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DIFFICULT MATH: TRUMP BUDGET; CBO SCORE COULD ADD UP TO POLITICAL PERIL

Some of those voters
Might do the calculations
In the ballot box.

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Summaries Of The News:

Health Law

GOP Plan Would Result In 23 Million More Uninsured, Potentially Soaring Costs For Sickest Americans

The nonpartisan Congressional Budget Office releases its score for the amended American Health Care Act passed by the House earlier this month.

The Associated Press: GOP Health Bill: 23M More Uninsured; Sick Risk Higher Costs
The Congressional Budget Office report, issued Wednesday, also found that average premiums would fall compared with President Barack Obama's health care overhaul, a chief goal of many Republicans. But that would be partly because policies would typically provide fewer benefits and sicker people would be priced out, it concluded. (Fram and Alonso-Zaldivar, 5/25)

Los Angeles Times: GOP Health Bill Would Raise Deductibles, Lessen Coverage And Leave 23 Million More Uninsured, Analysis Finds
The House bill would be particularly harmful to older, sicker residents of states that waive key consumer protections in the current law, including the ban on insurers charging sick consumers more. The budget office estimates that about one-sixth of the U.S. population live in states that would seek such waivers, which would be allowed under the House bill. “Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance,” the report notes. (Levey, 5/24)

CQ Roll Call: CBO: 23 Million More Uninsured Under House Health Care Bill
The effects of the bill would be immediate. In 2018, 14 million more people would be uninsured if the bill became law. Premiums would rise by an average of about 20 percent in 2018, CBO said. However, average premiums starting in 2020 would partially depend on changes states might seek to Obamacare insurance requirements. (Young and Raman, 4/24)

Kaiser Health News: Millions Of Ill People May Face ‘Extremely High Premiums’ Under House Bill, CBO Says
The report incorporates the changes to the bill made just before it narrowly passed the House on May 4. Those changes included an amendment offered by Rep. Tom MacArthur (R-N.J.) that would let states waive some key provisions of the health law, including requirements to cover “essential health benefits” and to offer insurance to people with preexisting conditions at no extra cost. (Rovner, 5/24)

Bloomberg: Republican Health Overhaul Would Leave Millions More Uninsured 
The waivers states are allowed to take would let insurers offer plans that don’t cover some benefits, such as maternity care. That would mean people would have to pay for those treatments on their own, or buy separate insurance coverage for them. An add-on policy that covers maternity care could cost $1,000 a month or more, CBO said -- raising both up-front and out-of-pocket costs for women. (Edney, Tracer and Litvan, 5/24)

The Washington Post: Uninsured Ranks Still To Grow By Tens Of Millions Under Latest House Health-Care Bill, CBO Says
Congressional analysts concluded that one change to the House bill aimed at lowering premiums, by allowing states to opt out of some current insurance requirements, would encourage some employers to maintain coverage for their workers and get younger, healthier people to buy plans on their own. But those gains would be largely offset by consumers with preexisting conditions, who would face higher premiums than they do now. “Their premiums would continue to increase rapidly,” the report found. (Eilperin and Snell, 5/24)

Quick Takes: Key Highlights Of The CBO Report

Media outlets cut through the paperwork to lay out what you need to know about the analysis.

Politico: 10 Key Points From The CBO Report On Obamacare Repeal
Here are some key facts and figures from the new CBO report on the American Health Care Act, the House-passed bill to repeal and replace Obamacare. CBO stressed the uncertainty of its estimates, given that it's hard to know which states would take up the chance to opt out of certain key parts of Obamacare. All figures are for the decade spanning 2017-2026 unless otherwise specified. (Kenen, 5/24)

KQED: Your CBO Cheat Sheet: 5 Takeaways From GOP Health Bill
An estimated 23 million additional Americans will become uninsured over the next decade if the current version of the Republican health care bill goes into effect, according to a Congressional Budget Office analysis released Wednesday. This is only slightly lower than the 24 million predicted in March, before Republicans tweaked the bill to pull in critical votes from both moderate and hard-right Republicans. (Feibel, 5/24)

Modern Healthcare: 15 Quick Facts From CBO Report On Obamacare Repeal Bill
Here's what the CBO reported on the cost and coverage impact of the House Republicans' bill to repeal and replace the Affordable Care Act. ... Prompt a few million people to use premium tax credits to buy plans that don't cover major medical costs. ... Result in 4 million more people in employer-based health plans by 2026, mainly because employers would see the individual market as a less desirable option for their workers. (Meyer, 5/24)

The Washington Post: How The CBO Thinks The Republican Health-Care Bill Will Affect Your Pocketbook
But what does that mean to most Americans? The CBO helpfully broke down how much insurance premiums would cost for people at two income levels — $26,500 and $68,200 annually — at three ages. The upshot is that people making $68,200 a year who are in the two younger ages (21 and 40) will pay less in premiums annually because they will get a tax credit not available to people at their income level under Obamacare. But for older and poorer Americans, the effect will mostly be worse. (Bump, 5/24)

Read the CBO analysis here.

Senators Rush For Distance From CBO Report: 'The AHCA Is A First Step, But Not The Solution'

Now that the legislation has been scored by the Congressional Budget Office, the Senate can officially move forward with its own plans. But lawmakers in the upper chamber were quick to say their version will look different than the one that passed the House.

The Washington Post: Senate Republicans Have All The Evidence They Need To Reject The House-Passed Health-Care Overhaul
For a week now, some congressional insiders had been whispering that the critical “score” from the Congressional Budget Office, on the legislation that narrowly passed the House earlier this month, might not provide any real deficit savings. Such a finding would have violated the Senate’s more arcane rules for considering budgetary items under fast-track rules — and it might have forced House Speaker Paul D. Ryan (R-Wis.) to redraw the legislation and hold another vote. So there were a few sighs of relief late Wednesday afternoon when the CBO declared the legislation would find $119 billion in savings over 10 years, more than enough to allow it to pass muster under the Senate’s so-called reconciliation rules, which allow a simple majority for passage rather than the usual 60-vote majority. That’s an important feat for Senate Republicans, who control just 52 seats. (Kane, 5/25)

The Wall Street Journal: CBO Report On Health Bill: What It Is And Why It Matters
Under budget rules, the health bill must cut the federal deficit (the House’s first version did that to the tune of $337 billion), so that is an important number. It is also important to look at how much of the budget savings would come from reduced Medicaid spending, because steep cuts mean more people without insurance. That is another key figure: the increase in the uninsured compared with leaving the ACA in place. The more uninsured, the harder it may be for Republicans to sell their plan to the public. And effects on premiums matter, since Senate GOP lawmakers have said their main goal is to bring down premium costs. (Armour, 5/24)

The Wall Street Journal: House GOP Health Bill Would Add 23 Million Uninsured, Cut $119 Billion In Deficit Through 2026, CBO Says
The findings provide ammunition for the two competing factions that Senate Republican leaders need to pull together to pass a bill. Centrist Republicans, concerned about the number of uninsured, hope to make the House bill less far-reaching, while conservatives want to double down on measures the CBO suggests will lower premiums on average. (Armour and Peterson, 5/25)

Politico: Peril For Republicans If They Push Forward With Obamacare Repeal
Obamacare repeal is in trouble in the Senate, and a nonpartisan analysis of the House’s repeal legislation issued Wednesday only reinforced that reality. Within minutes of the release of the report showing 23 million fewer Americans would be insured over a decade, two Senate Republicans blasted the estimate and the House bill, underscoring just how much the legislation will have to change to get through the upper chamber. (Demko and Haberkorn, 5/24)

The Hill: New CBO Score Triggers Backlash
In a flurry of statements, Senate Republicans stressed that they are starting fresh on the healthcare bill and that it will be changed significantly — and scored again by the CBO — before it becomes law. “While I am in favor of repealing ObamaCare, I am opposed to the American Health Care Act (AHCA) in its current form,” Sen. Dean Heller (R-Nev.), who faces a close reelection race next year, said in a statement. “This bill does not do enough to address Nevada’s Medicaid population or protect Nevadans with pre-existing conditions.” (Sullivan 5/24)

The Hill: GOP Senators Distance Themselves From House ObamaCare Repeal Bill 
Republican senators quickly distanced themselves from a House-passed ObamaCare repeal and replacement bill after a new analysis of the legislation was released on Wednesday. The American Health Care Act (AHCA) would result in 23 million more uninsured Americans over a decade, according to the Congressional Budget Office analysis. The CBO also found that in states that would let insurers charge sick people more, some could be priced out of being able to afford insurance. (Carney, 5/24)

Bloomberg: GOP Obamacare Repeal Effort Hits Latest Obstacle With CBO Score 
Senator Bill Cassidy, a Louisiana Republican, said the House bill failed to meet what he called the “Jimmy Kimmel Test,” a reference to the late-night talk-show host’s infant son, who was born with a heart defect, and the idea that any new health law should provide generous-enough insurance to cover critical medical needs. “Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel Test. The AHCA does not,” he said in a statement. His Republican colleague, Senator Susan Collins of Maine, likewise said that the GOP bill would “disproportionately affect older, low-income Americans.” (Edney, Tracer and Litvan, 5/25)

The Hill: Trump Health Chief Blasts CBO Score 
President Trump’s healthcare chief slammed the CBO score of the GOP healthcare bill as “wrong again” minutes after its release on Wednesday, immediately dismissing the conclusion that it would substantially raise premiums for sick people. “The CBO was wrong when they analyzed ObamaCare’s effect on cost and coverage, and they are wrong again,” Health and Human Services Secretary Tom Price said in a statement. (Hellmann, 5/24)

McConnell Confides Uncertainty Over Health Plan: 'I Don't Know How We Get To 50' Votes

Senate Majority Leader Mitch McConnell said he won't reach out to Democrats because the differences between the parties are too stark.

