gutierrez’s death comes amid increased scrutiny of fatal confrontations with police officers, in South Florida and across the United States. Some of those cases include people who die after being zapped by police Taser stun guns, a weapon hailed by authorities as a less-than-lethal way to stop violent offenders, but criticized by others as a weapon that too often proves deadly. (Ovalle, 6/26)

Sacramento Bee: Mt. Shasta Issues Boil Water Warning Due To E. Coli Bacteria
The city of Mt. Shasta put out a notice warning residents to bring all water to a boil for a minute before drinking it, cooking with it, making ice, brushing teeth or washing dishes. City officials said in the notice they expect to resolve the problem in seven to 10 days, meaning the issue could continue through the Fourth of July, when the city hosts some of its most popular events. (Garrison, 6/25)

Tampa Bay Times: Legalized Medical Marijuana Signed Into Law By Rick Scott
Gov. Rick Scott on Friday signed into law a broader medical marijuana system for the state, following through on a promise he made earlier this month. Lawmakers passed the measure, SB 8A, in a special session after failing in their regular session that ended in May to implement a constitutional amendment legalizing the drug, which was supported by 71 percent of voters last year. (Auslen, 6/23)

Milwaukee Journal Sentinel: Mobile Market Rolls Groceries Into Milwaukee's Food Deserts
First started in 2015 as an initiative between Pick 'n Save and the Milwaukee-based Hunger Task Force, the store makes fresh and healthy foods available to people who would otherwise have limited access to those options. The store supplements other efforts to expand food access in the city by addressing the question of "how do we give people dignity," Hunger Task Force executive director Sherrie Tussler said. (Liu, 6/25)

Denver Post: Fort Collins Podiatrist Guilty Of Fraud.
A Fort Collins podiatrist has been sentenced to prison for billing Medicare for trimming clients’ toenails, which is not covered by the national social insurance program. Dr. Michael Thomas, 55, pleaded guilty to eight counts of health care fraud, according to a news release from the Acting U.S. Attorney, District of Wyoming. Thomas, who was sentenced to six months in prison and a $20,000 fine, fraudulently billed Medicare from December 2011 through November 2016. (Nicholson, 6/23)

Health Policy Research

Research Roundup: AHCA's Impact On Medicaid; Hearing Aids In Free Clinics

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: The Impact Of The AHCA On Federal And State Medicaid Spending And Medicaid Coverage: An Update 
This paper examines the coverage and financing impacts of the Medicaid provisions of the American Health Care Act (AHCA), including the reduction in the federal matching rates for ACA and pre-ACA expansion populations and per capita caps. Estimates for three scenarios of state responses to the bill’s changes are provided... The first scenario would reduce federal spending by $373.6 billion from 2019 to 2028, the second by $803.2 billion, and the third by $938.3. (Holahan et al., 6/16)

JAMA: Income Disparities in Cardiovascular Risk Factors in the United States
Are there socioeconomic disparities in 10-year predicted absolute cardiovascular disease risk and individual risk factors (systolic blood pressure, smoking, diabetes, and total cholesterol) among U.S. adults? A cross-sectional analysis using data on adults 40 to 79 years of age without established cardiovascular disease ... showed the percentage of adults with diabetes and the mean total cholesterol level did not vary by income. The authors concluded that adults in each socioeconomic stratum have not benefited equally from efforts to control cardiovascular risk factors. (Odutayo, Gill, Shepherd, et al, 6/7)

JAMA Psychiatry: Efficacy Of A Maternal Depression Prevention Strategy In Head Start
In this randomized clinical trial of 230 Head Start mothers, those receiving problem-solving education experienced a 60% incident rate of depressive symptom episodes compared with those not receiving it. Among the subpopulation with low symptom levels at baseline, those receiving problem-solving education experienced a 39% incident rate. The efficacy of problem-solving education demonstrates the promise of embedding maternal depression prevention programs in Head Start; additional effectiveness studies are necessary to develop meaningful public health programs. (Silverstein et al., 6/14)

