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Here's today's health policy haiku:

CRYSTAL BALLING THE POLITICS OF GRAHAM-CASSIDY

Here’s the big question:
Will Senate votes now alter
Election outcomes?

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Summaries Of The News:

Health Law

For GOP, Political Incentive Is 'As Much Of A Reason As The Substance' To Pass Repeal Bill

The driving force behind this last-ditch attempt for many lawmakers it the simple fact that they promised their constituents they'd make it happen. Meanwhile, Sen. Lisa Murkowski (R-Alaska) is once again in the spotlight with one of the deciding votes. And news organizations look at where other Republicans stand on the matter.

The Associated Press: Republicans See Political Necessity In Health Care Effort
It's divisive and difficult, but the Republican drive to erase the Obama health care overhaul has gotten a huge boost from one of Washington's perennial incentives: Political necessity. In the two months since Senate Republicans lost their initial attempt to scuttle President Barack Obama's statute, there's fresh evidence GOP voters are adamant that the party achieve its long-promised goal of dismantling that law. This includes conservative firebrand Roy Moore forcing a GOP primary runoff against Sen. Luther Strange, R-Ala., who's backed by President Donald Trump, and lots of money, plus credible primary challenges facing Republican Sens. Jeff Flake of Arizona and Nevada's Dean Heller. (Fram, 9/21)

The Washington Post: Ready To Deal This Time? Alaska’s Murkowski Is In The Health-Care Spotlight. Again.
Lisa Murkowski walked briskly down a cavernous hallway on the first floor of the Capitol, awash in a small sea of reporters. Suddenly she paused, seemingly overcome by the pressure of the moment. “You guys — hold,” the Republican senator from Alaska said curtly. “Give me breathing room, please. It gets a little intense. I know you guys don’t feel it, but it’s like, whoa.” Another effort to replace the Affordable Care Act is underway, and in Washington that means one thing: Murkowski is at the center of it all — under the glare of the national spotlight and squarely on the minds of White House officials and Senate Republican leaders who are strenuously seeking her support. (Sullivan, 9/20)

The Hill: The Two Senators Who Will Likely Decide Fate Of ObamaCare Repeal
All eyes are on Sens. John McCain (Ariz.) and Lisa Murkowski (Alaska) as Republicans try to approve a new ObamaCare repeal bill in the next 11 days. The two were among the three Republicans who sank the last GOP effort to repeal ObamaCare, and President Trump and his allies probably can’t afford to lose either if they are to win a vote next week. (Hellman, 9/20)

Roll Call: Republicans Cast Aside Previous Concerns In Latest Repeal Effort
Republican senators face the prospect of retreating from their previous public stances in order to support fast-moving legislation that would significantly overhaul the U.S. health care system. Concerns about the impact on people suffering from opioid addiction, drastic cuts to Medicaid and the lack of robust analysis from the nonpartisan Congressional Budget Office appear to have vanished as the GOP hopes to advance a bill to repeal the 2010 health care law before the fast-track budget reconciliation mechanism they are using expires on Sept. 30. Lawmakers say any concerns are addressed by the state flexibility included in the proposal. (Williams, 9/20)

Politico: The Unlikely Group Who Brought Obamacare Repeal Back To Life
Senate Republicans’ last-ditch attempt to repeal and replace Obamacare rests on the unlikely collaboration of a veteran senator who can’t stand health policy, a wonky freshman who has never passed major legislation and a former senator who lost his seat a decade ago. Together, Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.) and former Pennsylvania Sen. Rick Santorum crafted the latest GOP repeal bill in hopes of delivering on the party’s seven-year-old campaign promise to repeal Obamacare. (Haberkorn and Bade, 9/21)

Roll Call: Analysis: Why Ryan Has Stepped Into the Senate Health Care Debate
So if Ryan wanted to “reserve judgement” and give the Senate space on health care in July, why is he not doing so now? One answer is likely because senators didn’t want Ryan to stay quiet on the issue. When the Senate was getting ready to vote on the skinny repeal bill, several senators said they would have a hard time voting “yes” without knowing whether Ryan would actually agree to go to conference. ... Senators’ need for assurances on what the House will do may also be why Ryan told Senate Majority Leader Mitch McConnell, Graham and likely other senators that a bipartisan market stabilization plan that Health, Education, Labor and Pensions Chairman Lamar Alexander and ranking Democrat Patty Murray had been negotiating is not a viable health care solution for House Republicans. (McPherson, 9/21)

Politico: Christie Says He Opposes Graham-Cassidy Bill
Gov. Chris Christie said on Wednesday that he opposes the latest Senate plan to repeal and replace Obamacare, deeming it “too injurious” to New Jersey. “I oppose Graham-Cassidy because it is too injurious to the people of New Jersey,” Christie told reporters standing outside an addiction treatment center in Somerset County. “I’m certainly not going to support a bill that takes nearly $4 billion from people in the state.” (Jennings, 9/20)

Bloomberg: Christie Opposes Senate GOP Health Bill
Under the latest Republican bill, states could get a waiver allowing insurers to charge people more if they or a dependent have a pre-existing condition, or if they get sick and want to keep their insurance. The key provision in the bill has vague language requiring a state to first show how it "intends to maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions." (Dennis and Kapur, 9/20)

The Hill: New Mexico Gov: GOP Healthcare Bill 'Still Needs Some Work'
New Mexico’s Republican governor is not yet persuaded to support the latest GOP effort to repeal ObamaCare. “While it’s encouraging that Congress is working on a healthcare solution, the governor is concerned this bill could hurt New Mexico and still needs some work,” a spokesman for Gov. Susana Martinez told The Albuquerque Journal. (Shelbourne, 9/20)

Arizona Republic: After Call From Trump On 'Obamacare,' Ducey Endorsed Latest GOP Effort
President Donald Trump phoned Arizona Gov. Doug Ducey on Saturday to discuss Senate Republicans' latest effort to repeal "Obamacare." Two days later, the Republican governor used Trump's favored social media platform — Twitter — to announce his support for the legislation that would represent a key victory for the president and Capitol Hill Republicans. (Wingett Sanchez, 9/20)

Majority Of States Would Lose 'Jaw-Dropping' Amounts Of Funding Under Graham-Cassidy Bill

A new study by Avalere Health finds that red states would disproportionately benefit, while 34 states would be hit hard by cuts under the proposal for Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.).

The Associated Press: Study: Most States Would Take A Hit From GOP Health Bill
Most states would take a stiff budgetary hit if the latest Senate GOP health care bill becomes law, according to an analysis released Wednesday. That would likely result in more uninsured Americans. The study by the consulting firm Avalere Health found that the Graham-Cassidy bill would lead to an overall $215 billion cut to states in federal funding for health insurance, through 2026. Reductions would grow over time. (Alonso-Zaldivar, 9/20)

The Washington Post: Under Latest Health-Care Bill, Red States Would Benefit Disproportionately
The latest Republican proposal for curtailing the Affordable Care Act was assembled with such haste that it may get a vote before a full cost estimate is finished. But it is not a new idea. At its core, the bill introduced by Sen. Bill Cassidy (R-La.) and Sen. Lindsey O. Graham (R-S.C.) would implement a decades-old conservative concept, capping the amount that taxpayers spend on Medicaid and giving states full control over the program. As he’s sold the legislation to conservative governors and activists, Graham has described it as a possible triumph for federalism, and a way to end the progressive dream of universal health care managed from Washington. (Weigel, 9/20)

The Washington Post: Cassidy-Graham Bill Would Cut Funding To 34 States, New Report Shows
More than half of the overall cuts in the legislation — named for its primary sponsors, Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.) — would come from Medicaid, the analysis shows. States with relatively low medical costs, skimpy Medicaid benefits and no program expansion would win out. Texas would gain more than any state, about $35 billion from 2020 through 2026. On the other hand, states with higher-priced medicine and generous benefits for their low-income residents, such as California and New York, would lose billions of dollars. (Goldstein, Weigel and Eilperin, 9/20)