Reuters: McConnell Frets About Healthcare, Hopeful On Tax Overhaul
U.S. Senate Majority Leader Mitch McConnell said on Wednesday he does not yet know how Republicans will amass the votes needed to pass legislation now being crafted to dismantle Obamacare, but expressed some optimism on another top priority, overhauling the tax code. In an exclusive interview with Reuters, McConnell said healthcare and taxes still top the Republican legislative agenda, and he added that he will not reach out to the minority Democrats on either one because differences between the two parties are too stark. (Cornwell and Abutaleb, 5/24)

House Republicans Sidestep Negative Aspects Of Report, Focus On The Positive

They say the Congressional Budget Office analysis doesn't "tell the whole story" about their legislation.

USA Today: CBO: House Obamacare Repeal Will Increase Uninsured By 23 Million
Many House Republicans avoided specifics of the analysis and instead focused on the overall picture which was "that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit," House Speaker Paul Ryan, R-Wis., said. “We’re on a rescue mission, and today’s CBO report reinforces what we’ve said before — our American Health Care Act will lower premiums and reduce the deficit," said House Republican Conference Chair Cathy McMorris Rodgers, R-Wash. "The CBO report doesn’t tell the whole story when it comes to the benefits of this bill, but we’re one step closer to keeping our promise to repeal and replace Obamacare." (Collins, 5/24)

Separately, House Speaker Paul Ryan (R-Wis) acknowledges the party will face attacks over health care —

Roll Call: Ryan On GOP Health Care Bill: ‘We Will Get Hit For This’
Speaker Paul D. Ryan is acutely aware that Republicans will be attacked over the health care bill that his chamber passed a few weeks ago, but the Wisconsin Republican felt that inaction was not an option. “I’ll accept that we will get hit for this,” Ryan said Wednesday at an Axios’ News Shapers event. “But we’re in leadership. We don’t have a choice. … What are we supposed to do, just sit back and let this thing collapse?” The speaker has consistently made the case that the 2010 health care law is collapsing and it’s incumbent upon Republicans to fulfill their campaign promise to repeal and replace it. (McPherson, 5/25)

Republicans Should 'Throw Their Bill In The Trash Can,' Democrats Galvanized By CBO Analysis Say

Democrats say the report should be the final nail in the coffin for Republicans' current legislative proposals to dismantle the Affordable Care Act.

Politico: Senate Dems Seize On CBO To Slam GOP
Senate Democrats on Wednesday seized on a new projection that 23 million more Americans would be uninsured under the House GOP’s Obamacare repeal to hammer the Republican senators now crafting their own plan. Led by Minority Leader Chuck Schumer, Senate Democrats staged a fiery press conference less than 45 minutes after the non-partisan Congressional Budget Office released its report on the House-passed Obamacare repeal. Schumer argued that Senate Republicans are making a mistake similar to their House counterparts’ hasty passage of a bill before its CBO score emerged. (Schor, 5/24)

The Hill: Schumer: Republicans Should Throw Their Health Bill 'In The Trash' 
Senate Democratic Leader Charles Schumer (N.Y.) on Wednesday denounced the House-passed healthcare reform bill after an analysis by the Congressional Budget Office (CBO) showed it would cause millions of Americans to lose health coverage. "Republicans in Washington and the president should read this report cover to cover, throw their bill in the trash can and begin working with Democrats on a real plan to lower costs for the American people,” Schumer said at a press conference held shortly after the CBO released its report. (Bolton, 5/24)

San Francisco Chronicle: CBO: House GOP Health Bill Would Leave 23 Million More Without Coverage
But Sen. Kamala Harris, D-Calif., called the bill “nothing short of a disaster,” and House Minority Leader Nancy Pelosi, D-San Francisco, took aim at provisions in the bill that the CBO said repeal $664 billion in taxes on high-income earners and insurers. “Trumpcare is a billionaire’s tax cut disguised as a health care bill: one of the largest transfers of wealth from working families to the rich in our history,” Pelosi said. (Lochhead, 5/24)

Denver Post: Colorado Republican Lawmakers React To Congressional Budget Office Score
Colorado lawmakers feuded Wednesday night over the release of a new report which estimated the Republican health care plan that passed the U.S. House in early May would lead to a loss of insurance for up to 23 million Americans by 2026. The analysis by the Congressional Budget Office, a nonpartisan government research group, also found the measure to replace the Affordable Care Act would reduce the federal deficit by $119 billion over the next 10 years while providing lower premiums for some consumers — as compared to a previous Republican proposal — though that decline would be driven by less robust insurance coverage. (Matthews and Ingold, 5/24)

Meanwhile, when it comes to 2018 attacks, the Democrats are torn on what to go after —

Politico: Health Care Or Russia? Democrats Divided On 2018 Focus
The Democratic Party is embroiled in a debate over where they should focus their efforts to win back political power: health care or Russia. The party’s campaign committees and many of Democrats’ leading super PACs have spent virtually all their energy this year on shaming Republicans for their push to repeal Obamacare, an issue that clearly touches voters’ daily lives. (Robillard and Schor, 5/24)

How The GOP Plan Will Affect You Depends On What State You Live In

The Congressional Budget Office predicts that premiums will be affected in states that choose to seek a waiver for covering essential health benefits.

The CT Mirror: CBO: GOP Health Bill’s Impact On CT, Other States Would Vary Widely
An analysis of the likely impact of the final House GOP bill to repeal and replace the Affordable Care Act says it would leave an additional 23 million uninsured and reduce the federal deficit by $119 billion over the next decade. The bill’s impact in Connecticut would depend on how the state decides on choices the legislation provides for changing insurance regulations. (Radelat, 5/24)

Cleveland Plain Dealer: Republican Health Care Bill Would End Insurance For Millions, Congressional Budget Office Says
Democrats in the U.S. Senate used the CBO statistics to forecast that the bill would cause 292,982 Ohioans to lose private insurance coverage next year, and would increase the cost of uncompensated care to Ohio hospitals by $263,684,124 in 2018. They said it would also increase premiums for Ohioans who buy insurance through the ACA exchanges by $550 next year. Ohio Democratic Sen. Sherrod Brown said millions of Americans will lose their health insurance if the GOP bill becomes law, leaving them with "no real path" to gain insurance. (Eaton, 5/24)

California Healthline: Citing CBO Report, Critics Decry GOP Bill’s Potential Fallout In California
Though the budget analysis released Wednesday on the GOP health care bill didn’t address California specifically, both the state’s Medicaid program and its individual market could be seriously harmed if the legislation passes, according to legislators, consumer advocates and other critics. “I feel like I am in a bad dream,” said Sen. Ed Hernandez, the West Covina Democrat who chairs the state Senate Health Committee. (Gorman, 5/25)

Following Analysis, Hospitals Speak Out Against Republicans' Health Plan

"We cannot support legislation that the Congressional Budget Office clearly indicates would jeopardize coverage for millions of Americans," said Rick Pollack, president of the American Hospital Association. AARP is also against the legislation.

Modern Healthcare: Hospitals Worry About The 23 Million That Would Lose Coverage Under AHCA 
The House's version of the Affordable Care Act repeal-and-replace bill would leave 23 million more people uninsured and save the federal government $119 billion, according to the Congressional Budget Office. And that has hospitals wondering how they'll care for those uninsured. In its highly anticipated scoring of the American Health Care Act, the CBO said the bill, by 2026, would reduce the federal deficit by $32 billion less than an earlier version of the bill that the nonpartisan budget office analyzed. (Lee, 5/24)

Reporter Accuses Montana Candidate Of 'Body-Slamming' Him After Asking About CBO Report

The special election for the House seat is being closely watched in a district that was typically a Republican stronghold.

