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Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Wreak Havoc?'" by Matt Wuerker, Politico.

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Senate Plan Phase Two
It's still a mean tasting brew.
Next phase red and blue?

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Summaries Of The News:

Health Law

GOP Unveils Tweaked Health Care Bill In Its Attempt To Woo Reluctant Senators

Here's a look at some of the overall changes that were made between the two drafts.

The Associated Press: Revised GOP Health Bill Stresses Bare-Bones Private Coverage
The latest changes to the Senate Republican health care bill are geared to increasing access to bare-bones private insurance. There's also an additional $45 billion to help states confronting the opioid epidemic. But Senate Majority Leader Mitch McConnell, R-Ky., would keep in place Medicaid cuts that GOP governors and Senate moderates have objected to. No Democrats are supporting the plan. (Alonso-Zaldivar, 7/13)

Los Angeles Times: Divided Senate Republicans Unveil New Version Of Obamacare Repeal Bill
The bill would earmark an additional $70 billion in federal money to help stabilize health insurance markets across the country, funded in part by preserving two Obamacare taxes on wealthy Americans that the previous GOP legislation eliminated. And in an effort to woo several GOP senators from states dependent on Medicaid to address the opioid crisis, McConnell earmarked an additional $45 billion in the bill to confront the epidemic. (Mascaro and Levey, 7/13)

Bloomberg: New GOP Health Bill Leaves Big Problem Untouched: Patient Costs 
Republican senators’ latest effort to repeal and replace Obamacare still fails to address a key complaint about the 2010 health law: Patients are using too much of their own money to pay for care. The bill, rolled out anew on Thursday after a raft of Republican defections threatened to sink the original legislation, faces a tough path to becoming law. Senate Majority Leader Mitch McConnell wants a vote next week, but two GOP lawmakers immediately rejected the revised plan, and losing the support of a third Republican could doom the measure. The Congressional Budget Office will release a score of the rewritten legislation as soon as Monday. (Tracer and Edney, 7/14)

Road To 50 Votes Paved With Uncertainty, Doubts Despite Changes In Drafts

Sens. Rand Paul (R-Ky.) and Susan Collins (R-Maine) have already said they won't support the new bill, which leaves Senate Majority Leader Mitch McConnell no room for error in his quest for 50 votes.

Politico: Senate Republicans One Vote Away From Obamacare Repeal Failure
Majority Whip John Cornyn acknowledged GOP leaders don’t have the minimum 50 votes right now but insisted, "We're making good progress." He said he and Senate Majority Leader Mitch McConnell were not making "state-specific" promises to wavering senators and were instead merely trying to convince them that the bill is better than Obamacare."We're not through yet," Cornyn said of his and McConnell's work. (Everett and Haberkorn, 7/13)

The Associated Press: Trouble For Revised Senate Health Bill; Trump Wants Action
Moderate Sen. Susan Collins of Maine told reporters she had informed McConnell she would be voting against beginning debate on the bill, citing in part cuts in the Medicaid health program for the poor and disabled. Sen. Rand Paul of Kentucky, who has repeatedly complained that McConnell's efforts don't amount to a full-blown repeal of Obamacare, also announced he was a "no." That means McConnell cannot lose any other Republican senators. (Werner and Fram, 7/14)

The Hill: Moderates Holding Back Support For New Senate Bill 
Sen. Shelley Moore Capito (R-W.Va.), who has been an ally of Portman's during the healthcare talks, said she doesn’t know whether she’ll vote to proceed to the bill after hearing a presentation from Senate Republican leaders at the Capitol. (Bolton, 7/13)

CQ HealthBeat: New Health Care Draft Does Not Win Over Many Holdouts
McConnell is urging his party’s holdouts, including Rob Portman of Ohio and Shelley Moore Capito of West Virginia, to back the legislation because the majority leader said the bill's sharpest cuts, which go into effect in 2026, would never happen. Portman issued a statement saying he'd review the text and the upcoming CBO analysis, adding that he opposed the previous version because of its Medicaid cuts. (Clason, 7/13)

Bloomberg: Republican Health Bill Draft May Be Destined For Another Rewrite 
Republican Senator Ron Johnson of Wisconsin, who had opposed plans to advance an earlier version of the bill in late June, said Thursday that he will support debating the current bill, although he isn’t ready to give his full backing. Johnson said he expects some of the remaining deficit reduction in the bill to be spent, though he would prefer to shrink the budget gap. (Dennis and Litvan, 7/14)

KCUR: Moran Studying Changes To Senate Health Bill, Opponents Urging Him To Stand Firm 
U.S. Sen. Jerry Moran’s silence Thursday on the GOP’s revised bill to repeal and replace the Affordable Care Act prompted one Capitol Hill reporter to refer to him as a “mystery man.” Several Republican senators who either opposed or had concerns about an initial draft of the bill commented on changes unveiled Thursday by GOP leaders in an effort to gain votes. But not Moran. In response to repeated emails, a spokesperson in his office said only that the senator was analyzing the changes “to fully understand the impact on Kansas.” (Mclean, 7/14)

McClatchy: Marco Rubio Will Vote To Proceed On Obamacare Repeal Bill
After the bill was released on Thursday and he huddled with his Republican colleagues, Rubio said his demands were met, and Florida’s junior senator was ready to announce his support... Two Republican senators said Thursday they are not in favor of moving forward with the bill: Maine Sen. Susan Collins, a moderate, and conservative Kentucky Sen. Rand Paul. (Daugherty, 7/13)