The Hill: 34 States Would See Funding Cut From New ObamaCare Repeal Bill: Study
Cassidy, Graham and the other co-sponsors of the bill said the legislation is about fairness. It aims to redistribute money from high-spending Medicaid expansion states — like California — to states that rejected the expansion — like Texas. But it isn't just blue states that stand to lose under the Graham-Cassidy proposal. (Weixel, 9/20)

Modern Healthcare: GOP Senators In Quandary Over Cassidy-Graham Bill's Projected Cuts To Their States
Big cuts in funding to states for coverage subsidies, Medicaid expansion, and traditional Medicaid under the latest Senate Republican bill to repeal and replace the Affordable Care Act have created a political migraine for GOP senators, as Majority Leader Mitch McConnell pushes for a vote on the bill next Wednesday. Two nonpartisan analyses of the Graham-Cassidy bill show that many states represented by Republican senators would lose billions of dollars in federal healthcare funding through 2026, and far larger amounts after that. Total funding would be significantly lower than under current law. (Meyer, 9/20)

San Francisco Chronicle: California Would Lose $78 Billion — More Than Any Other State — Under GOP Health Bill
California would lose more federal funding than any other state under the latest GOP plan to repeal the Affordable Care Act, according to an analysis released Wednesday by the health policy consulting firm Avalere Health. By 2026, California would lose $78 billion in federal money for the Medi-Cal insurance program for the poor and in federal subsidies for low-income residents who buy health insurance through Covered California, the state exchange created under the ACA. (Ho, 9/20)

The Oregonian: Oregon Hardest-Hit State In US Under GOP'S New Health Care Bill
Oregon would be the hardest hit state – losing at least $13 billion in funding -- if the latest Republican health care bill becomes law, according to two analyses of the bill issued this week. Avalere Health, a health care consulting firm, on Wednesday pegged Oregon’s losses at $13 billion over 10 years and $111 billion over 20 years. (Manning, 9/20)

Georgia Health News: Study: Georgia Would See Big Gains Under GOP Bill, But Not Long Term
Georgia and several other Southern states initially would gain in federal health care funding under a Republican bill speeding through the U.S. Senate, a new analysis finds. But that effect would begin to wear off after a decade, and ultimately could lead to losses for all states as compared with current funding streams, according to the study by consulting firm Avalere Health, released Wednesday. (Miller, 9/20)

State Flexibility At Core Of Republicans' Latest Repeal-And-Replace Efforts

Outlets take a look at what's in the Graham-Cassidy bill and how it would all work.

The New York Times: How The Latest Obamacare Repeal Plan Would Work
The latest Republican proposal to undo the Affordable Care Act would grant states much greater flexibility and all but guarantee much greater uncertainty for tens of millions of people. The legislation, proposed by two Senate Republicans, Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would not only reduce the amount of federal funding for coverage over the next decade, but also give states wide latitude to determine whom to cover and how. The result is a law that would be as disruptive as many of the Republicans’ previous proposals, but whose precise impact is the hardest to predict. (Abelson and Sanger-Katz, 9/20)

NPR: Republicans Try One Last Effort To Repeal Obamacare
Graham-Cassidy essentially deconstructs all of the major programs created by the Affordable Care Act, gathers up the money and hands it over to states to run their own health care programs. It gets rid of both the subsidies that help people buy individual health insurance policies and the reimbursements to insurance companies for offering price breaks on copayments and deductibles to the lowest-income customers. It rolls back the Obamacare Medicaid expansion that was adopted by 31 states and Washington, D.C., and it eliminates the Basic Health Program that was created under the ACA and implemented in New York and Minnesota. (Kodjak, 9/19)

Stat: Abortion Coverage Would Be Restricted Under New GOP Health Care Plan
The GOP health care overhaul barreling toward a possible Senate vote this month would restrict abortion coverage for some people as early as next year. Most of the major changes included in the package, from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, wouldn’t take effect until 2020. That’s when the legislation would end the subsidies currently available to consumers who don’t get their health insurance through their job or a government program. It’s also when the legislation would overhaul — and cut — government contributions to state Medicaid programs. (Mershon, 9/20)

Critics Point To Loopholes In Republicans' Promise That Bill Covers Preexisting Conditions

Sen. Bill Cassidy (R-La.) says states would have to tell the government how they would provide “adequate and affordable” coverage to people with pre-existing conditions. Experts say that's not enough.

The Hill: GOP Takes Heavy Fire Over Pre-Existing Conditions
The new ObamaCare repeal measure from Senate Republicans would give states a way to repeal protections for people with pre-existing conditions, a controversial move that opponents of the bill are denouncing. The provision attracted widespread attention on Wednesday after late-night host Jimmy Kimmel blasted Sen. Bill Cassidy (R-La.), a lead author of the legislation. Kimmel said the senator is violating the “Jimmy Kimmel test,” which Cassidy coined as a way of saying that no one should be denied care because they can’t afford it. “This guy Bill Cassidy just lied right to my face,” Kimmel said. (Sullivan, 9/20)

The Hill: Blue Cross Warns GOP Repeal Bill 'Undermines' Pre-Existing Condition Rules
The Blue Cross Blue Shield Association warned against a new GOP ObamaCare bill on Wednesday, saying it would "undermine" protections for pre-existing conditions. "The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions," the association said in a statement. (Sullivan, 9/20)

Atlanta Journal-Constitution: New GOP Health Care Plan Faces Questions Over How It Deals With Pre-Existing Conditions
The issue of how people with pre-existing conditions are treated has been a controversial one throughout this year’s legislative push by the GOP to coalesce behind a plan that would repeal and replace the Obama health law, as supporters of the law argue it’s one of the most popular aspects of the existing law, as it prevents insurance companies from discriminating against people because of their past medical history. (Dupree, 9/21)

The Hill: Trump: New ObamaCare Repeal Does Cover Pre-Existing Conditions
President Trump argued Wednesday that the latest Republican effort to repeal much of ObamaCare does include coverage of pre-existing conditions. “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal & Replace,” Trump wrote on Twitter, referring to the legislation being pushed by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.). (Shelbourne, 9/20)

McConnell Will Bring Graham-Cassidy To Floor Next Week -- But Only If He's Sure It Will Pass

Senate Majority Leader Mitch McConnell (R-Ky.) left himself some wiggle room if negotiations don't go his way.

The Washington Post: McConnell Intends To Bring Repeal Bill To Senate Floor Next Week, Spokesman Says
Senate Majority Leader Mitch McConnell (R-Ky.) plans to bring a bill to undo the Affordable Care Act to the Senate floor next week, a McConnell spokesman said Wednesday. His statement marked McConnell’s most concrete commitment yet to moving ahead with the bill from Sens. Bill Cassidy (R-La.) and Lindsey O. Graham (R-S.C.). It signaled that a vote would be expected next week. (Sullivan, 9/20)

The Wall Street Journal: McConnell Plans Vote On GOP Health Bill Next Week
A spokesman for Mr. McConnell (R., Ky.) said it was “the leader’s intention to consider Graham-Cassidy on the floor next week,” referring to the bill sponsored by GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The spokesman’s statement didn’t commit the Senate to a vote, which would need to happen before the end of next week for Republicans to pass the measure by a simple majority. (Peterson and Radnofsky, 9/20)

Politico: Senate Girds For Final Obamacare Repeal Vote
McConnell has told colleagues he will only bring up the bill if it will succeed. The statement does leave some wiggle room to not proceed with a vote. It's still anyone's guess whether the bill's backers can get to 50 votes. One Republican senator suggested that McConnell may ultimately decide to bring the bill up for another failed vote, in part to show GOP donors and President Donald Trump that the Senate GOP tried again. (Everett and Kim, 9/20)

Modern Healthcare: McConnell Plans Floor Vote On Graham-Cassidy Bill
The Senate is in a bit of a time crunch to take another crack at repealing the ACA. The goal is to move the legislation under budget reconciliation rules, which only require a simply majority for passage. The Senate parliamentarian said budget reconciliation rules end with the fiscal year on Sept. 30. (Weinstock, 9/20)

Trump Predicts Some Furious Lobbying Over Next Few Days, But Thinks Bill Has 'Very Good Chance'

By President Donald Trump's reckoning, “we’re at 47 or 48 already, senators, and a lot of others are looking at it very positively.”