The Guardian: Newspapers Ditch Republican Charged With Assaulting Guardian Reporter
A Republican candidate for the US Congress has lost the support of two newspapers in his state after he was charged with the assault of a Guardian reporter who tried to ask him about his party’s healthcare plan. Greg Gianforte, who is running for Montana’s congressional seat in a special election to be held on Thursday, was charged with misdemeanour assault after Ben Jacobs made a complaint to police about the incident at Gianforte’s campaign headquarters on Wednesday. (Gayle, 5/25)

CNN Money: GOP Candidate Charged After Allegedly 'Body Slamming' Reporter
"He took me to the ground," Jacobs told his paper. "This is the strangest thing that has ever happened to me in reporting on politics. "The audio file provided by Jacobs backs up his account of the incident and so did accounts by other journalists who witnessed the incident. (Byers and McLean, 5/25)

Politico: Montana House GOP Candidate Cited After Reporter Says He 'Body-Slammed Me'
The incident rocked a closely watched contest, just hours before voters cast their ballots in Thursday’s special House election in Montana to replace Ryan Zinke, who is now the Trump administration's secretary of the interior. Gianforte, a technology executive, is running against Democrat Rob Quist, a folk singer and first-time candidate. The race in the traditional Republican stronghold is turning out to be closer than many thought it would be. (Gold and Debenedetti, 5/25)

Marketplace

Sole Marketplace Insurer In One-Fifth Of Mo.'s Counties Latest To Withdraw From ACA Exchanges

Blue Cross and Blue Shield of Kansas City announced it has lost $100 million through 2016 selling plans under the Affordable Care Act, calling the losses "unsustainable." Meanwhile, Anthem is saying it is still up in the air whether it will continue to participate in the individual marketplace next year.

The Wall Street Journal: Another Insurer To Leave Missouri’s ACA Marketplace
Blue Cross and Blue Shield of Kansas City plans to pull out of the Affordable Care Act health insurance exchanges next year, a move that leaves a region in northwestern Missouri at risk of having no available marketplace plans. The nonprofit said that after losing more than $100 million on ACA plans through 2016, it will stop offering exchange plans in 30 counties in northwestern Missouri and two counties in Kansas. (Wilde Mathews, 5/24)

The Hill: Only ObamaCare Insurer In Parts Of Missouri Pulls Out Of Exchanges
About 25 counties in Missouri might have no insurers on the ObamaCare exchanges next year after Blue Cross Blue Shield of Kansas City (Blue KC) announced Wednesday it won’t participate. Blue KC cited losses and uncertainty as a reason it decided to exit the individual markets both on and off the exchanges. The move comes as insurers are deciding whether to offer plans in the ObamaCare marketplaces next year and are asking Congress and the administration for certainty that they’ll continue to get crucial payments from the federal government. (Roubein, 5/24)

Kansas City Star: Blue Cross Blue Shield Of Kansas City Out Of Obamacare 
Danette Wilson, Blue KC’s president and CEO, said the company has lost more than $100 million total on its exchange plans since the Affordable Care Act rolled out in 2014. “This is unsustainable for our company,” Wilson said. “We have a responsibility to our (customers) and the greater community to remain stable and secure, and the uncertain direction of this market is a barrier to our continued participation.” (Marso and Lowry, 5/24)

Reuters: Anthem Still Weighing 2018 Obamacare Individual Participation
Anthem Inc on Wednesday said its plans for selling 2018 Obamacare individual plans are still up in the air because of political and regulatory uncertainty, making it the latest health insurer to say questions about continued funding of government subsidies will affect consumers next year. Anthem, the biggest provider of individual health plans, is looking at all 14 states where it sells Obamacare coverage to determine to what extent it will participate next year, given the continued uncertainty around subsidies and regulations, its chief executive said on Wednesday. (Humer, 5/24)

In other news about the Affordable Care Act —

The Hill: House Dems Demand Trump Make ObamaCare Insurance Payments 
Nearly 200 House Democrats are demanding President Trump fund ObamaCare's Cost Sharing Reduction (CSR) payments to insurers. "The law requires, and it is your obligation under the law" to make the payments "and to stop other acts of sabotage that undermine Americans' access to affordable, quality health insurance," the House Democrats wrote in a letter to Trump. (Weixel, 5/24)

Modern Healthcare: Insurance Premiums Have Doubled Since 2013, But Policies Are More Generous 
An HHS report released late Tuesday paints a grim picture of the rising health insurance premiums under the Affordable Care Act. But health policy experts explained that while premiums may have gone up since the ACA was implemented, consumers are also getting more bang for their buck. The report, which is the first ACA report out of HHS' Office of the Assistant Secretary for Planning and Evaluation published under the direction of the Trump administration, concluded that individual health insurance premiums grew 105% on average between 2013—before the ACA exchange went into effect—and 2017. (Livingston, 5/24)

Politico Pro: House Ways And Means Advances Three Obamacare Repeal Bills
The House Ways and Means Committee on Wednesday evening advanced three health care bills that make up a small part of the Republicans' larger Obamacare replacement strategy. The bills, all approved largely on party lines, are part of the GOP's "third bucket" of its health reform plan, which is expected to include other measures. They were written to work in conjunction with the GOP's repeal bill, which is being fast-tracked through the budget reconciliation process. (Ehley, 5/24)

The Wall Street Journal: Health-Tech Startups Pivot As Obamacare Uncertainty Mounts
As Congress grapples with possible repeal of the Affordable Care Act, political uncertainty is prompting some health-technology startups to revamp their sales pitches or products, while others are finding it tougher to attract fresh capital. The challenges are likely to be greatest for very young firms with limited resources, companies tied directly to the insurance market or that sell to hospitals facing potential cuts in Medicaid, say some investors and others that work with startups. (Simon, 5/24)

Administration News

Despite Budget Director's Artful Evasiveness, Medicaid Is Most Definitely On The Chopping Block

Office of Management and Budget Director Mick Mulvaney went to Capitol Hill to sell President Donald Trump's proposed budget, saying, "There are no Medicaid cuts in the terms of what ordinary human beings would refer to as a cut." The Associated Press fact checks his claim.

The Associated Press Fact Check: Medicaid A Target For Cuts Despite Assurance
Medicaid is clearly in line for cuts under President Donald Trump's budget despite assurances to the contrary from his budget chief. Mick Mulvaney, director of the Office of Management and Budget, while introducing the budget Tuesday: "There are no Medicaid cuts in the terms of what ordinary human beings would refer to as a cut. We are not spending less money one year than we spent before." (5/25)

The Associated Press: Trump Budget Faces Dem Opposition, GOP Doubts About Math
Mulvaney gave an unapologetic defense of Trump proposals to slash programs related to the environment, education, health care for the poor and foreign aid. The former tea party congressman told the Budget Committee that he went line by line through the federal budget and asked, “Can we justify this to the folks who are actually paying for it?” Democrats charged that Trump’s cuts would rip apart the social safety net. Rep. Pramila Jayapal, D-Wash., told Mulvaney that the proposed cuts to food stamps, payments to the disabled, and other programs are “astonishing and frankly immoral.” (Taylor, 5/24)

The New York Times: In One Chart: Trump Plans To Cut Medicaid After Promising Not To
President Trump has long promised not to cut Medicaid, Medicare and Social Security. But in his budget released on Tuesday, he proposes making massive cuts to Medicaid. Mr. Trump is proposing to cut $610 billion from Medicaid benefits. This could come on top of more than $800 billion in cuts to Medicaid sought in the health care overhaul bill passed by the House on May 4. (Park, 5/24)

Providence Journal: Hospital Official: Cut To Medicaid ‘Almost Unfathomable’
President Trump’s proposal to slash more than $600 billion over 10 years from Medicaid would cut deep into the government health program for low-income people that insures nearly one-third of Rhode Island residents. Hospital officials and health care analysts said Tuesday it’s too soon to quantify the impact of the proposed cuts on Rhode Island. But the direction of the latest plan, they say, is painfully clear. ... The prospect of more uninsured patients worries hospital officials. Lifespan, the state’s largest health system, reports that its charity or so-called uncompensated care has fallen by more than half during the last five years. “Clearly, the sheer size of the proposed Medicaid cuts ... would be detrimental to health care here and throughout the nation and in addition a hardship for hospitals and other health care providers,″ David Levesque, a spokesman for Lifespan, said in an e-mail. (Arditi, 5/23)

In other budget news —

WBUR: Trump Wants Families On Food Stamps To Get Jobs. The Majority Already Work
When President Trump's budget director, Mick Mulvaney, unveiled the administration's budget blueprint earlier this week, which calls for significant cuts to food stamps, he noted that the aim of the budget was to get people working... But the reality is, many people (44 percent) who rely on SNAP — the Supplemental Nutrition Assistance Program, as food stamps is now known — have at least one person in the family working, according to the latest figures from the U.S. Department of Agriculture. (Godoy and Aubrey, 5/24)

Mental Health 'Czar' Nominee Renews Debate Between Community And Hospital Care Models

Those on the medical side seek more hospital beds and involuntary drug treatment for people in need but the other side suggest medical treatment alone is not enough. Also, the Veterans Affairs secretary tells a House hearing that the VA wants to begin offering mental health services to former service members with less-than-honorable discharges.