Meanwhile —

Kaiser Health News: Opposition To GOP Repeal Bill Inches Up, Intensifies
Public opposition to the Republican effort to replace the Affordable Care Act grew stronger this month, but a core group of Republicans remained in support, according to a poll released Friday. Sixty-one percent of the public said this month they did not like the GOP health care effort, now undergoing a revised push in the Senate. (Rau, 7/14)

New Bill Tries To Lure Conservatives With Option To Sell Cheap, Bare Bone Insurance Plans

The option is part of an amendment by Sen. Ted Cruz (R-Texas) that was included in the newly unveiled legislation despite insurers' warning that it will further destabilize the marketplace.

USA Today: Senate Health Care Bill: Republicans Woo Conservatives In Latest Draft
The draft bill, released on the Senate Budget Committee's website, tries to appeal to conservatives by including a version of an amendment by Sen. Ted Cruz, R-Texas, that would allow the sale of deregulated insurance plans as long as Obamacare-compliant plans are also still sold. Cruz confirmed to reporters that his amendment is in the bill and called that "very significant progress." “If this is the bill, I will support it,” Cruz told reporters Thursday afternoon. But Sen. Mike Lee, R-Utah, who helped craft the original amendment with Cruz, was undecided about how he would vote on the bill because the amendment was changed during negotiations, his spokesman said. (Kelly, Collins and Shesgreen, 7/13)

USA Today: Sick? You Might Not Like The GOP's Latest Health Bill
The Senate dropped a new version of its beleaguered health bill Thursday, tacking on a Ted Cruz proposal in order to win over conservatives like Ted Cruz. It basically lets people buy cheap, bare-bones insurance plans alongside more robust, Obamacare-compliant plans. That's good news for the healthy, and bad news for the sick: If healthy folks flock to cheaper plans, the other plans covering pre-existing conditions will grow more expensive — destabilizing the market in the process, insurance companies say. (Hafner, 7/13)

The Hill: Senate GOP May Not Use CBO To Score Cruz Amendment
Senate Republicans may not use the Congressional Budget Office (CBO) to score a version of Sen. Ted Cruz’s (R-Texas) controversial amendment that was included in the updated Senate healthcare bill. Instead, a member of Senate GOP leadership said analysis from the Trump administration — including the Health and Human Services Department and the White House Office of Management and Budget — might be used instead of the nonpartisan CBO. (Weixel, 7/13)

Despite Outcry From Moderates, Governors, Deep Medicaid Cuts Left Mostly Untouched

The reduction of more than $750 billion to the program over a decade is one of the sticking points for many Republicans opposed to the legislation.

The Hill: Five Takeaways From The GOP's Healthcare Reboot 
The updated legislation left the deep Medicaid cuts from the first version of the bill essentially unchanged, which could be a big problem for moderate GOP senators like Rob Portman (Ohio), Shelley Moore Capito (W.Va.) and Lisa Murkowski (Alaska). The legislation would put a cap on federal Medicaid reimbursement for states, dramatically changing the program from an open-ended entitlement. It would end ObamaCare’s increased funding for states to expand Medicaid by 2024, and cut the rate of inflation. Taken together, the bill would cut $772 billion from Medicaid funding over a decade and result in 15 million fewer people enrolled, according to the Congressional Budget Office. (Roubein, Hellmann and Weixel, 7/13)

The Wall Street Journal: Hospitals Could Gain Under New GOP Health Bill
Among the provisions in the revised version of the Senate Republicans’ health bill is a provision that would restore certain federal funding to some hospitals—but with a catch. Under the Affordable Care Act, hospitals were set to lose out on extra funding known as Medicaid “disproportionate share” payments meant to help cover uninsured patients. The Senate GOP’s early health bill restored the funds, but exclusively to hospitals in states that didn’t expand Medicaid. (Evans, 7/13)

Modern Healthcare: New Senate Bill Retains Medicaid Cuts, Provides More Money To Stabilize Individual Market
The per-capita cap system is designed to reduce the federal budget for Medicaid. The law would set different caps for different populations through 2024, with some federal spending matching the rate of medical inflation, and some pegged at medical inflation plus one percentage point. Those 20 and younger with chronic medical conditions "that either requires intensive healthcare interventions or meets the criteria for medical complexity" are excluded from the per capita cap. The bill says that in 2020, states must identify all these different categories of people covered on Medicaid or CHIP. (Lee, 7/13)

Kaiser Health News: Transgender Health Care Targeted In Crusade To Undo ACA
Solorah Singleton has been waiting years for breast augmentation. She doesn’t want to jinx it now, but the Philadelphia resident thinks it’s finally within reach. Singleton, 36, was born male but identifies as female. For seven years, she has had regular hormone therapy, never seeing surgery as an option. She previously didn’t have health insurance and didn’t think she could cover the cost of the procedure out-of-pocket. (Luthra, 7/13)

Arizona Republic: Advocates Warn Of Harm To Ariz. Medicaid Recipients Under Senate Bill
Republicans in the U.S. Senate on Thursday released an updated version of their health-care legislation, which includes a proposal to cut Medicaid funding and roll back Medicaid coverage expansion under "Obamacare." State Reps. Heather Carter, R-Cave Creek, and Michelle Udall, R-Mesa, members of the House Health Committee, spoke out against the measure at a news conference at Phoenix Children's Hospital on Thursday. (Stanford, 7/13)

In other Medicaid news from Colorado —

Three Obamacare Taxes Left In Place In Revised Version Of Health Bill

The move is a departure from earlier plans to repeal the taxes.