JAMA Otolaryngology–Head & Neck Surgery: Comprehensive Hearing Aid Intervention At A Free Subspecialty Clinic
Is it possible to provide free, comprehensive audiologic services to indigent patients? In this observational cohort study at a preexisting free clinic, 34 patients were identified as eligible for a free hearing aid and 20 of these patients (59%) received hearing aids. The value of services provided was estimated to be $2260 per patient. It is feasible to provide free, comprehensive audiologic care, including hearing aids and fitting, in a well-established, free clinic model. (Wertz et al., 6/15)

New England Journal of Medicine: Changes In Hospital Quality Associated With Hospital Value-Based Purchasing 
The Patient Protection and Affordable Care Act (ACA) established value-based purchasing programs throughout Medicare, including the Hospital Value-Based Purchasing (HVBP) program... Our estimates of the effect of HVBP on clinical process, patient experience, and mortality were small, not consistent with one another in the direction of the association, and generally nonsignificant. The significant reduction in 30-day risk-standardized mortality among patients who were admitted to the hospital for pneumonia was driven by an increase in mortality in the matched sample of Critical Access Hospitals. (Ryan et al. 6/15)

Editorials And Opinions

The Medicaid Debate: Does The Senate GOP Plan Mean Reform Or Is It Just Plain Mean

Editorial writers take hard-line positions on how the pending GOP repeal-and-replace plans would reduce funding for the low-income health insurance program and change its structure.

USA Today: GOP Medicaid Cuts Would Hurt Much More Than Health Care
The Senate’s new health bill, the Better Care Reconciliation Act, proposes even deeper cuts to Medicaid than the House bill. ... As physicians, we are dismayed by the prospect of millions of patients losing access to the medical care they need. But what is often lost in the debate about who should have health care and who should pay for it is the larger fact that Medicaid helps people live healthier, fuller and more productive lives. The unavoidable reality for those trying to dismantle the program is that the health of people is intimately linked to the health of communities, local economies and the nation as a whole. (Dhruv Khullar and Anupam Jena, 6/26)

The Wall Street Journal: Health-Reform Principles That Can Cross Party Lines
The current congressional debate about health reform focuses on two closely linked issues: how to structure subsidies and the future of Medicaid. We write to support two propositions that can better serve economically vulnerable families, while also ensuring that public dollars are spent effectively. First, we believe public subsidies for private insurance premiums should be means-adjusted to make coverage affordable for lower-income people. Second, we believe states should be given new flexibility to streamline coverage options in Medicaid, the Children’s Health Insurance Program (CHIP) and other publicly supported insurance, so that families can obtain the coverage that best suits their circumstances and serves their needs. (Lanhee J. Chen and Ron Pollack, 6/25)

The Washington Post: Republicans Have Long Dreamed Of Cutting Medicaid. Trumpcare Might Really Do It.
As disabled protesters were being dragged, bleeding, from Senate Majority Leader Mitch McConnell’s office on Thursday after he released his version of Trumpcare, I sat at home working line by line through the 142-page bill. As many have observed, it contains deep cuts to Medicaid, redistributes wealth from the poorest to the richest, and guts all the hard-won protections on preexisting conditions, reproductive care and lifetime spending limits that the Affordable Care Act had brought. What struck me, though, is how familiar all the material on Medicaid looks. Republicans have been trying to gut funding for Medicaid for more than 35 years. The only difference is that this time, they might get away with it. (David Perry, 6/26)

Huffington Post: Kellyanne Conway Defends Medicaid Cuts, Says Adults Can Always Find Jobs
White House counselor Kellyanne Conway on Sunday came right out and said what so many Republicans are probably thinking ― that taking Medicaid away from able-bodied adults is no big deal, because they can go out and find jobs that provide health insurance. Apparently nobody has told Conway that the majority of able-bodied adults on Medicaid already have jobs. The problem is that they work as parking lot attendants and child care workers, manicurists and dishwashers ― in other words, low-paying jobs that typically don’t offer insurance. Take away their Medicaid and they won’t be covered. (Jonathan Cohn, 6/25)