After Other September Successes, Unlikely Duo 'Chuck And Nancy' Set Sights On Health Care

Democrats are trying to rally to stop the last-ditch Republican efforts to repeal and replace the Affordable Care Act. If they can stop it, will Senate Minority Leader Charles Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif.) convince President Donald Trump to consider modest reform measures?

The New York Times: ‘Chuck And Nancy,’ Washington’s New Power Couple, Set Sights On Health Care
When Representative Nancy Pelosi, the House Democratic leader, introduced Chuck Schumer to members of her caucus this month, she warmed up the room with a well-worn joke about her Senate counterpart: “You know they say the most dangerous place in Washington is between Chuck and a camera.” Mr. Schumer’s love of the spotlight aside, it has been behind the scenes where “Chuck and Nancy,” as President Trump calls them, have forged what may be the most surprisingly potent partnership in Mr. Trump’s Washington. (Stolberg, 9/20)

The Hill: Blumenthal: ObamaCare Repeal Bill One Of The ‘Most Cruel’ Acts In History
Sen. Richard Blumenthal (D-Conn.) said Democrats will use “all the tools and tactics” they can to stop the new Republican effort to repeal ObamaCare, legislation he called “the most cruel and outrageous.” “We are preparing and planning to use every tool and tactic available to us because we are on the precipice of one of the most cruel and outrageous legislative acts in recent history,” Blumenthal told CNN’s “The Situation Room.” (Shelbourne, 9/20)

Politico: Left On ‘Full War Footing’ To Stop Obamacare Repeal
The liberal activists roused into the streets by President Donald Trump are revving up for one last campaign to save Obamacare.The sudden resurgence of Republicans’ repeal push appeared to catch Democrats and their base by surprise. But ahead of Senate Majority Leader Mitch McConnell’s plans to vote next week on a new bill to dismantle the health law, the Democratic grass roots is on what one leading activist called “full war footing.” (Schor, 9/20)

Roll Call: House Democratic Candidates Capitalize On Graham-Cassidy
Democratic House candidates are trying to appeal to Republican senators in their states as Republican prepare for another vote to repeal the 2010 health care law. ... Chrissy Houlahan, who is running in Pennsylvania’s 6th District against Ryan Costello, appealed to the state’s Republican Sen. Pat Toomey, saying the bill was “dangerous” and that it would “take away insurance from some of our most vulnerable citizens.” Former Arizona Rep. Ann Kirkpatrick, who represented the state’s 1st District and is now running to challenge Rep. Martha McSally in the state’s 2nd District, tweeted a photo of her calling Sens. John McCain and Jeff Flake. (Garcia, 9/21)

Meanwhile, on the single-payer front —

The Washington Post: Republicans Tweak Sanders Over Health Care, But Cassidy-Graham Could Open A Path For His Bill
One short week ago, 16 Senate Democrats and dozens of progressive groups rallied with Sen. Bernie Sanders (I-Vt.) to celebrate the release of his Universal Medicare for All bill — a moonshot that they hoped would reset the national conversation on health care. Sen. Lindsey O. Graham (R-S.C.) sounded downright giddy. His own legislation to curtail the Affordable Care Act, and block grant Medicaid, was released just a few hours before Sanders’s, to a smaller but just as skeptical group of reporters. (Weigel, 9/20)

PolitiFact: Comparing Administrative Costs For Private Insurance And Medicare
Sen. Bernie Sanders, I-Vt., said that switching to a single-payer "Medicare for all" health system would save billions of dollars in administrative costs. ... Is the gap between private and public health insurance providers’ administrative costs really that high? Most experts agreed the numbers looked about right. But because of key differences between Medicare and private insurance, the trade-off isn’t as simple as Sanders suggests. (Tobias, 9/20)

Insurers Were Reluctant To Criticize Previous GOP Efforts, But New Bill Prompts Them To Speak Out

Not only would the legislation further destabilize the marketplace and jeopardize patient care, but it could potentially allow “government-controlled single payer health care to grow,” said AHIP's Marilyn B. Tavenner. Among the other groups opposed to the bill are the American Cancer Society Cancer Action Network, the American Heart Association, the American Medical Association and more.

The New York Times: Insurers Come Out Swinging Against New Republican Health Care Bill
The health insurance industry, after cautiously watching Republican health care efforts for months, came out forcefully on Wednesday against the Senate’s latest bill to repeal the Affordable Care Act, suggesting that its state-by-state block grants could create health care chaos in the short term and a Balkanized, uncertain insurance market. In the face of the industry opposition, Senate Republican leaders nevertheless said they would push for a showdown vote next week on the legislation, drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. (Pear, 9/20)

The Hill: Insurer Trade Group Blasts Latest ObamaCare Repeal Bill
In a letter to Senate leadership, America's Health Insurance Plans said a repeal bill sponsored by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) would have "real consequences on consumers and patients." The bill would further destabilize the individual market; cut Medicaid; pull back on protections for pre-existing conditions; not end taxes on health insurance premiums and benefits; and potentially allow government-controlled, single-payer health care to grow, wrote Marilyn Tavenner, the group's President and CEO. (Hellmann, 9/20)

The Wall Street Journal: With Timing Tight For GOP’s Health-Law Repeal Effort, Opponents Rush To Mobilize
Opponents of a Republican plan to dismantle most of the Affordable Care Act are scrambling to ramp up a resistance campaign before a possible Senate vote next week on a bill many never expected would gain traction. With such a narrow window, consumer and other groups are seeking to pressure specific GOP senators they see as most likely to waver. They also assert that Republicans are trying to ram through a bill outside the normal process while reneging on a promise to preserve the ACA’s consumer protections, claims the bill’s sponsors reject. (Armour, 9/21)

Tennessean: Nashville Veterans Lobby Against Graham-Cassidy Health Care Plan
Kelly Gregory, an Air Force veteran with stage 4 breast cancer, Tennessee Consumer Action Executive Director Andy Spears and State Rep. Mike Stewart pointed to a recent Rand Corp. study published last week, that says a repeal of the ACA, like that proposed in a pair of Republican-backed bills known as the AHCA and Graham-Cassidy, would reduce the number of non-elderly veterans with health insurance in Tennessee and across the country. (Lowary, 9/20)

'It Wasn't Perfect, But It Was Better': Obama Defends Health Law, Calls Repeal Efforts Aggravating

Former President Barack Obama spoke about the frustration of watching "people trying to undo that hard-won progress for the 50th or 60th time with bills that would raise costs or reduce coverage."