The New York Times: Trump’s Pick For Mental Health ‘Czar’ Highlights Rift
For decades, therapists, patient advocates and countless families have worked to elevate mental health care in the political conversation. Their cause recently received a big boost when a new law created a federal mental health “czar” to help overhaul the system and bridge more than 100 federal agencies concerned with mental health. But the White House’s choice for the first person to fill that position has already been divisive, exposing longstanding rifts within the field that may be difficult to mend. (Carey and Fink, 5/24)

The Associated Press: VA Plans Mental Care For Discharged Vets, But At What Cost?
Veterans Affairs Secretary David Shulkin touted new efforts Wednesday to expand urgent mental health care to thousands of former service members with less-than-honorable discharges, even while acknowledging his department isn’t seeking additional money to pay for it. Testifying at a House hearing, Shulkin offered new details on his initiative announced in March to stem stubbornly high rates of suicide. Stressing a need at that time for “bold action,” he noted the additional coverage would help former service members who are more likely to have mental health distress. Of the 20 veterans who take their lives each day, about 14 had not been connected to VA care. (Yen, 5/24)

Consultant, HHS Employee and Hedge Fund Workers Charged In Insider Trading Scheme

Prosecutors say the government worker passed along information about funding plans for cancer treatments and kidney dialysis to the consultant, who shared it with the hedge fund.

The Associated Press: Consultant Charged In Scheme To Trade US Secrets For Profit
A Washington consultant, three hedge fund workers and a government employee were blamed Wednesday by federal prosecutors for an insider trading scheme that converted government secrets into hedge fund profits. ... Acting U.S. Attorney Joon H. Kim said the defendants used "highly sensitive and confidential information" from the Centers for Medicare & Medicaid Services, part of the U.S. Department of Health and Human Services, to enable three hedge fund workers to make over $3.5 million illegally for their company from 2012 through 2014. The Securities and Exchange Commission said the profits reached $3.9 million. (Neumeister, 5/24)

The Wall Street Journal: U.S. Charges Four With Trading Insider Tips On Health-Care Policy
The tips concerned information about government-funding levels for cancer treatments and kidney dialysis from 2012 to 2014, according to prosecutors. Christopher Worrall, a senior technical adviser to the Centers for Medicare and Medicaid Services, allegedly passed information about the funding to a consultant in the political-intelligence business, David Blaszczak, who in turn told the traders. (Mullins and Pulliam, 5/24)

Reuters: Five Charged With Insider Trading Involving U.S. Health Agency
Prosecutors said that from 2012 to 2014, [hedge fund employees Rob] Olan, [Ted] Huber and [Jordan] Fogel schemed to get confidential information about CMS's internal decision-making from Blaszczak, who previously worked there. Blaszczak in turn got the information from his former colleague and "close friend" Worrall, prosecutors said. (Pierson, 5/24)

Medicaid

GOP Senators Struggling To Find A Compromise On Overhaul Of Medicaid In Replacement Bill

Lawmakers are trying to find a way to hold down costs but also treat states fairly. News outlets also report on efforts to change Medicaid operations in Wisconsin, Indiana, Kansas, Oregon and Nebraska.

Modern Healthcare: Capping Medicaid Spending May Prove Harder Than It Sounds For Senate Republicans 
Behind closed doors, Senate Republicans are struggling to agree on how to restructure Medicaid as part of their quest to repeal and replace Obamacare. One of the biggest points of contention for the sequestered senators is whether and how to convert open-ended federal funding for all Medicaid beneficiaries into a system of capped payments to the states that would cut the growth of those contributions. That change would affect all of the nearly 70 million Americans—including children, pregnant women, and elderly and disabled people—who now receive benefits through the $552 billion program, for which the federal government picks up about 57% of the cost. (Meyer, 4/24)

The Associated Press: Wisconsin Seeks To Be First To Drug Test Medicaid Applicants
Gov. Scott Walker wants to make Wisconsin the first state in the country to require childless adults applying for Medicaid to undergo drug screening, a move that could serve as a national model. Walker's plan, which needs federal approval, comes as he prepares to run for a third term next year. Wisconsin's Republican-controlled Legislature approved Walker's request for a waiver to do the drug tests two years ago, but is now digging into the details of how it would actually work. (Bauer, 5/25)

Indianapolis Star: Gov. Eric Holcomb Wants Some Medicaid Recipients To Work
Gov. Eric Holcomb is seeking permission from the federal government to require some Medicaid recipients to work or do work-related activities. Indiana’s governor announced Wednesday he’s amending the state’s January application for its alternative Medicaid program to ask for that — and other changes — as the federal government decides whether to keep the Healthy Indiana Plan going past this year. (Groppe, 5/24)

KCUR: Federal Officials OK ‘Corrective Plan’ As Kansas Pursues KanCare Extension 
Federal officials this week approved a corrective plan for Kansas’ privately managed Medicaid program, easing pressure on the state before a year-end deadline. As part of the plan, state officials agreed to keep track of the number of grievances and appeals they receive from Kansans in Medicaid who say they were denied appropriate services. That and other elements of the plan were outlined in a letter the state received Monday from James Scott, associate regional administrator for Medicaid and children’s health operations at the Center for Medicare and Medicaid Services. (Wingerter, 5/24)

East Oregonian: Oregon Had No Plan For Checking Medicaid Eligibility 
When Oregon expanded access to Medicaid in 2014, it had no system in place to perform the annual checks on recipient eligibility required by federal law. That was one of the many flaws of Cover Oregon, a state health care exchange also intended to handle patient registration for Medicaid. Medicaid is the federal government’s health care coverage for the poor and other qualifying groups. In Oregon, about a quarter of the state’s population — approximately 1 million people — receives it. More than three years after the expansion was launched under the Affordable Care Act, the state is scrambling to finish verifying whether every Oregonian on Medicaid — the Oregon Health Plan — meets the criteria. (Withycombe, 5/24)

The Oregonian: Audit: Oregon's Medicaid Computer Systems Work Well, But Human Errors Remain 
Oregon's two computer systems that determine Medicaid eligibility and send payments to health care providers are functioning correctly, according to an audit released by the Secretary of State's office on Wednesday morning. But human error, through employee overrides of the computer systems and manual data entry, could result in people inappropriately being issued or denied coverage, the auditors wrote. Oregon's Medicaid program costs $9.3 billion annually, with the state paying $1.2 billion and the federal government covering the remainder. The program, known as the Oregon Health Plan, provides health coverage to more than 1 million low-income Oregonians. (Borrud, 5/24)

Omaha World-Herald: U.S. Government OKs Nebraska's Medicaid Waivers For Developmental Disabilities Services
Nebraska has gotten good news from the federal government about services for people with developmental disabilities. Courtney Miller, director of the state developmental disabilities division, said Wednesday that federal officials approved both of the state’s Medicaid waiver applications. The approvals mean that federal Medicaid dollars will continue flowing to Nebraska to help pay for community-based services for developmentally disabled people. (Stoddard, 5/25)

Pharmaceuticals

Johnson & Johnson To Pay $33M In Investigation Over Manufacturing Practices

“Johnson & Johnson’s disregard for proper manufacturing practices of children’s medications was unacceptable,” says Illinois Attorney General Lisa Madigan in a statement.