CQ Roll Call: Retooled Senate Health Care Bill Muddles Tax Strategy
The revised Senate health care bill released Thursday does not repeal three taxes created by Obamacare, raising concerns that a tax on investment income paid by the wealthy will continue and create problems for a larger tax overhaul. The new Senate draft does not repeal a 3.8 percent net investment tax and a Medicare payroll surtax, which are aimed at individuals earning more than $200,000 and couples earning more than $250,000. The rewritten health care bill also does not change a provision in the 2010 health care law that prevents insurance companies from writing off the salaries and compensation of highly paid executives. (Ota, 7/13)

In related news —

The Washington Post: The GOP’s Under-The-Radar Tax Break For The Upper Middle Class
A new tax break for the upper middle class was offered up Thursday in Senate Republicans' revised version of their bill to dismantle the Affordable Care Act, also known as Obamacare. The legislation would make health insurance premiums more affordable for consumers who buy the kinds of inexpensive policies that are crucial to the GOP health-care agenda. Yet independent analysts caution that the benefits would mainly accrue to affluent households, and the provision might not substantially expand coverage among the uninsured. (Ehrenfreund, 7/13)

CQ Roll Call: Revised Health Care Bill Still Faces Challenges
The revised Senate health care bill that was rolled out Thursday morning would allow individuals to use tax credits to purchase catastrophic health insurance and would let insurers sell plans on the exchanges that don’t meet Obamacare requirements in certain situations. The move is designed to attract the support of conservatives such as Sen. Ted Cruz, R-Texas, and Sen. Mike Lee, R-Utah, who proposed an amendment that is relatively similar. The bill would create a $70 billion fund to make payments to certain health insurers to help cover high-risk individuals in exchange policies that meet the health care law’s requirements. (McIntire, 7/13)

Is Polar Payoff The New Cornhusker Kickback? Change In GOP's Plan Benefits Alaska, And Alaska Only

Sen. Lisa Murkowski of Alaska is a crucial vote, and a new provision seems to recognize that fact.

Bloomberg: GOP Health Bill Steers Cash To The Home State Of A Reluctant Senator 
Call it the Polar Payoff. Changes made to the Republican legislation to repeal large parts of Obamacare would send hundreds of millions of extra federal dollars to Alaska, whose Republican Senator Lisa Murkowski has been holding off from giving her much-needed vote to the bill. Under formulas in the revised legislation, only Alaska appears to qualify for the extra money. The money comes from the legislation’s $182 billion in funding meant to help stabilize insurance markets and help states provide coverage. Under the formulas, states -- in this case just Alaska -- with disproportionately higher premiums would get extra funds from that account. (Edney, Recht and Litvan, 7/13)

Two Republican Senators Offer A Plan B If Leadership's Measure Fails

Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) have been working on a measure that they could sell to Democrats as a "repair" bill.

Politico: Graham Introduces Repeal Back-Up Plan
A new health care proposal from GOP Sen. Lindsey Graham that would direct much of Obamacare's federal funding directly to the states could offer a starting point for Congress if the Senate GOP effort fails next week, according to a summary of the bill obtained by POLITICO. The bill from Graham is intended to appeal to Republicans as a replacement plan for Obamacare, while he hopes to sell the effort to Democrats as a repair plan. (Everett, 7/13)

The Fiscal Times: Surprise! There Are Now Two Senate GOP Health Care Bills In Play
The Graham-Cassidy plan would leave some of the Affordable Care Act’s taxes in place, but would take those funds and turn them over to state governments in the form of a block grant, leaving state lawmakers and governors to reform the health insurance system within their own borders. “In a nutshell, we’re keeping the taxes in place on the wealthy, we’re repealing the individual mandate and the employer mandate, and the medical device tax that 75 senators voted to repeal,” Graham said. (Garver, 7/13)

Trump: 'The Only Thing More Difficult Than Peace Between Israel And The Palestinians Is Health Care'

Despite acknowledging how tough it is going to be to get legislation passed, President Donald Trump voiced optimism that Congress will get it done.

The Hill: Trump: Achieving Healthcare Harder Than Mideast Peace 
President Trump this week lamented the difficulty of passing the Republican healthcare plan though Congress, likening it to the decadeslong Israel-Palestine conflict. “I’d say the only thing more difficult than peace between Israel and the Palestinians is healthcare,” he told reporters aboard Air Force One on Wednesday night en route to France.  (Fabian, 7/13)

Boston Globe: Trump Tweets From Paris About Health Care Bill
President Trump tweeted from Paris Friday morning that he has his “pen in hand” and will be ready to sign the health care bill designed to repeal and replace Obamacare. Republicans Senators are working hard to get their failed ObamaCare replacement approved. I will be at my desk, pen in hand! (Gans, 7/14)

The Associated Press: Analysis: Trump Will Take Health Care Credit Or Cast Blame
If congressional Republicans succeed in repealing and replacing "Obamacare," expect a big Rose Garden celebration with President Donald Trump taking credit. If they fail? Trump has already indicated he will hold Senate Majority Leader Mitch McConnell responsible, setting up an intraparty blame game that could be devastating for the GOP. (7/14)

Administration News

412 Charged In DOJ's Largest-Ever Health Care Fraud Takedown

“Too many trusted medical professionals like doctors, nurses and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” says Attorney General Jeff Sessions. Many of the crimes were related to the opioid epidemic sweeping the country.