The Associated Press: Obama: GOP’s Efforts To Repeal Health Care ‘Aggravating’
Former President Barack Obama on Wednesday called repeated Republican efforts to repeal his signature health care law “aggravating” as he urged people not to be discouraged by unsteady progress as they work on pressing global issues. Speaking at a summit hosted by billionaires Bill and Melinda Gates to coincide with the United Nations General Assembly, the Democrat said the real problems facing the world “can’t discourage any of us from the belief that individually and collectively, we can make a difference.” (Hajela, 9/20)

The Washington Post: Obama Says Repealing The ACA Would Inflict ‘Real Human Suffering’ On Americans
“It wasn’t perfect, but it was better,” the former president said of the ACA. “And so when I see people trying to undo that hard-won progress, for the 50th or 60th time, with bills that would raise costs or reduce coverage, or roll back protections for older Americans, people with preexisting conditions, the cancer survivor, the expectant mom, or the child with autism, or asthma, for whom coverage will once again will be unattainable, it is aggravating.” (Eilperin, 9/20)

WBUR: Obama Argues Against Dark Worldview, Defends Health Care Law
"We have to reject the notion that we are suddenly gripped by forces that we cannot control," Obama said at a Goalkeepers conference, a gathering of young, international activists sponsored by the Bill and Melinda Gates Foundation (which is among NPR's financial supporters). "[We've] got to embrace the longer and more optimistic view of history and the role that we play in it. And if you are skeptical of such optimism, I will say something that may sound controversial. ... By just about every measure, America is better and the world is better than it was 50 years ago, 30 years ago, or even 10 years ago. And I know that statement doesn't jibe with the steady stream of bad news and cynicism that we're fed through television and Twitter. But it's true. Think about it: I was born at a time, for example, when women and people of color were systematically excluded from big chunks of American life. ... Even if we still have miles to travel and innumerable laws and hearts and minds to change, the shift in what this country is and what it means is astonishing, remarkable and it's happened, when you measure it against the scope of human history [snaps fingers] in an instant." (Montanaro, 9/20)

Politico: Obama Calls Constant GOP Efforts To Repeal Obamacare 'Aggravating'
Sen. Lindsey Graham of South Carolina, one of the Republicans pushing the latest effort to undo Obamacare, said after Obama's speech that it would be "unrealistic" to expect the former president to acknowledge problems with his namesake law. "It’s no surprise President Obama opposes sending money and power back to the states and closer to where the patients live," Graham said in a statement. "Obamacare was designed with the exact opposite goal in mind — which is to consolidate health care power and decision-making in Washington." (Dovere, 9/20)

Jimmy Kimmel's Back-And-Forth With Bill Cassidy Captures Confusion, Rhetoric Around Hurried Health Bill

The health policy debate is more complicated than the soundbites from both sides may convey.

The Washington Post Fact Checker: Sen. Cassidy’s Rebuttal To Jimmy Kimmel: ‘More People Will Have Coverage’
Late-night host Jimmy Kimmel attacked Cassidy over the health-care repeal plan crafted by Cassidy and Sens. Lindsey O. Graham (R-S.C.),  Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) as a last-ditch effort to replace the Affordable Care Act. Kimmel asserted, among other things, that the proposed law “will kick about 30 million Americans off insurance. ”Firing back, Cassidy flatly stated that “more people will have coverage … There are more people who will be covered through this bill than under the status quo.” (Kessler, 9/21)

PolitiFact: Bill Cassidy Offers Misleading Defense In Face-Off With Jimmy Kimmel
Following a sharp rebuke by late-night talk show host Jimmy Kimmel, Sen. Bill Cassidy, R-La., hit the airwaves on Sept. 20 to defend his bill that would undo much of the Affordable Care Act. ... We decided to take a closer look at the way Cassidy described the potential impact of his bill. We found that, according to the best available analysis, Cassidy is not fully accurate about the funding increase. (Jacobson, 9/20)

Huffington Post: Livid Kimmel Turns Up The Heat On Sen. Cassidy For A 2nd Night
Kimmel used the opening monologue of his Tuesday “Jimmy Kimmel Live” show to slam Cassidy and Sen. Lindsey Graham (R-S.C.), co-sponsors of a measure that would end the Affordable Care Act. ... Kimmel accused Cassidy of lying to him during the senator’s appearance on his show in May, when the lawmaker pledged that no family would be denied medical care because they couldn’t afford it. (Visser, 9/21)

Marketplace

Given State Of Affairs Around Health Law, States Stuck Approving Sharp Premium Increases

Because of all the uncertainty in D.C., states like Kentucky, Mississippi and Virginia are approving average rates for major insurers that are at least 25 percent higher than they were in 2017. Meanwhile, Department of Health and Human Services documents show that outreach efforts under the Obama administration actually were working.

The Wall Street Journal: States Back Big Insurance Increases Amid Health Law’s Uncertainty
Many state regulators are approving sharp rate increases for Affordable Care Act insurance plans that will be sold next year, as they are forced to make decisions despite the latest uncertainty about the law’s future. The 2018 premiums for ACA plans are supposed to be locked in Wednesday, under a federal deadline, at the same time that Republicans in the Senate are moving toward a potential vote next week on legislation that would scrap most of the health law. (Wilde Mathews, 9/20)

The Hill: Insurers Are Scrambling To Keep Up With ObamaCare Drama
Insurance companies blindsided by the Senate GOP’s decision to pull the plug on bipartisan talks and move forward again with ObamaCare repeal are scrambling to figure out how to move forward. The death of the bipartisan push leaves them with no clear way to shore up fragile marketplaces ahead of the 2018 enrollment season, which begins Nov. 1. (Roubein, 9/21)

Chicago Tribune: Illinois Submits Big Obamacare Rate Increases To The Feds
Hundreds of thousands of Illinois consumers who buy health insurance on the state's Obamacare exchange will likely see average rates increase by 16 percent to 37 percent next year for the lowest-priced plans, according to a new analysis. The Illinois Department of Insurance submitted rates to the federal government Wednesday that would increase the average cost of the lowest-priced silver plans by 35 percent statewide. (Schencker, 9/20)

Marketplace: HHS Documents Show Obamacare Marketing Was Working In 2016
After the U.S. Department of Health and Human Services announced it was slashing its Obamacare marketing budget by 90 percent on Aug. 31, agency spokespeople cited “diminishing returns” from its television, radio and Internet ads that encourage people to sign up for health insurance. (Gorenstein, 9/20)

Medicaid

Children's Health Program And Community Health Centers' Funding Stuck In Senate Logjam

A bipartisan deal on the popular Children's Health Insurance Program was reached by senators earlier this month, but it looks unlikely to get a vote before the program's authority expires on Sept. 30 because the Senate is consumed with efforts to replace the federal health law. Also in Medicaid news, officials in New Mexico unveil plans to charge enrollees premiums and copayments.

The Wall Street Journal: Health-Law Repeal Push Could Jeopardize Children’s Program Funding
The 11th-hour push to dismantle major portions of the Affordable Care Act by the end of the month is imperiling funding for several popular bipartisan health programs that are set to expire Sept. 30. The top Republican and Democrat on the Senate Finance Committee brokered a deal last week to reauthorize funding for the Children’s Health Insurance Program, or CHIP, for five years, just as the program’s funding is set to phase out. (Hackman, 9/20)

Sante Fe New Mexican: State Pursues Medicaid Premiums, Copays To Cover Rising Costs
New Mexico residents enrolled in Medicaid may have to cough up more money for their health care costs by the end of the year or early next year under a proposal that aims to offset state spending on the program. The state Human Services Department is proposing copays and even monthly premiums for patients in the state’s Medicaid program, which provides coverage for low-income people. Patient advocates say the expenses will create a hardship for some of New Mexico’s poorest residents, but officials argue the patient contributions would be a reasonable way to control costs in a health care system that requires a growing share of the state budget. (Oxford, 9/20)

Albuquerque (N.M.) Journal: Legislators Assail Proposed State Medicaid Changes
Democratic state lawmakers on Wednesday bluntly criticized a proposal that would impose co-pays and monthly premiums on more of the low-income New Mexicans who rely on Medicaid for their health care. The proposal would also scale back some benefits. On the same day that Republican Gov. Susana Martinez expressed misgivings about a Republican bill to repeal Obamacare, her administration characterized the state-level benefit changes as minor, with exemptions built in to soften the impact. (McKay, 9/20)

Administration News

Use Of Private Jets Justified Because Of Tom Price's 'Incredibly Demanding Schedule,' Spokeswoman Claims

Each one of the chartered flights is estimated to have cost tens of thousands of taxpayer dollars. Health and Human Services Secretary Tom Price has advocated cost-cutting at his agency. His predecessors often traveled by commercial flights or on trains.