Stat: J&J To Pay $33 Million For Lapses That Led To 'Phantom Recalls'
Johnson & Johnson agreed to pay $33 million to 42 states to settle allegations that its over-the-counter subsidiary falsely claimed have to followed federal manufacturing practices that led to the recall of millions of bottles of Tylenol, Motrin, Benadryl, and Sudafed. The settlement comes eight years after an embarrassing scandal for the health care giant, which endured congressional investigations, shareholder lawsuits, and a disturbing loss of market share in a key business over its handling of the manufacturing lapses. (Silverman, 5/24)

In other pharmaceutical news —

Stat: Drug Pricing Battle Hits Ohio With Dueling Ads Over Ballot Measure
The next battleground over prescription drug prices is now playing out in Ohio, where consumer groups and the pharmaceutical industry this week launched dueling ad campaigns over a controversial November ballot measure that is being promoted to lower costs. At issue is the Ohio Drug Price Relief Act, which would require state agencies to pay no more for medicines than the US Department of Veterans Affairs. The agency currently gets a 24 percent federally mandated discount off average manufacturer prices and the measure, if passed, would presumably benefit more than 3.4 million residents. (Silverman, 5/24)

Stat: No One Says 'Cure,' But Pipeline For ALS Treatments Looks Promising
Considering it took more than two decades for a second ALS drug to make it to the US market, you might think that few companies are willing to take the risk of developing such treatments. But in fact, it hasn’t been for lack of trying. After the Food and Drug Administration approved MT Pharma America’s Radicava this month, experts said there have always been a number of possible therapies being explored and tested in ALS — commonly known as Lou Gehrig’s disease — but without much success. Now, though, researchers say advances in the field over the past few years mean the treatments that are currently in clinical trials seem to hold greater potential than in the past. (Joseph, 5/25)

The New York Times: Rare Gene Mutations Inspire New Heart Drugs
What if you carried a genetic mutation that left you nearly impervious to heart disease? What if scientists could bottle that miracle and use it to treat everyone else? In a series of studies, the most recent published on Wednesday, scientists have described two rare genetic mutations that reduce levels of triglycerides, a type of blood fat, far below normal. People carrying these genes seem invulnerable to heart disease, even if they have other risk factors. (Kolata, 5/24)

The Cannabist: Report: Medical Marijuana Could Poach $4 Billion From Pharmaceutical Sales Annually
If the United States legalized medical marijuana for conditions such as chronic pain, anxiety and seizures, cannabis could siphon more than $4 billion annually from the nation’s pharmaceutical industry, a new study hypothesizes. The report expected to be released Wednesday by New Frontier Data, a provider of data and analytics to cannabis businesses, is intended to show how cannabis could disrupt pharmaceutical sales in nine key treatment areas. (Wallace, 5/24)

Public Health And Education

In Snapshot Of How Bad Opioid Crisis Has Become, Counselors Overseeing Halfway House Die Of Overdoses

“The staff members in charge of supervising recovering addicts succumbed to their own addiction and died of opioid overdoses. Opioids are a monster that is slowly consuming our population,” Pennsylvania's Chester County District Attorney Tom Hogan said.

The Washington Post: Residents Of Halfway House Found Two Men Dead From Overdoses — Their Drug Counselors
The man's losing battle with heroin was laid out right there on the nightstand of the halfway house. There were three morning devotionals, including “God Calling,” geared toward keeping a person's thoughts pointed heavenward. Then there was the nicotine: two packs of cigarettes, a vaporizer and a case of snus to quell cravings. And near the edge: empty packets of heroin, a spoon and a syringe half full of the last hit the man would ever inject. (Wootson, 5/24)

Meanwhile, in Tennessee —

Nashville Tennessean: State Data Confirms Overdose Deaths Are Primarily White Opioid Users
A new report from the Tennessee Department of Health on drug overdose deaths sheds new light on the opioid epidemic plaguing the state, darkening the lines of an emerging portrait of the typical abuser killed by the powerful painkillers. The drug overdose fatalities are overwhelmingly white, mostly male and increasingly less likely to have prescriptions for the drugs that kill them. And, across Tennessee, those killed are more likely to overdose on opioids — including heroin and fentanyl — than on any other kind of drug. (Fletcher, Nelson and Wadhwani, 5/24)

Patients Seeking Aid In Dying Driven More By Psychological Suffering Than Physical Pain, Study Finds

“It's what I call existential distress. Their quality of life is not what they want.” says researcher Madeline Li, an associate professor at University of Toronto. Today's other public health news stories cover so-called "conversion therapy," Zika, tuberculosis, fitness trackers, knee arthritis and "high-intensity" drinking.

The Washington Post: It’s Not Pain But ‘Existential Distress’ That Leads People To Assisted Suicide, Study Suggests
A few decades ago, doctor-assisted suicide was considered a fringe idea despite surveys showing many physicians support the idea under certain circumstances. The face of euthanasia at that time was Jack Kevorkian, a Michigan pathologist nicknamed “Dr. Death.” By his own admission, he helped 130 people end their lives. He was convicted of homicide and served eight years in prison. While doctor-assisted suicide remains a polarizing issue, some countries and states have begun to accept it. Belgium, the Netherlands, Luxembourg and Switzerland have legalized voluntary euthanasia. In 2016, Canada legalized “medically assisted death.” Australia, France, South Africa and the United Kingdom are considering similar measures. (Cha, 5/24)

The New York Times: Nevada And Connecticut Are Latest To Ban Discredited ‘Conversion Therapy’
At least nine states now ban “conversion therapy” for minors, a discredited method meant to change a person’s sexual orientation or gender identity, after Nevada and Connecticut this month joined others in prohibiting the practice. Gov. Brian Sandoval of Nevada last week signed Senate Bill 201, making it illegal for any licensed medical or mental health care professional to provide sexual orientation or gender conversion therapy to anyone under 18 years of age, a statement from his office said. (Hauser, 5/24)

NPR: The Zika Virus Made Its Way To Miami Earlier Than Thought
Last year's Zika outbreak in Miami likely started in the spring of 2016, with the virus introduced multiple times before it was detected, researchers say. And most of those cases originated in the Caribbean. The study, published Wednesday in Nature, examined more than 250 cases of local Zika transmission in three Miami neighborhoods. Researchers analyzed 39 Zika virus genomes isolated from 32 people who had been infected and seven Aedes aegypti mosquitoes, the species that carries Zika. (Allen, 5/24)

WBUR: Tuberculosis And Rural Healthcare In America 
In most places tuberculosis is a disease from the past. But in the small county of Perry, Alabama it’s a near outbreak... It was so bad, the county finally paid residents to get tested. It all comes down to racial divides. (Yellin, 5/24)

NPR: Some Fitness Trackers Give Inaccurate Measurements Of Calories Burned
Sleek, high-tech wristbands are extremely popular these days, promising to measure heart rate, steps taken during the day, sleep, calories burned and even stress. And, increasingly, patients are heading to the doctor armed with reams of data gathered from their devices. "They're essentially asking us to digest the data and offer advice about how to avoid cardiovascular disease," says cardiologist Euan Ashley, associate professor of medicine at the Stanford University Medical Center and Stanford Hospital and Clinics in northern California. (Neighmond, 5/24)

Houston Chronicle: New Study Shows Increase In 'High-Intensity' Drinking, Defined As Consuming 10 Or More Drinks
With a three-day weekend upon us, several Texans will be stocking up on beer and wine for weekend cook-outs. That also means more drunk drivers on the road. One new study suggests that young drivers could be more dangerous on roadways today than ever before, since they're engaging in "high-intensity" drinking, which is defined as consuming 10 or more drinks in a row...The May 2017 report indicates that "one in nine young adults (11 percent) were classified as high-intensity drinkers from 2005 to 2015" with "similar prevalence" among high school-aged students. (Guillen, 5/24)

Marijuana Extract Found To Reduce Seizures In Kids With Epilepsy

The study adds another layer to the debate over the health benefits of the plant.

The Washington Post: Marijuana Extract Sharply Cuts Seizures In Severe Form Of Epilepsy
An oil derived from the marijuana plant sharply reduces violent seizures in young people suffering from a rare, severe form of epilepsy, according to a study published Wednesday that gives more hope to parents who have been clamoring for access to the medication. Cannabidiol cut the median number of monthly convulsive seizures from 12.4 to 5.9 in 52 children with Dravet syndrome who took the medication over a 14-week test period, according to research published in the New England Journal of Medicine. Fifty-six children using a placebo saw the number of seizures drop only from a median of 14.9 to 14.1 per month. (Bernstein, 5/24)

The Associated Press: Marijuana Extract Helps Some Kids With Epilepsy, Study Says
“This is the first solid, rigorously obtained scientific data” that a marijuana compound is safe and effective for this problem, said one study leader, Dr. Orrin Devinsky of NYU Langone Medical Center. He said research into promising medical uses has been hampered by requiring scientists to get special licenses, plus legal constraints and false notions of how risky marijuana is. “Opiates kill over 30,000 Americans a year, alcohol kills over 80,000 a year. And marijuana, as best we know, probably kills less than 50 people a year,” Devinsky said. (Marchione, 5/24)

State Watch

State Highlights: Vt. Gov. Vetoes Pot Bill; Pa. Gov. Taps Teresa Miller To Head Proposed Health And Human Services Department

Media outlets report on news from Vermont, Pennsylvania, New York, Minnesota, Massachusetts, Texas, California, Virginia and Arizona.