Los Angeles Times: The Senate GOP Hid The Meanest Things Very Deeply In Its Obamacare Repeal Bill. We Found Them
The Affordable Care Act repeal bill unveiled Thursday by Senate Republicans has aptly drawn universal scorn from healthcare experts, hospital and physician groups and advocates for patients and the needy. That’s because the bill is a poorly-disguised massive tax cut for the wealthy, paid for by cutting Medicaid — which serves the middle class and the poor — to the bone. (Michael Hiltzik, 6/23)

Louisville Courier-Journal: McConnell Will Cause Many To Suffer
Led by Kentucky’s Mitch McConnell, Congress is poised to undermine the 52-year-old program that covers more Kentuckians and Americans than any other form of health insurance: Medicaid. The word rarely passes McConnell’s lips in public, because his criticism of “Obamacare” focuses on its worsening markets for private health insurance, which he and President Trump have helped sabotage. But in his floor speech on his health bill Thursday, the Senate majority leader said Republicans “agree on the need to strengthen Medicaid.” (Al Cross, 6/23)

State Perspectives: Counting The Reasons To Oppose Republican Plans For Medicaid

Editorial pages across the country detail how their states and jurisdictions would be hit by the proposed cuts to this program.

Billings (Mont.) Gazette: What Medicaid Cap Would Mean For Montana
One in seven people using Medicaid has a disability — many of them are children — and the health services they depend on are now in jeopardy. That’s because proposed changes to Medicaid in the Senate this month will lead to extensive service cuts if they become law. (Michelle Belknap, 6/25)

Cleveland Plain Dealer: Gov. Kasich Should Veto Ohio Medicaid Cutoff If It Makes It To His Desk
With national attention riveted on congressional attempts to gut Medicaid, some pernicious amendments to Ohio's must-pass 2017-19 budget bill may be flying under the radar. They shouldn't. Gov. John Kasich should wield his line-item veto if any of them makes it past the Ohio House-Senate conference committee and into the final budget that the GOP-run legislature must send to the Republican governor's office by June 30. (6/24)

Different Takes On The Politics Swirling Around The Senate GOP's Health Plan

Opinion writers offer their thoughts on the high political stakes in play regarding the legislation that the Senate Republican leadership has named The Better Care Reconciliation Act of 2017. But will it be better?

The New York Times: The Health Debate Shows What Both Parties Care About Most
Economists believe what people do more than what they say. It’s called revealed preference: People’s actions are the best indication of what they actually want, not their words. The same applies to political parties. This is plain to see in the Senate health care bill, which would eliminate large parts of President Barack Obama’s health care overhaul. (Neil Irwin, 6/23)

The Washington Post: Replacing Obamacare Is A Make-Or-Break Moment For Republicans
Sen. Dean Heller (R-Nev.) threw himself off a political cliff last week when he declared full-throated opposition to the Senate version of the Obamacare repeal bill, and it remains to be seen if Heller is hanging by a limb out of sight and can climb back to electoral sanity or has hit rock bottom in his public career. (Hugh Hwitt, 6/25)

Bloomberg: Those Moderates Are Screwing Up Health-Care Reform
For most of the last decade, moderate Republicans have sounded just like their conservative colleagues on Obamacare: The law was a disaster and had to be replaced. Once Republicans were in a position to do something about the law, though, they were forced to think, apparently for the first time, about specific health-policy decisions. At that point the moderates decided that they want to keep Obamacare but make it cheaper. (Ramesh Ponnuru, 6/23)