The New York Times: Spokeswoman Cites ‘Demanding Schedule’ For Health Secretary’s Use Of Private Jets
Tom Price, the health and human services secretary, spent tens of thousands of taxpayer dollars to fly on private jets to attend routine public events instead of taking cheaper commercial airliners because he has an “incredibly demanding schedule,” his spokeswoman said Wednesday. Mr. Price, a physician and former Republican congressman from Georgia, chartered five work-related flights last week alone. In all, the private flights cost the federal government as much as $60,000, according to a report by Politico, citing internal department documents. (Thrush, 9/20)

The Wall Street Journal: HHS Defends Tom Price’s Use Of Private Jets
Politico reported late Tuesday on five recent trips taken by Dr. Price on charter flights estimated in the report to have cost tens of thousands of dollars apiece. These trips occurred in situations where driving, passenger rail or commercial flights were all viable options, according to the report. “The Trump administration treats taxpayer dollars like they are frequent-flier miles, while they try to take health care away from millions,” the Democratic National Committee said Wednesday. “These funds could be used to make health care more affordable and accessible, to help fund Medicaid, combat the opioid epidemic or increase ACA enrollment.” (Radnofsky, 9/20)

The Hill: Top Dem Asks Watchdog To Look Into Price Private Jet Travel
A top House Democrat is asking the inspector general of Health and Human Services (HHS) to look into a report that the head of the department took private jets to travel for official business. Rep. Frank Pallone Jr. (N.J.), the top Democrat on the House Energy and Commerce Committee, released a statement Wednesday saying he would ask the HHS inspector general for a "full accounting" of Secretary Tom Price's travel. (Sullivan, 9/20)

Concord Monitor: Shaheen Calls For HHS Secretary To Reveal Source Of Money For N.H. Trip
The announcement that Health and Human Services Secretary Tom Price was visiting a small Seacoast city last week caught some in New Hampshire by surprise. The Somersworth city manager wasn’t alerted ahead of time ... Now, the senator is calling on the secretary to release how, exactly, his trip to the Granite State was funded, after it was reported that Price took private jets on five separate flights for official business, including his jaunt here. (Andrews, 9/20)

Pharmaceuticals

Pfizer-J&J Legal Brawl Could Set Precedent For Competition In Biosimilar Landscape

If Pfizer is successful, it could discourage brand name companies from using deals with insurers to limit competition in the emerging biosimilar market. If Pfizer loses, the case could highlight a strategy those companies could continue to use to deter competition.

The Washington Post: Pfizer Sues Johnson & Johnson, Alleging Anticompetitive Practices To Maintain A Drug Monopoly
A legal brawl between two of the world’s largest drug companies could shape the future of a nascent market of copycat drugs that are intended to bring down the cost of the most advanced and expensive medicines. Pfizer filed a lawsuit Wednesday against fellow pharmaceutical giant Johnson & Johnson for using “anticompetitive” tactics to quash its cheaper version of a powerful rheumatoid arthritis drug. Johnson & Johnson issued a statement saying the lawsuit had no merit. (Johnson, 9/20)

The Wall Street Journal: Pfizer Alleges J&J Thwarted Competition To Remicade, In Legal Test Of Biotech-Drug Copies
The complaint, filed Wednesday in U.S. District Court in Philadelphia, says J&J’s “exclusionary contracts” for Remicade with health insurers, hospitals and clinics effectively prevented them from offering Pfizer’s lower-priced copy so they could retain rebates and other J&J perks. The lawsuit is the first antitrust action to surface amid the emergence of biosimilars, which are copies of popular biotech drugs, after years of litigation over patents and timing of launches. Pfizer’s Inflectra is the biosimilar of Remicade. (Rockoff, 9/20)

Stat: Pfizer Accuses J&J Of Illegally Stifling Coverage For Its Biosimilar
The move comes nearly a year after Pfizer launched its drug amid speculation that a price war with J&J would ensue, since prevailing wisdom says a lower price is needed to gain market share. But despite initially pricing Inflectra at a 15 percent discount to the $31,500 list price for Remicade, the drug generated just $172 million in sales during the first six months of this year. By contrast, Remicade notched $3.2 billion in global sales – and $1 billion in U.S. sales – during that time. (Silverman, 9/20)

Stat: Advocacy Groups Get Some, But Not All, Trial Data On Gilead Hepatitis C Drugs
File this under, “Half a loaf.” After a two-year battle, a pair of public health advocacy groups obtained sought-after clinical trial data from regulators for two hepatitis C treatments sold by Gilead Sciences (GILD). But they failed to gain access to the most coveted information that would allow researchers to independently verify test results which were originally generated by the company. (Silverman, 9/20)

Quality

Florida Closes Nursing Home Tied To 9 Patient Deaths, Issues Rebuke For False Patient Records

Staff at the home entered normal vital signs into the medical records of several residents after they had already been evacuated, Florida officials said.

The Associated Press: Florida Suspends License Of Nursing Home Over Irma Deaths
Florida officials have suspended the license of a nursing home that had nine patients die after Hurricane Irma knocked out its air conditioning. The Agency for Health Care Administration said Wednesday that it suspended the license of the Rehabilitation Center at Hollywood Hills. The agency previously banned the facility from admitting new patients and from receiving Medicaid. The home filed a lawsuit trying to block those orders. (9/20)

Miami Herald: Irma Aftermath: Nursing Home Where 9 Died Shut Down By State
The Hollywood Hills nursing home that became a sweltering deathtrap for nine seniors after Hurricane Irma was shut down Wednesday. ... A statement released by the Agency for Health Care Administration said the center’s license was suspended, and unveiled new details about the nursing home, which has a history of poor inspections by state regulators. (Madan, 9/20)

The New York Times: Florida Nursing Home Listed Dead Resident As ‘Resting In Bed,’ State Says
A state agency has found that the Florida nursing home where eight residents died after it lost air-conditioning following Hurricane Irma “presents a danger to every person on its premises” and must close after staff at the facility failed to call 911 for its overheated patients, even as their temperatures began spiking as high as 109.9 degrees Fahrenheit. The agency also rebuked the nursing home for entering normal vital signs, or mildly elevated temperatures, into the medical records of several residents after they had already been evacuated or, in one case, had already died. Those entries, it said, were made “under dubious circumstances.” (Yee and Fink, 9/20)

The Wall Street Journal: Florida Suspends License Of Nursing Home Tied To Eight Deaths
The latest order comes a day after the Rehabilitation Center at Hollywood Hills filed a lawsuit against the state to block two previous orders, both of which effectively shut down the home, claiming the orders weren’t justified. Under direction from Gov. Rick Scott, the state has taken several steps to stop operations at the Hollywood, Fla., facility following the deaths last week. The nursing home’s residents “did not receive timely medical care because the trained medical professionals at the facility overwhelmingly delayed calling 911,” Florida’s Agency for Health Care Administration said, citing initial findings from an ongoing investigation. (Evans and Kamp, 9/20)

And in a look at other medical services affected by natural disasters —

Stat: Mobile Dialysis Could Save Lives In A Disaster. But Is There A Cost To Safety?
The calls started coming in the days after Hurricane Sandy. Flooded dialysis centers had shuttered across New York and New Jersey. Some patients and practitioners didn’t know where to turn. So they dialed Anita Chambers. “It was difficult to hear stories of patients being driven four to eight hours to find a center that could take them,” Chambers, said recalling the 2012 superstorm. “There were centers open that had all the patients in the day — seeing these patients in the middle of the night.” (Blau, 9/21)

Public Health And Education

Bouncing Back From Trauma Is Possible, But Some People Have To Work Harder Than Others

Dr. Dennis Charney has spent years studying trauma. And then he joined the ranks of the patients he worked with. In other public health news, ADHD, embryo editing, effects of gender stereotypes, the science of weight loss, the flu and more.