WBUR: Vermont's Governor Vetoes Recreational Pot Bill
Vermont Governor Phil Scott, a Republican, said on Wednesday he was vetoing a bill to legalize marijuana, and sending it back to the legislature for changes... Though he said he views the issue "through a libertarian lens," Scott vetoed the bill due to concerns about detecting and penalizing impaired drivers, protecting children, and the role and makeup of a Marijuana Regulatory Commission. (Wamsley, 5/24)

The Philadelphia Inquirer: Nominee For New Pa. Health And Human Services Dept. Digging In
Teresa Miller, nominated Tuesday by Gov. Wolf to be the inaugural secretary of the proposed Pennsylvania Department of Health and Human Services, said she is a big believer in her boss’s “government that works” mantra.“...Advocates worry that initiatives, such as heightened oversight of nursing homes by the Department of Health, could fizzle because of the proposed consolidation of the departments of health, human services, aging, and drug and alcohol programs. (Brubaker, 4/24)

ProPublica: In A Lonely Corner Of Coney Island, A Fight Over Care For The Vulnerable 
Today, Oceanview has taken on a distinctive role in the latest act of the legal saga surrounding the adult homes. Lawyers for the adult home industry have sued the state on behalf of a single former resident at Oceanview, a man who had taken advantage of the judge’s plan and moved into alternative housing, but who the lawyers say now wants to return. The man missed his friends and the conveniences of the Coney Island neighborhood, the lawyers argue. (Sapien, 5/24)

The Star Tribune: Annandale Nursing Home Is Faulted In Patient's Death 
An Annandale nursing home resident developed internal bleeding and died after being denied crucial blood-thinning medication for 15 days, according to a state investigation that blamed the death on the facility’s procedural shortcomings. The state Health Department’s investigation into the stroke patient’s Nov. 28 death concluded that the nonprofit Annandale Care Center “had no system, policies or procedures in place” to ensure that certain medications and some other services were being provided as prescribed. (Walsh, 5/24)

Boston Globe: Surgeon Who Raised Concerns About Double-Booked Surgeries Faced Retaliation, Judge Rules 
A prominent Boston neurosurgeon was illegally forced out of his previous job at a New York hospital for strongly objecting to a policy that allowed another surgeon to perform complex spine surgeries on two patients simultaneously, a judge ruled. Double-booking, as the practice is sometimes called, triggered a fierce dispute among doctors at Massachusetts General Hospital in recent years, leading to the 2015 dismissal of an orthopedic surgeon who opposed it. But Dr. James Holsapple may be the first doctor to win a lawsuit alleging he faced retaliation for challenging the practice. (Saltzman, 5/24)

The Star Tribune: 26 Patients Die After Upgrading Abbott Blood Pump At Home 
At least 26 patients in advanced heart failure have died after replacing the controller for an Abbott Laboratories blood pump while out of the hospital. Abbott has issued an alert for 28,882 HeartMate II controllers that includes new software and alarm guides, after reports of 70 incidents in which the life-preserving device malfunctioned after a patient changed out the controller at home. Those incidents included 26 deaths and 19 injuries. (Carlson, 5/24)

Austin American-Statesman: Texas Senate Approves Priority House Bills To Address Foster Care Woes
The Texas Senate unanimously passed a priority House bill Wednesday that would make several changes to the foster care system, including keeping children at risk of entering foster care with their parents. House Bill 7, filed by Rep. Gene Wu, D-Houston, would, among several other provisions, bar a court from taking children away from parents on the grounds that they home-schooled their children, were economically disadvantaged, had reasonably disciplined their children or had been charged with a nonviolent misdemeanor. (Chang, 5/24)

San Jose Mercury News: Second Botulism Death Unrelated To ‘Extremely Rare’ Nacho Cheese Botulism 
The country’s foremost researchers on botulism in dairy products are calling the recent outbreak at a gas station in Walnut Grove a “perfect storm” of circumstances that left one dead and nine sickened... Although extremely rare, Northern California has seen two deaths from foodborne botulism in the last few months. Within the last month, Napa County has had one death from botulism related to canned goods, according to county health officials. (Davis, 5/24)

San Francisco Chronicle: Nearly 1 In 4 San Franciscans Struggle With Hunger 
According to the SF-Marin Food Bank, 23 percent of San Francisco residents struggle with hunger. The number is a striking amount, and much higher than the city’s homeless population, which the city said was 6,886 in 2015 (though others estimate it to be much higher), making it less than 1 percent of the population. (Duggan, 5/24)

Richmond Times-Dispatch: McAuliffe Signs Bill On Jail Deaths Related To Jamycheal Mitchell On Same Day Portsmouth Prosecutor Requests Special Grand Jury Into His Death At Hampton Roads Regional Jail 
In the name of Jamycheal Mitchell on Wednesday, the state’s highest elected official signed a bill in Richmond strengthening oversight of Virginia’s 60 local and regional jails, and a prosecutor in Portsmouth requested a special grand jury convene to investigate how the mentally ill 24-year-old wasted away behind bars... Still, no information has been provided publicly that explains what led to Mitchell’s death. His family has said he was physically healthy but had been diagnosed with schizophrenia and bipolar disorder. (Kleiner, 5/24)

Richmond Times-Dispatch: 'This Is A Public Health Epidemic:' Experts Speak To State Commission On Preventing Childhood Trauma In Virginia
Childhood traumatic experiences have strong links to dozens of adult health conditions, such as HIV, heart disease and cancer. In states that track such data, childhood trauma is considered a cause in between 11 and 89 percent of those health conditions. On average, whenever a toxin impacts more than 10 percent of health conditions, awareness grows and lawmakers, advocates and public health officials become interested in how to stop it to save lives, said Allison Sampson-Jackson. (O'Connor, 5/24)

Arizona Republic: Would Legalizing Marijuana Bring Money To Arizona Schools?
A fact sheet presented by the anti-marijuana group Arizonans for Responsible Drug Policy, which helped defeat Prop. 205 last November, mentions projected social costs outweigh the revenue provided by legalization... Merilee Fowler, vice chair of ARDP, said via email that “there are many unintended consequences of legalization that produce costs for the state.” (Jarvis, 5/24)

Weekend Reading

Longer Looks: Shuttering Abortion Clinics, Obamacare In The Senate And A Lead-Poisoned Generation

Each week, KHN's Shefali Luthra finds interesting reads from around the web.

Vox: The Obscure Senate Rule That Could Sink Obamacare Repeal, Explained
The fate of the Republican drive to repeal and replace Obamacare — and of the 24 million more Americans who could be uninsured if they succeed — now lies with obscure, complex Senate rules. One rule in particular will determine what Republicans can include in the bill, how much of Obamacare they can repeal, and perhaps whether the bill can pass at all. And the last-minute additions that got conservatives on board with the House version of the American Health Care Act might run into trouble, according to experts and recent legislative precedents. (Dylan Scott, 5/22)

FiveThirtyEight: The Obamacare Marketplaces Aren’t In A Death Spiral
Are the insurance marketplaces created by the Affordable Care Act really on the verge of collapse, as President Trump and GOP leaders have repeatedly claimed? Three months ago, this story would have started like this: It depends on where you look and who you ask. Today, it goes something like this: They are in a fragile state pretty much everywhere. (Anna Maria Barry-Jester, 5/19)

WIRED: Medicine Is Going Digital. The FDA Is Racing To Catch Up
When Bakul Patel started as a policy advisor in the US Food and Drug Administration in 2008, he could pretty much pinpoint when a product was going to land in front of the reviewers in his division. Back when medical devices were heavy on the hardware—your pacemakers and your IUDs—it would take manufacturers years to get them ready for regulatory approval. FDA reviewers could keep up pretty well. (Megan Molteni, 5/22)

The New Yorker: A Bipartisan Way To Improve Medical Care
The health-care crisis in the United States is in many ways a pricing crisis. Nearly all medical care is paid on a fee-for-service basis, which means that medical providers make more money if they perform more procedures. This is perverse. We don’t want an excess of health-care services, especially unnecessary ones; we want health. But hardly anybody gets paid when we are healthy. (Adam Davidson, 5/22)

The Atlantic: The Lead-Poisoned Generation In New Orleans
There is no safe level of lead in the human body. Even at low levels, chronic exposure can damage the brain and the central nervous system, and can cause symptoms from hearing loss to IQ deterioration to lack of impulse control. Over time, lead gets absorbed into the bones, making them brittle and stunted, and causes teeth to crack and rot. Exposure in young children with developing minds and growing bones is most destructive, and in times of serious stress and trauma—common in places like the New Orleans projects in the 1990s—those effects are magnified. (Vann R. Newkirk II, 5/21)

Vox: 45 Million Americans Rely On Food Stamps. Trump Wants To Gut The Program.
In the 1960s and 1970s, food stamps were rolled out in different counties at different times — and researchers have used this variation as a natural experiment to examine the health impacts of SNAP. From improving birth weight to reducing obesity, food stamps were associated with a number of positive health effects. (Julia Belluz, 5/23)

Editorials And Opinions

Different Visions: Are Republicans Trying 'To Starve' Obamacare To Death; Analyzing The State Of ACA Insurance Markets And Premiums

Opinion writers offer a variety of thoughts on health policy issues, including whether the health law is "collapsing under its own weight," some ominous predictions about the individual insurance markets, the importance of the public option and a range of other ideas.