Reuters: Doctors, Nurses Among Hundreds Charged With Defrauding U.S. Health Programs
A total of 412 people, including almost 115 doctors, nurses and other medical professionals, have been charged in the sweeping enforcement action, the biggest ever by the multi-agency Medicare Strike Force, the Justice Department said in a statement. More than 120 people were accused of illegally prescribing and distributing opioids and other dangerous narcotics, charges that come as about 91 Americans die daily from opioid-related overdoses. (Simpson, 7/13)

The Wall Street Journal: U.S. Charges More Than 400 With Committing Health Care Fraud
Justice Department officials said the charges were filed in the past few weeks, and the initiative was the “largest health-care fraud takedown operation” in U.S. history, Mr. Sessions said. New Hampshire Gov. Chris Sununu, who represents one of the states hardest hit by the opioid epidemic, called the Justice Department action a “great first step” and a sign that the new presidential administration is taking the scourge seriously. (Wilber, 7/13)

Bloomberg: Trump’s First Health-Care Fraud Sweep Targets Doctors, Opioids
Sessions faulted the accused medical professionals of putting greed ahead of patients, turning practices into multimillion dollar criminal enterprises and ultimately sparking broader ills. “Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards,” Sessions said. “We will continue to find, arrest, prosecute, convict and incarcerate fraudsters and drug dealers wherever they are.” (Schoenberg and McLaughlin, 7/13)

Pioneer Press: 10 Minnesotans Linked To $1.3 Billion National Health Fraud Bust 
Ten Minnesotans were charged as part of a national health care fraud takedown, Minnesota Attorney General Lori Swanson announced in a news conference Thursday morning. The “largest health care fraud takedown operation in American history,” according to Attorney General Jeff Sessions, involved more than 400 licensed health professionals nationwide and totaled $1.3 billion in false billing. (Chavey, 7/13)

The Star Tribune: Minnesota AG Charges Three More With Personal Care Attendant Fraud
The Minnesota attorney general’s office charged three more people in connection with operating fraudulent personal care attendant agencies that stole more than $900,000 in tax funds meant to benefit people who need help with their daily living. ... The crackdown is part of a national effort, with the federal Department of Justice on Thursday announcing that 412 people have been charged with $1.3 billion in fraud. (Stahl, 7/13)

Chicago Sun-Times: Chicago-Area Medical Professionals Charged With Health Care Fraud 
The national enforcement action was taken by the Medicare Fraud Strike Force, a joint initiative between the Department of Justice and HHS to prevent and deter health care fraud around the country. Several defendants were from the Chicago area, including Beatta Kabbani, a physical therapist charged in a 13-count indictment with health care fraud and aggravated identity theft, according to the feds. (7/13)

Miami Herald: Nationwide Medicare Fraud Bust Includes 80 Suspects In South Florida
More than 400 suspects nationwide have been charged with falsely billing $1.3 billion to the taxpayer-funded Medicare program as well as some private insurers, including about 80 defendants in South Florida — the country's epicenter of healthcare fraud, federal authorities said Thursday. Of the total nationwide, more than 100 suspects work as doctors, nurses and other medical professionals, who are charged with conspiracy and related offenses to defraud the massive government health insurance program. (Weaver, 7/13)


Health Of Medicare Trust Fund Improves, Staving Off Need For Dreaded 'Death Panels'

The board reports that it will be depleted in 2029, a year later than the Obama administration had last projected. The estimate helped avoid activating the Independent Payment Advisory Board.

Kaiser Health News: Medicare’s Financial Outlook Slightly Improved, Trustees Say
The Trump administration said Thursday that the financial outlook for Medicare’s hospital insurance trust fund improved in the past year due to health costs rising more slowly than expected and predictions that enrollees will use hospital services less often. The report said that trust fund would last through 2029, one year later than what was projected last year. Two years ago, 2030 was the projected depletion date. (Galewitz, 7/13)

The Wall Street Journal: Social Security, Medicare Face Depletion Within 17 Years, Trustees Say
The trust funds were built when more people paid into the system than received benefits. As the population ages, benefit payments are projected to exceed revenues, drawing down fund balances. Under current law, when the trust funds are emptied, benefits from the programs will be abruptly reduced. The latest projections say retirement benefits would be slashed by 25%. The status of the funds is thus a potential trigger for reforms in the programs. (Zumbrun, 7/13)

CQ Roll Call: Health Improves For Social Security Disability Insurance Fund
The Social Security Disability Insurance trust fund is now projected to be able to pay full benefits for an additional five years, through 2028, the Social Security trustees said Thursday. The report cited lower-than-expected applications for and awards of the benefit to people who are considered no longer able to work or work full time. In the organization’s annual report, the Social Security and Medicare Boards of Trustees extended the projected depletion date for disability insurance from 2023 to 2028. (Krawzak, 7/13)


Ohio Working Quietly To Wiggle Out Of ACA Mandates

Ohio is seeking waivers for the individual and employer mandates in the Affordable Care Act. Meanwhile, Colorado is expected to announce its premium increases today, and residents have been warned to be braced for sharp hikes.