Stat: As A Scientist, He Studied Trauma Victims. Then He Became One
Dr. Dennis Charney stepped forward to address the court here, the man who tried to kill him standing no more than 20 feet away. He stated his full name for the record and then began detailing what happened. How one morning as he picked up his iced coffee and lightly buttered bagel, he heard a shotgun boom and saw blood pouring from his shoulder and chest. How he spent five days in the intensive care unit and then was scared to sleep with the lights off. How even now, a year later, he carried buckshot in his body. (Joseph, 9/21)

The Washington Post: Could ADHD Be A Type Of Sleep Disorder? That Would Fundamentally Change How We Treat It.
Over the past two decades, U.S. parents and teachers have reported epidemic levels of children with trouble focusing, impulsive behavior and so much energy that they are bouncing off walls. Educators, policymakers and scientists have referred to attention-deficit/hyperactivity disorder, or ADHD, as a national crisis and have spent billions of dollars looking into its cause. They've looked at genetics, brain development, exposure to lead, the push for early academics, and many other factors. But what if the answer to at least some cases of ADHD is more obvious? (Cha, 9/20)

NPR: Embryo Editing Yields DNA Clues To Early Human Development
For the first time, scientists have edited the DNA in human embryos to make a fundamental discovery about the earliest days of human development. By modifying a key gene in very early-stage embryos, the researchers demonstrated that a gene plays a crucial role in making sure embryos develop normally, the scientists say. (Stein, 9/20)

Minnesota Public Radio: The Science Of Weight Loss
We've all heard the conventional wisdom on how to lose weight: eat less and exercise more. But new research shows that shedding pounds and keeping them off may be more complicated than a "one-size-fits-all" approach. (Miller and Franz, 9/20)

Chicago Sun-Times: Mother Says Insurers Failed Her Suicidal Son
It was a year ago this week that Joseph “Joey” Dailidas took his own life with an intentional overdose of prescription medicine. ... Despite laws intended to require insurers to provide parity between coverage for mental health treatment and other medical conditions, many believe mental health and addiction treatment are still getting short shrift. (Mark Brown, 9/20)

Baltimore Sun: Mosquito Emoji: A Pair Of Public Health Workers Have An Itch To Make It Happen
Why shouldn’t people who hate the little blood suckers in the backyard, as well as those who love them in the lab, be able to express their feelings about them in a single character via text or on social media, ask Marla Shaivitz, a digital communications manager at the Johns Hopkins Bloomberg School of Public Health’s Center for Communication Programs, and Jeff Chertak, a senior program officer for malaria advocacy and communications at the Bill & Melinda Gates Foundation. (Cohn, 9/20)

Kaiser Health News: Caregivers Draw Support By Mapping Their Relationships
Every time Jacque Pearson tried to devise a plan to move her 81-year-old dad, who has Alzheimer’s, from his home in Boise, Idaho, to hers in Denver, she felt stuck. Then, two weeks ago, she had a breakthrough. It happened at an AARP-sponsored session in which Pearson created a “CareMap” — a hand-drawn picture showing all the people she cares for as well as the people surrounding those individuals and her own sources of support. (Graham, 9/21)

CVS To Limit Duration, Dose Of Opioid Prescriptions For Some Patients

Starting in February 2018, if CVS-covered patients arrive at the pharmacy with a prescription above its new limits, the pharmacy will kick it back to the doctor for review.

In other news —

State Watch

State Highlights: Texas Bill To Curb 'Surprise Medical Bills' Now In Effect; Blue Cross Will Continue To Run N.C.'s State Health Plan

Media outlets report on news from Texas, North Carolina, Maine, Florida, California, Nevada, Colorado, Michigan, Missouri, New Hampshire, Louisiana and Minnesota.

The Associated Press: Lawsuit Challenges Law That Only Doctors Perform Abortions
The American Civil Liberties Union and Planned Parenthood filed a federal lawsuit Wednesday that challenges a Maine restriction common across most of the U.S. that abortions be performed solely by physicians. The two groups were joined by four nurses and abortion provider Maine Family Planning in challenging the law that prevents advanced practice registered nurses, such as nurse practitioners and nurse midwives, from performing the procedure. (9/20)

Las Vegas Review-Journal: Southern Nevada Medicare Dilemma: Pay More Or Switch Doctors
The recent decision by Southwest Medical Associates to stop covering traditional Medicare patients in Southern Nevada makes 66-year-old Anne Zarate sick to her stomach. That queasy feeling is not just because, as the Las Vegas woman puts it, she’s being “thrown out with 7,000 others in a city where access to medical care is weak at best.” She also sees Southwest’s action as an example of the inability of government to deliver quality health care in the United States. (Harasim, 9/18)

Weekend Reading

Longer Looks: Cassidy-Graham; A Man-Made Epidemic & A Single-Payer Failure

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

FiveThirtyEight: Republicans Really Could Repeal Obamacare This Time
So why are we going through this exercise again? For two reasons. First, Cassidy and Graham have been persistent. Senate Majority Leader Mitch McConnell, who had essentially said the party was done with attempting to repeal Obamacare after the most recent failed effort in July, is reportedly at least open to spending this week seeing if the bill can pass. Second, this may be Republicans’ last opportunity to repeal Obamacare — at least for a while. (Perry Bacon Jr., 9/18)

Vox: GOP Senators Are Rushing To Pass Graham-Cassidy. We Asked 9 To Explain What It Does. 
The stakes of the Republican rush to repeal and replace Obamacare could hardly be higher. The GOP has less than two weeks to pass a repeal-and-replace plan before their budget reconciliation instructions expire, and the insurance of tens of millions of Americans hangs in the balance. Vox conducted the interviews with nine Republican senators throughout the Capitol and Russell Senate Office Building on Tuesday. (Jeff Stein, 9/20)

CQ Magazine: A Simple Fix For Obamacare: Make Boomers Pay More
The dramatic collapse of the Republicans’ Senate health care bill in July put an end, for now, to talk of repealing the Affordable Care Act. And it’s raised the possibility that lawmakers might take to heart the admonition of their colleague, Arizona Republican Sen. John McCain, to seek targeted fixes to the problems in the health care marketplace that both Republicans and Democrats acknowledge.  One of the biggest problems is that many people making too much money to qualify for government subsidies still cannot afford to buy insurance. Those middle class and upper middle class Americans who don’t get insurance from their employers are the 2010 law’s biggest losers. (Shawn Zeller, 9/18)

New York Magazine: A New Last Chance
Monica Halem calls it the “fertility train.” Every woman who embarks on a cycle of in vitro fertilization is familiar with the ride: the multiple cycles of hormonal stimulation, the pain of the injections, the discomfort and the bloating; then the delicate harvest of eggs to be fertilized outside the body, and the anxious wait for genetic testing on the embryos to make sure they have the right number of chromosomes before they are transferred back; and then, if all of the embryo tests come back abnormal, or the embryos don’t implant, or the pregnancy ends prematurely in miscarriage, the process starts all over again. (Stephen Hall, 9/17)