The New York Times: How The G.O.P. Sabotaged Obamacare
Obamacare is not “collapsing under its own weight,” as Republicans are so fond of saying. It was sabotaged from the day it was enacted. And now the Republican Party should be held accountable not only for any potential replacement of the law, but also for having tried to starve it to death. The Congressional Budget Office on Wednesday released its accounting of the House Republicans’ replacement bill for the Affordable Care Act, and the numbers are not pretty: It is projected to leave 23 million more Americans uninsured over 10 years, through deep cuts to insurance subsidies and Medicaid. The report underscores how the bill would cut taxes for the rich to take health care away from the less well-off. (Abbe R. Gluck, 5/25)

The Wall Street Journal: How To Read An ObamaCare Prediction
The political world waited with rapt attention Wednesday for the oracles at the Congressional Budget Office to release their cost-and-coverage predictions for the revised House health reform bill, which arrived late in the afternoon. But while Washington stood by, two reports emerged from the real world that are far more consequential. (5/24)

Los Angeles Times: Trump's Team Issues A Stunningly Dishonest Study Of Obamacare Rate Increases
The Department of Health and Human Services seemed mightily pleased with a statistic it issued Tuesday. The agency’s figures showed that premiums on the Affordable Care Act exchanges “doubled” from 2013 through this year. This might not sound like good news for the people buying their coverage on those exchanges, but to HHS it was vindication. “This report is a sobering reminder of why reforming our healthcare system remains a top priority of the Trump administration,” agency spokesperson Alleigh Marré said. (Michael Hiltzik, 5/24)

Stat: Native Americans’ Health Threatened By Denial Of Medicaid Expansion
America has broken several centuries worth of promises to its indigenous people. And we’re poised to do it again. ... The Affordable Care Act provided a way to improve the health of thousands of Native Americans through Medicaid expansion. It provided a much-needed injection of funding to the long-neglected Indian Health Service and tribal health facilities by raising the income level needed for eligibility. With the poverty rate at 28 percent among Native Americans, this group disproportionately benefited from Medicaid expansion. (Kevin Duan and Aaron Price, 5/25)

Milwaukee Journal Sentinel: Health Care Reform The Wisconsin Way
Wisconsin has been a leader in covering its residents with high-quality health care and providing community supports so people with disabilities and frail elders can stay in their homes and communities and out of costly facilities. The American Health Care Act poses a particularly dangerous threat to our state’s residents, in part because we have done so much right. (Barbara Beckert, 5/24)

Lexington Herald Leader: Calling Dr. Paul: Seriously, You Don’t Think The U.S. Can Afford Health Care?
The United States spends more per person on health care than any other country, but our health outcomes are far from the best. Simply put, the challenge facing Congress is how to get more value for all that money. Yes, the details are complex, but we’re a big, complex country with a big, complex economy. Our elected leaders should engage that complexity and produce practical reforms and solutions that inspire confidence in the future. That is a reasonable expectation. (5/24)

Perspectives On The Trump Budget: Questionable Math; Who Feels The Most Pain?

Editorial pages across the country include analysis and review of President Donald Trump's fiscal blueprint, including some tough talk about its political and policy implications.

The New York Times: Trump’s Budget: The Math Is Phony But The Cruelty Isn’t
Phony math is a time-honored tradition in the Washington world of budget making, but the first full fiscal plan from the Trump administration breaks new ground. The bottom line: A budget that the White House says will be in balance by 2027 would, in reality, remain deeply in red ink throughout the coming decade and ultimately add trillions of dollars to the national debt. ... This budget’s blatant disregard for intellectual integrity is matched by the extraordinary extent to which it seeks to slash social welfare programs, including another $616 billion out of Medicaid on top of $800 billion that would be sliced as part of the Republicans’ health care plan. That’s a 28 percent reduction to the existing Medicaid budget plan. (Steven Rattner, 5/24)

Chicago Tribune: Trump's Budget: A Slow Boat To Disaster
The plan has been assailed by Democrats and various activist groups for coddling the rich, punishing the poor and shortchanging important functions. Trump proposes to cut outlays for Medicaid, food stamps, Head Start and Social Security disability. Ditto for Environmental Protection Agency enforcement and State Department security. He would close the National Endowment for the Arts, the National Endowment for the Humanities and the Corporation for Public Broadcasting. (Steve Chapman, 5/24)

Forbes: Trump's Budget For Seniors: Bad, But It Could Have Been Worse
The best that can be said about President Trump’s 2018 budget and older adults: It could have been worse. In a fiscal plan focused on historic domestic spending cuts, programs for older adults were hit by substantial reductions, though not slashed as deeply as other domestic programs. Medicare was largely untouched. So was Social Security for seniors, although Trump would tighten eligibility and reduce some benefits in the Social Security disability program. (Howard Gleckman, 5/23)

The Des Moines Register: Donald Trump 2018 Budget Could Turn Off His Voters And Sink His Approval Rating
The best way to think about the fiscal 2018 budget released by the White House is as a Trump political campaign rally on paper. The budget was clearly developed to make a statement to President Trump’s base of voters in the hope that they will see it as him keeping his campaign promises. According to Office of Management and Budget Director Mick Mulvaney, the budget will be in surplus in 10 years, construction will start on the wall between the U.S. and Mexico, there will be more money for enforcing immigration laws, and there will be much more for the Pentagon. Meanwhile, wasteful government spending will be cut and taxes will be reduced. (Stan Collender, 5/24)

Louisville Courier-Journal: Tell Congress The Budget Must Provide For The Poor
“A preferential option for the poor” is a fundamental concept in Catholic social teaching. Though the phrase itself is only 50 years old, it derives from Jesus’ Gospel message to pay special attention to poverty. ... The concept is shared by many religions and has become part of the ethos of the United States. Whether through Social Security, Medicaid, food stamps or foreign aid, our nation has recognized that our worth is judged by how we treat the most vulnerable among us. ... The U.S. Congress is now considering a budget proposal by the current administration. So many helped in this country and abroad would be devastated by this budget. (Archbishop Joseph E. Kurtz, 5/24)

Ominous Conclusions From The CBO Analysis Of The GOP Health Plan: 'Fatal Flaws,' 'A Train Wreck'

Opinion writers use the Congressional Budget Office's recent analysis of the updated American Health Care Act to pan the House Republican's repeal-and-replace measure.

The Washington Post: The CBO Report Proves The GOP Health-Care Bill Is No Rescue Plan
Republicans sold the American Health Care Act (AHCA), the Obamacare repeal-and-replace plan that the House passed last month, with a number of untruths, chief among them that Obamacare is collapsing and the GOP effort is nothing short of a rescue plan. The Congressional Budget Office, Congress’s official scorekeeper, found Wednesday that the Republicans’ bill is no such thing. Not only would it result in 23 million more people lacking health insurance in a decade, but it would destabilize some states’ individual health-care insurance markets for all but relatively healthy people. (5/24)

The New York Times: C.B.O. Report Reveals Trumpcare’s Fatal Flaws
The Congressional Budget Office’s analysis of the House health care bill is a devastating indictment.The new report shows that millions of Americans would lose health insurance and the quality of insurance for millions more would deteriorate. The savings from that carnage — to borrow a favorite word of President Trump’s — would pay for tax cuts for the wealthy. (David Leonhardt, 5/24)

The New York Times: Republicans, Get Ready For The Trumpcare Headlines
In promising to repeal and replace the Affordable Care Act, many Republicans cited headlines from last year such as “Obamacare Premiums to Soar 22 Percent” and “As Obamacare Choices Dwindle, Feds Face Consumer, Political Backlash.” Yet based on a new analysis by the nonpartisan Congressional Budget Office, headlines would be even worse under the health care bill to repeal Obamacare, which was passed by the House this month. (Jeanne Lambrew, 5/24)