Bloomberg: Health-Care Bill Puts Senate In Uncharted Waters
Will it pass? The dominant attitude on Thursday (at least in my Twitter feed) was that Mitch McConnell is a master legislator who had carefully maneuvered the bill past various obstacles. Yes, many Republicans have expressed doubts about it, but surely they could be brought on board with amendments that allow them to claim credit back home. That's what happened in the House when their version of the bill looked dead. Moderates and those in states where it would be a tough vote -- Maine's Susan Collins, Alaska's Lisa Murkowski, Ohio's Rob Portman, Nevada's Dean Heller -- will fold, as that wing of the party always does. Those who feel the bill doesn't go far enough -- including Kentucky's Rand Paul, Utah's Mike Lee, Wisconsin's Ron Johnson, and Ted Cruz of Texas -- surely care about passing something, and the rest of the Republicans will likely give them what they need to vote yes. (Jonathan Bernstein, 6/23)

Roll Call: What’s At Stake For McConnell, Conservatives And The GOP
The last Republican president, George W. Bush, actually expanded Medicare entitlements. President Ronald Reagan worked with a Democratic Congress to stabilize Social Security, and President Richard Nixon oversaw a massive increase in eligibility for Medicare. Over the years, legislators and presidents have nipped, tucked and tweaked the entitlement programs, but no one has ever gotten so close to a fundamental reversal of their structure as congressional Republicans are now. That is, Republicans have campaigned on reining in spending but they haven’t really had the chance to take the “entitlement” out of the three major entitlement programs. Now, they are positioned to do just that with Medicaid. (Jonathan Allen, 6/26)

The Washington Post: The Senate’s Three Big Lies About Health Care
To succeed in gutting health coverage for millions of Americans, Senate Republican leaders need to get a series of lies accepted as truth. Journalists and other neutral arbiters must resist the temptation to report these lies as just a point of view. A lie is a lie. (E.J. Dionne, 6/25)

Parsing The Policies: What About Pre-Existing Conditions? Insurance Market Stability? Coverage For People With Disabilities?

Editorial and opinion writers examine how the health policies currently being debated will affect people who gained coverage under the Affordable Care Act as well as how forces within the health insurance marketplace would be altered by the Republicans' plan and how vulnerable populations could be impacted.

The New York Times: If We Lose Our Health Care ...
Republicans have demonized the Affordable Care Act for so long that people may have forgotten that nearly one in five nonelderly Americans lacked health insurance before the law was passed. Many of them didn’t get the care they needed because they feared it would bankrupt their families. The A.C.A., or Obamacare, has not solved those problems completely, but it has extended health care coverage to 20 million people. (6/24)

Los Angeles Times: The GOP Says Its Healthcare Bill Will Protect Those With Preexisting Conditions. Um, No It Won't
Here’s the opening quote from a press release Thursday from Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health, Education, Labor and Pensions Committee, about the Senate GOP leadership’s healthcare bill: “To begin with, the draft Senate healthcare bill makes no change in the law protecting people with preexisting conditions, no change in Medicare benefits, and increases Medicaid funding — that’s TennCare — at the rate of inflation.” (Jon Healey, 6/23)

Boston Globe: Health Reform Must Protect Patients With Preexisting Conditions
If the House or Senate version of the American Health Care Act becomes law, what will happen to Lauren and millions of other children and adults with preexisting conditions if they experience a gap in their health coverage? The suggestion that somehow those with illnesses have been irresponsible, or that they’ve invited bad health, is insulting and infuriating. (Jane Swift, 6/26)

The Washington Post: The Senate’s Health-Care Bill Could Be One Of The GOP’s Greatest Accomplishments
The Senate health-care legislative draft — officially titled the Better Care Reconciliation Act of 2017 — will, if passed, represent the greatest policy achievement by a Republican Congress in generations. Given that Democrats have filled the airwaves with wild claims that the bill amounts to mass murder, it may feel jarring to think of the bill as a historic achievement. But it is. (Avik Roy, 6/24)