The Huffington Post: San Diego's Hepatitis Outbreak Is A Man-Made Disaster
The outbreak has killed 16 people and infected 421 since November, ravaging San Diego’s large homeless and illicit drug-using population. It could eventually cost the county health department up to a million dollars, a local health official estimated. But San Diego could have avoided its hepatitis A crisis — or at least ensured it didn’t get this bad — if its homeless residents had better access to housing and the city provided the services they need to stay healthy, activists and public health experts say. (Dana Liebelson and Lauren Weber, 9/19)

Vox: Single-Payer Health Care Failed Miserably In Colorado Last Year. Here’s Why.
On the day the state of Colorado voted for Hillary Clinton over Donald Trump by about 5 points, voters there also rejected a ballot measure to enact a state-based single-payer system by an astounding margin of 79 percent to 21 percent. Amendment 69, the Colorado Creation of ColoradoCare System Initiative, would have created a system in which all Coloradans would gain insurance through a tax-funded government insurance program. Private health insurers would have been rendered obsolete. (Dylan Matthews, 9/14)

Editorials And Opinions

Political Reverberations: How Graham-Cassidy Impacts The Health Care Debate

Editorial pages feature opinions praising this "last-chance" legislation or calling it "nonsense" and "cynical." They also detail how, regardless of the outcome of the vote planned for next week, the GOP will own it.

The Wall Street Journal: Republicans Get One Last Chance On ObamaCare Reform
For seven years Republicans promised to repeal ObamaCare, and now they have one last chance to deliver. A bill recently introduced by Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson would eliminate some of ObamaCare’s most unpopular provisions and enact reforms that would lower costs, expand choices, promote federal fiscal responsibility, and give power back to states and consumers. ... The Graham-Cassidy bill’s biggest strength is the idea that states are uniquely equipped to design and implement health care programs that suit their residents. The bill would consolidate much of the federal funding given to states under ObamaCare’s coverage provisions—including money for its Medicaid expansion and subsidies to help people buy private insurance—into a single block grant, which states could use for a wide variety of health reforms. (Lanhee J. Chen, 9/20)

JAMA Forum: Republicans Will Own Whatever Happens To The ACA And Health Care Reform
As has become clear, “Repeal and Replace” of the Affordable Car Act (ACA), a mantra that provided such a unifying theme for Republicans when Democrats controlled the White House, has been much harder than Republicans expected when they achieved “full control” of the government. Republicans were barely able to pass a health care bill in the House despite their substantial majority over Democrats (240-194) and the Senate fell short of passing the so-called “skinny” repeal bill, HR 1628, which repealed only a limited portion of the ACA. (Gail Wilensky, 9/19)

The Washington Post: Lots Of Vulnerable House Republicans Come From States That Will Lose Under Cassidy-Graham
If the Senate passes Cassidy-Graham, its latest attempt to repeal Obamacare, the legislation will then go to the House for a vote. If that happens, Speaker Paul D. Ryan (R-Wis.) has vowed to engineer its quick passage in the lower chamber, too .... certain states are going to be hit with major losses if this bill becomes law. And it turns out that those states that would lose out happen to be heavy with incumbent House Republicans whose seats are vulnerable in 2018. Will those vulnerable House Republicans vote for a bill that drains their states of huge sums of money that could have been used to cover their own constituents? (Sarah Posner and Greg Sargent, 9/20)

The Wall Street Journal: The Republicans Who May Save ObamaCare
Like Lazarus, the Republican effort to repeal ObamaCare has risen from the dead. Pundits dutifully filled out the toe tag in July, after a repeal-and-replace bill failed to pass the Senate. Now comes new legislation championed by Sens. Lindsey Graham and Bill Cassidy, which just might get the 50 GOP votes needed for Vice President Mike Pence to break the tie and pass the bill. ... Senate passage would clear the way to ending the individual and employer mandates, repealing the medical-device tax, and phasing out the ObamaCare exchanges and their highly prescriptive regulations. ... The danger is that there are at least four Republican senators at risk of voting “no.” (Karl Rove, 9/20)

Bloomberg: Republicans Peddle Nonsense To Sell Health-Care Plan
Graham and Cassidy have sold this hastily assembled measure as a bipartisan compromise that, rather than cutting coverage, merely gives the states the funds and flexibility to determine their own health-care policies. None of that holds up. The bill is purely partisan—it's being rushed through for the simple reason that it lacks any Democratic support. Graham, in press conferences, has hailed the plan as a middle-ground compromise between Obamacare and the coverage-slashing Republican proposals that collapsed in July. That's nonsense. (Albert R. Hunt, 9/20)

Boston Globe: Yet Another Cynical GOP Ploy On Health Care
The latest Republican vehicle for repealing and replacing Obamacare is Graham-Cassidy, a bill that would dramatically cut federal health care spending and block-grant remaining monies to the states while not requiring those states to spend the money on expanding care. (Micheal Cohen, 9/20)

Bloomberg: How The Health-Care Debate Would Change If Graham-Cassidy Passes
What a difference a week makes. Last week, many commentators (including me) saw the Graham-Cassidy bill as a bit of Hail Mary legislating, a last desperate stand against Obamacare. This week, it started to look as if it might actually have some chance of passage. The legislative math remains daunting; the parliamentary obstacles high. But the status of Republican health-care efforts has moved from “flatline” to “still breathing, barely.” (Megan McArdle, 9/20)

Parsing The Policies: Is This Just Another 'Lousy' Bill Or Does It Advance A 'Great Idea'?

There are a variety of ideas about the Graham-Cassidy bill now pending in the Senate, with some saying it's "poison" and others praising its intent to give states flexibility.

Los Angeles Times: Graham-Cassidy: Another Day, Another Lousy GOP Healthcare Bill
The latest proposal — by Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) — suffers from the same fundamental problems as all of its predecessors. Aiming to lower insurance costs for the healthy, it would allow states to herd people with preexisting conditions or potentially expensive risks — say, women who might want maternity coverage — into insurance gulags with egregiously high premiums. (9/21)

USA Today: Last-Ditch Obamacare Repeal Would Be Poison
Given up as a lost cause this summer, the Republican effort to repeal and replace Obamacare is back, this time in the form of a last-ditch effort led by GOP Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson. Like previous efforts, this measure would strip tens of millions of people of their health coverage. It would gut Medicaid, the program responsible for funding nearly half of baby deliveries and most of nursing home care. It would allow insurers in some states to deny coverage based on a previous medical condition. And it would allow insurers to skip coverage of essential services, including maternity care. (9/20)

USA Today: Let States Tailor Health Care Plans
Under Obamacare, insurance premiums in the individual market have more than doubled nationally, and without billions of additional taxpayer dollars, many of those markets are at risk of collapse. Obamacare was never designed to be patient-friendly. In fact, one of the key tenets of Obamacare is taking power away from patients and local officials. Obamacare gives this decision-making power to the federal government, allowing bureaucrats to call the shots. (Sen. Ron Johnson, 9/20)

The New York Times: Graham-Cassidy Has One Great Idea
In the timid sense, the proposal would keep much more of Obamacare’s taxes and spending in place than previous Republican plans this year. Yet Graham-Cassidy makes more sweeping changes by turning money currently used on insurance subsidies and the Medicaid expansion into block grants to states. This change would give states more flexibility to design their own health care systems. (Philip Klein, 9/20)

The Washington Post: Cassidy-Graham Is Attractive In Theory. But It Has A Giant Flaw.
A group of Republican senators, led by Bill Cassidy (La.) and Lindsay O. Graham (S.C.), have revived GOP efforts to repeal and replace Obamacare. Their bill has a number of attractive attributes: It would repeal Obamacare’s individual mandate, for example, and make important reforms to Medicaid. But Cassidy-Graham also has an important, albeit fixable, flaw — what we might call “asymmetric federalism.” (Avik Roy, 9/20)

Los Angeles Times: The Disastrous Impact Of The GOP's Obamacare Repeal Plan, In Three Devastating Charts
The healthcare consulting firm Avalere on Wednesday released the latest in a series of independent analyses of Senate Republicans’ new effort to repeal the Affordable Care Act. The findings are beyond ugly. They show devastating cuts in healthcare funding for adults, children and the disabled — in effect, almost every population category in the U.S. other than seniors enrolled in Medicare. (Michael Hiltzik, 9/20)

State Perspectives: Outlooks Are Not Rosy Regarding The On-The-Ground Impact Of The Current GOP Repeal Plan

Newspapers offer their members of Congress a bleak picture of what would happen in their states if the Graham-Cassidy proposal were to become law.