Cleveland Plain Dealer: Ohio Is Trying To Get Out Of Obamacare Requirements
With little fanfare, Ohio is working on a request to President Trump's administration to end the Obamacare requirement that everyone have health insurance, as well as the mandate requiring employers to provide it. Ohio is trying to develop an alternative for its residents and get what's called an innovation waiver, has confirmed. In theory, the alternative would keep a majority of Ohioans covered, yet somehow do it without one of the very cornerstones of the Affordable Care Act. (Koff, 7/14)

Denver Post: Colorado Officials Expected To Announce Proposed Health Insurance Premium Increases Friday
Colorado’s health insurance system faces a day of reckoning Friday, when the state Division of Insurance is scheduled to release details of the plans proposed for the individual insurance market in 2018. The individual plans are purchased by the 6 or 7 percent of Coloradans who shop for insurance on their own. More than 80 percent of Coloradans receive health coverage either through their employers or through the government. (Ingold, 7/13)

In other marketplace and industry news —

Nashville Tennessean: With ACA Uncertainty, Consider These Health Insurance Alternatives
The uncertain repeal of the Affordable Care Act makes it hard for consumers to plan ahead for their health insurance needs. But in Tennessee, some consumers can take advantage of nontraditional coverage options. These ACA alternatives include MediShare, underwritten health plans and direct primary care.These types of plans allow consumers to access healthcare outside of ACA insurance, which could insulate consumers from disruption if the law is repealed. (Tolbert, 7/13)

Marketplace: Health Insurance Comes At A Cost But So Does Not Having It
As the the newly revised Senate health care bill is floundering and Americans still have no clarity on what will happen to health care policy in the U.S., we check in with East Hannon, Connecticut resident Bradley Gawthrop. We last talked with Gawthrop, who at the time was working as a pipe organ builder in Johnson City, Tennessee, when the Affordable Care Act was still being argued over in court. (Ryssal and Hollenhorst, 7/13)

Capitol Hill Watch

Federal Fund For Fetal Tissue Research Prohibited In HHS Spending Proposal

A House subcommittee’s draft 2018 spending plan bars federal funds from being spent on such research, a win for conservatives who are also taking aim at money for family planning programs. Only a small portion of the NIH budget was spent on fetal tissue research in 2016.

Stat: NIH Fetal Tissue Research Would Be Barred Under House Panel’s Plan
A House subcommittee’s draft 2018 spending plan would prohibit federal funds from being spent on research that uses fetal tissue, a symbolic win for conservatives who are also taking aim at money for family planning and public health programs around the country. The proposal from the House Appropriations health subcommittee is unlikely to be enacted, and the restriction would impact a tiny portion of the National Institutes of Health’s roughly $33 billion budget — in 2016, the agency spent roughly $103 million on research involving fetal tissue. (Facher, 7/13)

CQ Roll Call: House HHS Spending Bill Another Win For Anti-Abortion Efforts
Conservatives secured more wins this week with the addition of several anti-abortion provisions ta fiscal 2018 spending bill as well as language in the latest version of the Senate health care bill. The victories could be short-lived, though. The riders in the House Appropriations Committee’s Labor-HHS-Education proposed funding bill may not survive and become law. The full committee is expected to mark up the bill July 19. The fate of the Senate health care language also is not certain. The Senate retained the anti-abortion provisions that were in previous versions of the bill (HR 1628) despite arguments that they don't comply with budget rules. (Raman, 7/14)

Veterans' Health Care

House Votes Down Proposal To Block Funds For Soldiers Seeking Gender-Related Medical Treatment

“It’s a hurtful amendment, it’s not needed,” said Rep. Ileana Ros-Lehtinen (R-Fla), a noted advocate for LGBT rights who has a transgender son. “I view it as a personal issue, because as a mom I’m impacted, but it’s an issue of fairness for everyone."

McClatchy: Republicans Fail To Ban Medical Treatments For Transgender Troops
Two dozen House Republicans voted with 190 Democrats to sink the amendment that would prohibit military funds for soldiers seeking medical treatment related to gender transition... Hartzler’s proposal comes in the middle of renewed debate over transgender people serving in the military. (Daugherty and Bergengruen, 7/13)

In other veterans' health care news —

McClatchy: Burn Pit Veterans Wait For Judge's Decision
Hundreds of veterans and their families who have spent eight years in federal court trying to prove that burn pits in Iraq and Afghanistan made U.S. troops sick are worried they’ll hit a legal dead end if a Maryland judge decides the company that ran the smoke-belching disposal sites can’t be sued because it was working on behalf of the government... KBR has asked the judge to dismiss the burn pit case — a collection of more than 60 individual suits filed in multiple jurisdictions by military family members, veterans or former KBR employees — arguing that the federal courts lack jurisdiction to rule on a military decision to use the burn pits, and as a military contractor, it should be shielded from litigation. (Kime, 7/13)


CMS Considers Slashing 340B Payments As Way To Curb High Drug Spending

With the proposed changes, if a drug costs $84,000, CMS would pay just over $65,000, instead of $89,000.