The New York Times: Where The Senate Health Care Bill Fails
Speaking at a rally for his wife’s presidential campaign last year, Bill Clinton called Obamacare “the craziest thing in the world.” As he put it, “The people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half.” Mr. Clinton was right, and it’s why Republicans have been pushing to repair the damage done by Obamacare for so long. Our priority should be to bring relief, and better, less expensive care, to millions of working men and women. (Sen. Ron Johnson, 6/26)

The Wichita Eagle: Not Much For Disabled In Trump’s Budget Plan
Marlee Matlin, the Oscar-winning actress who is deaf, is worried. She thinks the Trump White House and GOP-led Congress want budget cuts, particularly in Medicaid, that will harm the disabled. She’s right; they will. That’s the bad news and the main point I’m making. But I take comfort in Matlin’s concern. It shows the disability rights movement, composed of people with sensory, intellectual, physical and other forms of disabilities, is as strong as it was in 1990 when the movement got the Americans with Disabilities Act (ADA) with little but guts and will and the clear fact we were morally, financially and politically right. (David Rundle, 6/25)

Indianapolis Star: Trumpcare Might Already Be Here
We don't yet know whether the U.S. Senate will pass its health reform bill during the coming week. But we know one thing: Obamacare already is being deconstructed. That became apparent in Indiana on Wednesday as Anthem Inc. and MDwise announced they will exit the state's individual health insurance marketplace. (James Briggs, 6/23)

Viewpoints: Are Safe Injection Sites Safe?; Thinking About Fake [Health] News

A selection of opinions on health care from around the country.

Los Angeles Times: Safe Injections Centers Are Not Opium Dens
Goovernment-sanctioned and supported “supervised injection centers,” where addicts can bring their illicitly obtained drugs and shoot up with little fear of arrest or a fatal overdose, have been in service in Europe for decades. There’s only one in all of North America, though. It’s in Canada — a Vancouver, Canada, center called Insite. Research found that after the center opened in 2003 fatal drug overdoses decreased by 35% in the nearby community. Earlier this month Canadian officials authorized injection centers in Montreal, Toronto and other cities. (6/24)

The Atlantic: 'Of All The Categories Of Fake News, Health News Is The Worst'
“Let’s take this back a couple hundred years,” said Brian Southwell, the director of the “Science in the Public Sphere” program at the Center for Communication Science at RTI International. “There was an ongoing debate between a couple guys in Europe: Spinoza and Descartes.” These two philosophers were debating, essentially, about whether people are able to readily identify fake news. (Julie Beck, 6/25)

Cleveland Plain Dealer: Berea Cop Sees Assisting Addicts, Not Just Arresting, As The Right Way To Protect And Serve
Berea Police Patrolman David Kammerman fumbled for the ringing cell phone. It was 4 a.m. and his shift in this low-crime college town didn't start for another few hours. "Hello?" On the other end was a drug addict whom Kammerman had encountered on the job. But he never arrested him. Instead, the guy came to Kammerman for help and the officer gave it, reassuring him that "addiction is not a choice, but recovery is." Then, as part of a cooperative program with Olmsted Township Police called "Safe Passages," the cop worked the phones and lined up a coveted inpatient treatment bed. (Michael K. McIntyre, 6/25)

WBUR: Dear Jeff Bezos, Please Help Save My Patients' Lives By Cutting Whole Foods Prices
But recently, as a result of talking with the patients I treat as a primary care physician, my organic blueberries come with a topping of guilt and concern about what my high-end groceries mean for the low-income people who live near Whole Foods markets. For them, my neighborhood is what I would call a “food desert of plenty,” with plenty of healthy foods in walking distance but economically out of reach. (Elisabeth Poorman, 6/23)

The Kansas City Star: It’s Time To Think About Replacing Osawatomie State Hospital
Osawatomie State Hospital, one of two state facilities for the severely mentally ill, has once again failed to achieve federal certification. That fact should disturb every Kansan. This should also prompt a serious discussion about the state of mental health treatment in Kansas, including the possibility of demolishing all or part of the existing Osawatomie facility and building a new 21st-century treatment center. (6/24)