The Kansas City Star: No, Sen. Pat Roberts, This Awful Health Care Bill Isn’t The Only Obamacare Alternative
The Category 5 Hurricane known as Graham-Cassidy is a man-made disaster that may yet be avoided. But if you’re asking why even the craziest storm chaser wouldn’t steer clear of the direct hit that this latest health care bill would amount to, well, talk to our own Sen. Jerry Moran, who remains undecided. Or better yet, listen to his fellow Kansas Republican, Sen. Pat Roberts, whose explanation of this final attempt to blow up the Affordable Care Act is daft but highly instructional. (9/20)

The Des Moines Register: Senate's Latest Health Bill Offers No Lifeline For Iowa
Gov. Kim Reynolds jumped aboard the latest Republican effort to repeal most of Obamacare as if it were the last lifeboat off the Titanic. “You know, this can work and I believe right now, this is the only vehicle we have to address Obamacare, that’s failing,” she said Tuesday. She was talking about legislation co-sponsored by Republican U.S. Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. The bill would put states in charge of designing their own health-care systems, with federal money from existing Obamacare taxes. Expansion of the federal program for low-income Americans, Medicaid, would end in 2020 and states would get block grants instead. (Kathie Obradovich, 9/20)

Lexington Herald Leader: Latest GOP Bill Greatest Threat To Ky. Health Care Coverage
The latest attempt to repeal the Affordable Care Act is known as Cassidy-Graham, and it very well may be the greatest threat to Kentucky’s health care. The state’s success in getting people coverage, and even health-care gains achieved decades ago, are at risk of being undone with this legislation. The bill, sponsored by Sens. Bill Cassidy and Lindsey Graham, is perhaps the final attempt at tearing up the ACA and doing permanent damage to Medicaid. It’s being rushed through before policymakers and the public can understand its implications. That’s because after Sept. 30, the Senate can no longer pass a partisan repeal bill with only 51 votes, due to chamber rules. (9/19)

Kansas City Star: Cassidy-Graham Health Care Bill Would Hurt Kansans
Now, in a last ditch effort to repeal the ACA by September 30, the end of the federal fiscal year, Congress is back with another destructive bill. Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina have introduced legislation that, like its failed predecessors, will result in coverage losses, higher costs, and elimination of consumer protections. (Sandy Praeger, 9/20)

Thinking About A Single-Payer System: Pros And Cons Of 'Medicare For All'

Opinion writers communicate their takes on the health care plan advanced by Sen. Bernie Sanders (I-Vt.).

USA Today: Bernie Sanders Medicare-For-All Plan Is All Wrong For America
My 93-year-old father recently came home from the hospital proudly harboring a life-saving $50,000 aortic valve paid for by Medicare, though he rode home in a wheelchair that Medicare didn’t pay for. This gap in services is growing, as Medicare struggles to cover emerging technologies that are not one-size-fits all while at the same time continuing to provide basic care. If Medicare is converted to single-payer or Medicare for all, as Sen. Bernie Sanders of Vermont proposes, tens of millions more patients will be added to an already faltering system, and the gap between the promise of care and actual care delivered will widen. (Marc Siegel, 9/20)

Los Angeles Times: There Are 3 Types Of Single-Payer 'concern Trolls' — And They All Want To Undermine Universal Healthcare
Some of the naysayers are conservatives who simply abhor “big government.” Some have perfectly valid reasons to question the merits of single payer in general or Sanders’ methods in particular. Yet others claim they support universal healthcare in theory (one day, perhaps) but cannot do so now because of a “concern.” They are “concern trolls” — broadly defined as “a person who disingenuously expresses concern about an issue with the intention of undermining or derailing genuine discussion.” (Adam H. Johnson, 9/21)

Viewpoints: The Promise And Price Tag Of A New Cancer Drug; Medicaid In Indian Country

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

JAMA: FDA Approval of Tisagenlecleucel: Promise and Complexities of a $475 000 Cancer Drug
Unlike most cancer therapies that are identical from patient to patient, CAR-T therapies are made by removing the T cells of a patient, genetically modifying them to respond to certain targets expressed on the patient’s cancer cells, and then reinfusing the cells. When the T cells come into contact with the relevant target (for instance, CD19 in the case of ALL), they proliferate while secreting a number of programmed substances including inflammatory cytokines that destroy the cancerous cells. Targeted killing of tumor cells by lymphocytes was first suggested by the graft-vs-leukemia effect in bone marrow transplantation, but that effect and the infusion of donor T cells more generally has no effect on solid tumor malignancies or most hematologic cancers. The innovation underlying CAR-T involved exploiting the specificity of antibody-mediated recognition of tumor antigens, and then engineering CAR-T cells to have the relevant antibody fragment fused to the T-cell receptor. Thus, the “living drug” infused into the patient is the patient’s own T cells altered to express a receptor that is specific for the target antigen on the tumor. (Peter B. Bach, Sergio A. Giralt and Leonard B. Saltz, 9/20)

High Country News: How Will Medicaid Cuts Affect Health Care In Indian Country?
In the legislation introduced by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., on Sept. 12, federal Medicaid and health insurance subsidy dollars would be given as a lump sum to states, which would have wide discretion in how they were spent. Nowhere would this be more devastating than in Indian Country. ... In Medicaid expansion states, from Alaska to Maine, the Affordable Care Act has meant that the Indian Health Service, which provides care to 2.2 million of the nation’s 5.3 million American Indians and Alaska Natives, has been able to provide preventive services. Those include screenings for breast and colon cancer, never before available to non-elderly adult patients. Now IHS can provide those services and get reimbursed by Medicaid, instead of having the cost of the services come out of IHS’s grossly inadequate budget. (Tanya H. Lee, 9/20)

The Charlotte Observer: Protests At Charlotte Abortion Clinic Go Too Far
Our government has a responsibility to protect people’s First Amendment right to assemble and peacefully protest. It is also incumbent on government to enforce people’s right to make their own decisions about their medical care. At A Preferred Women’s Health Center in east Charlotte, these two fundamental rights are clashing. Anti-choice protesters are harassing and obstructing people who attempt to perform and to gain access to abortions. And the city is giving an unfair boost to the protesters, compromising the health and safety of thousands of women. (Lisa Levenstein, 9/20)

Bloomberg: Defying Ethics Norms Flies With Trump
Health and Human Services Secretary Tom Price has been taking fancy charter flights when previous secretaries flew commercial. Well, what do you expect? Just think about the incentives in a normal administration and in this one. Normally, the president sets a reasonable example of good ethics practices. Oh, there are sometimes controversies, but normal presidents avoid conflicts of interest, follow the guidelines of ethics officials and other best practices, and generally act as if they care about the appearance, at least, of playing by the rules. This president has basically ignored ethics laws and norms from the beginning. It must be hard to care about saving the government a few dollars when the president is using his office to, for example, advertise his business interests. (Jonathan Bernstein, 9/20)