Los Angeles Times: CBO On GOP Obamacare Repeal: Still A Train Wreck
The Congressional Budget Office has spoken: The Obamacare repeal bill passed by the House GOP earlier this month could destroy the individual insurance markets in states where one-sixth of the population resides. It would cost 23 million people their insurance coverage within 10 years. And in many states it would be terrible for any but the most healthy Americans. That’s the CBO’s score of the latest version of the House bill, which only passed after it was amended to allow individual states to eviscerate consumer protections written into the Affordable Care Act. The CBO’s bottom line is that the bill is still a train wreck that will cost millions of Americans their coverage and sharply raise costs for millions more. (Michael Hiltzik, 5/24)

The New York Times: C.B.O. Has Clear Message About Losers In House Health Bill
The Senate now has a clearer sense of who would win and lose under the health bill the House sent them. It also got a startlingly direct message from government analysts about how destabilizing one of the House ideas could be. The Congressional Budget Office published its assessment of the House health bill on Wednesday, and warned that a last-minute amendment made to win conservative votes would result in deeply dysfunctional markets for about a sixth of the population. In those places, insurance would fail to cover important medical services, and people with pre-existing illnesses could be shut out of coverage, the budget office said. (Margot Sanger-Katz, 5/24)

Huffington Post: 23 Million Fewer People Would Have Coverage Under Obamacare Repeal Bill, CBO Confirms
[T]he reasons why health insurance would be less expensive for some aren’t much to cheer about, the budget report makes clear. Prices would come down for healthy people because those who are sick or have illness in their medical histories would have less access to coverage ― and the policies available on the market would tend to be a lot less comprehensive. In other words, the price for lower premiums would be some combination of higher out-of-pocket costs, fewer covered services, and coverage that would be harder to get for the people who need it most. (Jonathan Cohn and Jeffrey Young, 5/24)

RealClear Health: CBO And America's AHCA Headache
The much-anticipated Congressional Budget Office (CBO) score of the American Health Care Act (AHCA), the GOP’s effort to dismantle the Affordable Care Act (ACA) released yesterday, indicates that the bill would cause 23 million people to become uninsured while reducing the federal deficit by $119 billion. In that sense, there is little change from their assessment of the original version of AHCA. (Billy Wynne, 5/25)

USA Today: Republican Health Care Bill Indicted, Again
Now we know why House Republicans were so quick to ram through an Obamacare repeal-and-replace bill last month, not waiting for an estimate of its impact or holding any public hearings. On Wednesday the non-partisan Congressional Budget Office got around to “scoring” the bill, and the results are not pretty. By next year, 14 million fewer people would have health insurance. Within a decade, 23 million fewer people would be covered. (5/24)

USA Today: Republican Health Care Bill Fails The Jimmy Kimmel Test. Again.
Every so often a “national moment” takes us out of our day-to-day and helps shape our national thinking. The Exxon Valdez oil spill helped forge our national opinion about environmental responsibility. Terry Schiavo’s life-support case made the public contemplate a dignified death. Someday, when we look back on the current health care debate, we may see how a national moment helped us articulate a new consensus when late night TV host Jimmy Kimmel told the poignant story of the birth of his son Billy. (Andy Slavitt, 5/24)

Los Angeles Times: Trumpcare Will Make It Even Harder For Millions Of California's Kids To Graduate And Get Jobs
he latest report from the Congressional Budget Office once again exposes the sharp and bitter truth about the House Republican efforts to “repeal and replace” President Obama’s Affordable Care Act. The American Health Care Act — now in the hands of the Senate — represents a glaring transfer of wealth, security and opportunity from low-income to high-income individuals. Should the AHCA or anything close to it become law, the students we serve in the California State University system and California Community Colleges system will be among the hardest hit. (Zelman Epstein, 5/24)

Modern Healthcare: An Extremist Attack On Public Health
Anyone who knows anything about healthcare didn't need a Congressional Budget Office scorecard to understand the disastrous consequences of the American Health Care Act. That legislation, now before the Senate, passed the House in early May in a straight party-line vote without hearings or a CBO score. Now we know the score. 23 million would lose their health insurance over the next decade, including 14 million by the end of next year. (Merrill Goozner, 5/24)

Viewpoints: Sessions' War On Drugs; Contemplating Rural Hospitals; Packing Heat At Kansas' Psychiatric Institutions, State Facilities

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

Detroit Free Press: Sessions' Policies Stand To Destroy Minority Communities
U.S. Attorney General Jeff Sessions has announced he’s reigniting the “war on drugs,” ordering prosecutors to seek the toughest possible charges and sentences, even for minor drug crimes. What he’s really doing is declaring war on people of color, because his harsh policies will eviscerate struggling black and brown families across America. He is resurrecting a war that has destroyed generations of minority families without eradicating the commerce of illegal drugs or Americans’ appetite for them. (Benjamin Crump, 5/25)

JAMA Forum: Rethinking Rural Hospitals
Since 2010, 78 of the more than 2150 rural nonspecialty US hospitals have closed. While the closure rate has recently declined, the proportion of financially struggling rural hospitals has increased. When a rural hospital closes, the economic losses can devastate an already stressed community through loss of health care workers, emergency services, and primary care capacity, as well as higher unemployment and lower per-capita income, a drop in housing values, poorer health, and increasing health disparities. An urgent look at how to prevent these closures is merited, but it may also be time to rethink what a rural hospital should be. (Diana Mason, 5/24)

The Kansas City Star: Concealed Weapons Likely Are Coming To A Kansas Institution Near You
Hey, Kansans: Brace yourselves. Your state is about to change in a consequential way. Barring the unexpected, concealed weapons soon will be allowed in state hospitals, psychiatric institutions and on the state’s public university campuses. That’s happening in just 38 days unless pro-common-sense lawmakers pull a rabbit out of their hats and muscle through a new law. But that looks increasingly unlikely as the Legislature struggles with big issues in its ongoing wrap-up session. (5/24)

JAMA Forum: Payment Power To The Patients
There is broad consensus that the quality of care that is delivered in the United States is uneven and too often inadequate. For more than a decade, the approach to remedying deficiencies in health care quality has been through measurement, incentives, and accountability. But now consensus is emerging that efforts have not worked particularly well, and that doing more of the same is unlikely to lead to progress. It may be time to try a radically simple idea: let patients decide what comprises high-quality health care. (Ashish K. Jha, 5/22)

The New York Times: Get Married, Get Healthy? Maybe Not.
In a nation as divided and contentious as our own, it is rare to find a belief we all share. But trust in the transformative power of marriage is close to universal — and it has endured for decades. This isn’t just a matter of faith, we’ve been assured. It’s science. Research is said to have established what our fairy tales promised: Marry and you will live happily ever after. And you will be healthier, too. A new study challenges the claim that people who marry get healthier. (Bella DePaulo, 5/25)

JAMA: Finding Joy In Practice: Cocreation In Palliative Care
Four years ago, after nearly 20 years in practice, I walked out of the familiar world of infectious disease and into the world of palliative care. In the world I left, I cared for hundreds of patients, educated countless learners, led dozens of infection prevention efforts. But that world felt increasingly superficial, fragmented, isolated, a hard place to find joy and meaning in my work. (Kathryn B. Kirkland, 5/23,30)

The Columbus Dispatch: Treatment At Hospital Follows ‘Catholic Tradition’
A hospital policy with wide-ranging consequences for patients of Mercy Medical Center in Des Moines, Iowa, was made public recently through a Facebook post on a page for mothers. It came from a woman who was denied a tubal ligation after having a cesarean section because Mercy is a Catholic hospital. In verifying that prohibition, I discovered other religious-based restrictions at Mercy and 547 other Catholic hospitals across the U.S., which make up 14.5 percent of all acute care hospitals in the country. It raises a question of whether these institutions are fulfilling their legal and professional obligations to their patients and the taxpayers who subsidize them with billions of dollars. (Rekha Basu, 5/25)

St. Louis Post-Dispatch: The Immediate Need For Action On Life
The Missouri Legislature has for many years demonstrated a commitment to protecting the health and safety of women and the dignity of the unborn, passing various laws to further these ends. A number of recent developments, though, have dealt serious blows to these laws and merit immediate attention in a special session of the Legislature. On Monday, the maternity home Our Lady’s Inn, Archdiocesan Elementary Schools of the Archdioceses of St. Louis, and St. Louis businessman Frank O’Brien filed a federal lawsuit against the “abortion sanctuary city” ordinance passed by the city of St. Louis in February. As the plaintiffs note, the bill, which purports to be an anti-discrimination ordinance for those making “reproductive health decisions,” is so broad that it would “force nonprofit organizations like Our Lady’s Inn, whose mission is to promote and facilitate abortion alternatives, to hire abortion advocates, despite their opposition to the ministry’s reason for existence.” (State Sen. Bob Onder, 5/25)