Modern Healthcare: CMS Proposes Slashing 340B Rates, Allow Joint Procedures At Outpatient Facilties
The CMS wants to slash 340B drug payments to hospitals and allow Medicare to pay for hip and knee replacement procedures that take place in outpatient facilities, according to a proposal released Thursday. To agency proposes paying hospitals 22.5% less than the average sales price for drugs acquired under the 340B program. The CMS is looking to cut drug costs for a program intended to lower operating costs for hospitals with disproportionate numbers of low-income patients. (Dickson, 7/13)

Politico Pro: CMS Proposes 340B Changes With Aim Of Lowering Drug Costs
CMS is proposing to pay doctors and hospitals less for certain physician-administered drugs purchased through the 340B pricing program, a move the agency says helps fulfill President Donald Trump's promise to lower the cost of medicines. The agency wants to lower the reimbursement rate it gives 340B hospitals for Medicare Part B patients so it's more in line with the price hospitals actually pay for the drugs. (Karlin-Smih, 7/13)

Report On FDA's Tool For Tracking Side Effects In Drugs Finds Incomplete Data

“Not only does this data show that manufacturer performance is weak, by not revising its systems, the [Food and Drug Administration] is also missing an opportunity to enhance to post-marketing surveillance," said Thomas Moore, an ISMP senior scientist.

Stat: FDA System For Reporting Side Effects Has Its Own Side Effect: Incomplete Data
Once again, an analysis of the U.S. system for reporting patient injuries caused by prescription drugs is yielding an unexpected side effect — incomplete information. And a key reason is inconsistent reports filed by drug makers, according to the Institute for Safe Medicines Practices, a nonprofit that tracks drug safety issues. The Adverse Event Reporting System, which is run by the Food and Drug Administration, is the primary tool for collecting information about side effects that may be caused by medicines. Consumers and physicians may voluntarily report problems to the agency or to a drug maker. But drug makers are required to investigate and then report any side effect that may be attributable to one of their products. (Silverman, 7/13)

In other pharmaceutical news —

The Associated Press: Investors: 'Pharma Bro' Shkreli Was Shady-And Profitable
The jury at the securities fraud trial of "Pharma Bro" Martin Shkreli has heard investors accuse the quirky former biotech CEO of repeatedly giving them the runaround when they tried to pull their money out of his failing health care hedge fund. But the government witnesses have made a concession that the defense hopes plays in its favor: In the end, they made a killing. (7/13)

Public Health And Education

Heavy Painkiller Use, Abuse Remains Serious Problem For Medicare Patients, Report Finds

Doctor shopping -- obtaining large amounts of the drugs prescribed by four or more doctors and filled at four or more pharmacies -- also appears to be a major issue in the program.

ProPublica: ‘Extreme’ Use Of Painkillers And Doctor Shopping Plague Medicare, New Report Says
In Washington, D.C., a Medicare beneficiary filled prescriptions for 2,330 pills of oxycodone, hydromorphone and morphine in a single month last year — written by just one of the 42 health providers who prescribed the person such drugs... These are among the examples cited in a sobering new report released today by the inspector general of the U.S. Department of Health and Human Services. (Ornstein, 7/13)

Stat: Feds Identify Prescribers Giving Too Many Opioids To Part D Beneficiaries
In the latest bid to stem the opioid epidemic, investigators at the Department of Health and Human Services have identified excessive prescribing patterns in Medicare Part D involving hundreds of doctors and plan to work with law enforcement authorities to curtail the practice. In a new report, the HHS Office of Inspector General found that 401 prescribers last year wrote more than 256,200 prescriptions for nearly 90,000 Part D beneficiaries who were deemed to be at serious risk because they received “extreme” amounts of opioids or appeared to be doctor shopping. (Silverman, 7/13)

In other news on the crisis —

New Partnership Aims To Make Life Easier For Those With Diabetes

Silicon Valley-based Bigfoot and Chicago-based Abbott Laboratories are teaming up on technology intended to help diabetics better monitor insulin intake and glucose levels throughout the day.

In other news —

The Washington Post: ‘We’re Losing More People To The Sweets Than To The Streets’: Why Two Black Pastors Are Suing Coca-Cola
William Lamar, the senior pastor at D.C.’s historic Metropolitan African Methodist Episcopal Church, is tired of presiding over funerals for parishioners who died of heart disease, diabetes and stroke. So on Thursday, he and another prominent African American pastor filed suit against Coca-Cola and the American Beverage Association, claiming soda manufacturers knowingly deceived customers about the health risks of sugar-sweetened beverages — at enormous cost to their communities. (Dewey, 7/13)

State Watch

Impact Debated Of Large Nurses Strike At Boston-Area Tufts Medical Center

The hospital is telling patients that care quality has not suffered as a result of the walkout by its nurses union. But studies indicate that such work stoppages can have negative consequences.

Boston Globe: In Tufts Nurse Strike, Some Worry About Patient Care
Tufts Medical Center has gone to great lengths to reassure patients during this week’s strike by nurses, but there is some evidence that medical care can suffer when nurses walk the picket line. One of the few studies examining this question found that more patients die and are readmitted to the hospital during nurses’ strikes. (Kowalczyk and Arnett, 7/13)

Boston Globe: Tufts Medical CEO: Calm Tone, Tough Stance In Nurses Strike
Union leaders say Wagner and other Tufts executives are the ones doing the bullying by denying nurses the compensation and better working conditions they deserve. The strike began after the union and the hospital failed to agree on wages, benefits, and staffing levels for the more than 1,200 unionized nurses at Tufts. (Dayal McCluskey, 7/14)

State Highlights: Minn. Marks New Measles Case; Three Mass. Hospitals Reach Merger Agreement

Media outlets report on news from Minnesota, Massachusetts, Georgia, Missouri, California, Ohio, Michigan, Texas and Florida.

The Star Tribune: New Measles Case In Minnesota Extends Threat
A new measles case in Minnesota, reported just as the recent outbreak seemed to be winding down, has state health officials on alert because it involved a white adult who had visited public places in Hennepin, Ramsey and Carver counties while infectious and who had circulated among several people known to be unvaccinated. Reported Thursday by the Minnesota Department of Health, the case brings the total for the current measles outbreak to 79. (Olson, 7/13)

WBUR: Proposed Beth Israel-Lahey Merger Includes 13 Hospitals
A proposed hospital merger, spearheaded by Beth Israel Deaconess Medical Center and Lahey Health, became formal Thursday with the signing of a definitive agreement and a filing with the state's Health Policy Commission. If approved, it would be the largest hospital merger in Massachusetts since Partners HealthCare formed in 1994 — and it would include more hospitals. (Bebinger, 7/13)

Atlanta Journal-Constitution: Georgia To Pursue $49 Million For School Nurses
In a joint effort with the Georgia Department of Education, the Department of Community Health board voted to approve a nursing services reimbursement program that would draw an estimated $48.6 million in additional federal dollars, assuming no major changes to Medicaid. There were 1,629 nurses and 307 unlicensed health care and clinic workers in Georgia schools last spring. (Tagami, 7/13)

The Associated Press: Confusion Over How Anti-Abortion Bill Could Affect St. Louis
Missouri lawmakers are at a standstill on broad anti-abortion legislation more than a month after Republican Gov. Eric Greitens called them into a special session to deal with abortion issues. The legislation calls for several new regulations, such as annual state inspections of abortion clinics. But one of the provisions causing the most confusion addresses a St. Louis ordinance that city leaders say is intended to prevent discrimination based on reproductive health decisions, such as pregnancy and abortion. (7/14)

Atlanta Journal-Constitution: Best Hospitals In US: 8 Georgia Hospitals Among Most Advanced In Tech
And according to Hospitals and Health Networks 19th annual “Most Wired Hospitals and Health Systems” survey, eight Georgia hospitals or health systems (including four in metro Atlanta) rely heavily on digital innovation “to improve population health, capitalize on data analytics, boost patient engagement and introduce new efficiencies" ...The survey, conducted with the help of the American Hospital Association and health care experts, showed 82 percent of the nation’s hospitals and hospital systems use technological analysis tools to help improve quality and reduce costs, both clinically and administratively. (Pirani, 7/13)

Detroit Free Press: Beaumont Trumpets, Defends New Pricey Proton Beam Cancer Center
Beaumont Health officials showed off their new $40-million cancer-fighting machine on Thursday — the first of its kind in Michigan and purportedly more advanced and less costly to operate than earlier models of the sometimes controversial technology. The proton beam device is the centerpiece of the new Proton Therapy Center on Beaumont's Royal Oak hospital campus and one of just 25 in the country. (Reindl, 7/13)

Austin American-Statesman: Lawmakers Propose Reining In Health Costs For Texas Retired Teachers
After failing to temper soaring health care costs for retired teachers, state lawmakers are considering giving retired teachers up to $1,200 more a year and pumping $200 million into their health care over the next two years. Starting in January, many retired teachers, particularly those under the age of 65, will see higher premiums and deductibles grow as much as 10 times what they’re paying now. (Chang, 7/13)

Minnesota Public Radio: Crisis Connection Hotline Rescued, As Least Temporarily
A mental health hotline that's served Minnesotans for nearly 50 years will keep operating thanks to an eleventh-hour infusion of money. Crisis Connection had been scheduled to shut down Friday evening, but a grant from the state health department means the service will continue linking people suffering mental health emergencies to professional counselors. (Sepic, 7/14)

The Star Tribune: Minnesota Mental Health Crisis Line Gets Rescued At The Last Minute
In a last-minute move, the agency agreed late Thursday to provide enough funding, $139,000, to keep the crisis hot line open until late September. Canvas Health, the Oakdale-based nonprofit agency that operates the service, had previously announced the hot line would go dark on Friday, citing financial difficulties and a lack of state funding. The planned closing of Crisis Connection concerned state health officials and mental health advocates, because the line is so widely used and remains the only mental health crisis line that serves the entire state. (Serres, 7/13)

Health News Florida: Federal Judge Dismisses Request To Stop Spraying Pesticide Naled In Miami-Dade County
A federal judge has dismissed a request to stop aerial spraying of the pesticide Naled in Miami-Dade County, describing the plaintiffs' complaint as "poor" and recommending they get a lawyer before pursuing further legal action. Judge Federico Moreno, of the Southern District of Florida, gave the two Miami Beach residents who filed the complaint 60 days to amend it by clarifying why the case belongs in federal court and which laws they contend are being violated. (Stein, 7/13)

Editorials And Opinions

Perspectives On The Political Landscape: Winners, Losers, Distractions And... Is Bipartisanship Even Possible?

Editorial pages examine the political dynamics involved in the debate surrounding the Senate GOP's efforts to pass a health bill.

The New York Times: Revised Senate Health Bill Tries To Win Votes, But Has Fewer Winners
The revised Senate health bill has a dwindling list of winners and a bigger pool of potential losers. It would still make insurance much less affordable for poorer and older Americans who don’t get coverage through work or Medicare. It would make that insurance less valuable for many people with the most significant health care needs. The biggest beneficiaries of the original bill — the rich — would get less. (Margot Sanger-Katz, 7/13)

Bloomberg: The Senate's Health-Care Follies Are Years In The Making 
That's right. Senate Majority Leader Mitch McConnell new plan is to ask Republicans to suspend reality until after casting their vote: Regardless of what the bill actually says, it means whatever they want it to mean. To state the obvious, this is not exactly a strong position. Conservatives will believe they are being betrayed, while Republicans (and everyone else) who want to preserve Medicaid won't believe the reassurances. McConnell, whether his reputation as a master legislative technician is deserved or not, is no fool. He simply has only a few choices remaining at this point in the game. Playing pretend is one of the last tools left at his disposal. (Jonathan Bernstein, 7/13)

Bloomberg: How Would A Bipartisan Health Bill Even Be Possible?
Mitch McConnell is once again announcing that the Senate is going to come out with a new health-care bill and try to hold a vote next week. That exhaustion you feel is the same despair that seeps over you when a pair of ill-matched friends announce for the 17th time that they’re getting back together. (Megan McArdle, 7/13)

Critics' Take: The Updated Senate Health Bill Is Still Ugly After Cosmetic Changes; An 'Abomination'

Opinion writers reacted with tough talk to Senate Majority Leader Mitch McConnell's latest health bill tweaks. The Wall Street Journal, however, terms the bill a "net improvement over the Obamacare status quo."

USA Today: Senate Health Bill: Don't Throw Momma From The Medicaid Train
In the river of retrograde effects certain to follow if the latest version of the Senate Republican health care bill passes largely intact, none is more surprising than the injury to elderly Medicaid recipients. To state this is not to prioritize poor elderly over other deserving beneficiaries. It is simply to say that nearly two-thirds of Americans in nursing homes are, well, on Medicaid. And while not every American has a loved one who is disabled, or a poor child, or struggling with opioids, or belongs to another beneficiary group, it does seem fair to say that at one time in their life every American had parents. If they live long enough, most will be on Medicaid. (Peter Fromuth, 6/14)

The New York Times: The Cruelty And Fraudulence Of Mitch McConnell’s Health Bill
A few days ago the tweeter in chief demanded that Congress enact “a beautiful new HealthCare bill” before it goes into recess. But now we’ve seen Mitch McConnell’s latest version of health “reform,” and “beautiful” is hardly the word for it. In fact, it’s surpassingly ugly, intellectually and morally. Previous iterations of Trumpcare were terrible, but this one is, incredibly, even worse. (Paul Krugman, 7/13)

The Wall Street Journal: ObamaCare Moment Of Truth
Republican leaders unveiled a revised health-care bill on Thursday, setting up a Senate watershed next week. Few votes will reveal more about the principles and character of this Congress. Months of stations-of-the-cross negotiations between conservative and GOP moderates have pulled the bill towards the political center, and for the most part the new version continues the journey. This leftward shift is Majority Leader Mitch McConnell’s bid to meet the demands of still-recalcitrant Republican moderates. The bill remains a net improvement over the Obama Care status quo, but the question now is whether they’ll take yes for an answer. (7/13)

The Washington Post: The New Senate Health-Care Bill May Be Worse Than The Old One
Senate Republicans released Thursday a new version of their Obamacare repeal-and-replace bill. It is arguably worse than the unpopular bill that preceded it. The Congressional Budget Office projected that the previous iteration would result in 22 million more uninsured in a decade. “Looking at the revised Senate health bill, it’s hard to see how it could meaningfully alter CBO’s projection of how the uninsured will grow,” the Kaiser Family Foundation’s Larry Levitt noted. “The revised Senate bill reinstates taxes on wealthy people, but it mostly does not spend that money on health care for low-income people.” (7/13)

The Washington Post: The New GOP Health-Care Plan Is Still An Abomination
Senate Republicans are releasing the latest version of their health-care plan today, and there’s a temptation to focus solely on what’s changed from the previous iteration. The changes are important, and we have to understand them. But what we shouldn’t do is allow a relative judgment (maybe it’s better in this way but worse in that way) to distract us from the big picture, because what’s still in the bill from before is even more important than what has changed. (Paul Waldman, 7/13)

The Washington Post: The Senate Health Bill Would Make The Opioid Epidemic Worse. Here’s How.
Over the past two decades, the number of Americans dying each year from opioid overdoses has quadrupled. In the hardest-hit state, West Virginia, where the overdose death rate is about three times the national average, the crisis has resulted in an overwhelmed foster-care system and a state burial program for the poor that ran through its entire annual budget three months into the year. (Jonathan Gruber and Angela Kilby, 7/13)

Viewpoints: Public Health Implications Of Information Security; Who's Looking Out For Nursing Home Residents?

Opinion writers offer their thoughts on a range of health issues.

The New England Journal Of Medicine: Threats To Information Security — Public Health Implications
In health care, information security has classically been regarded as an administrative nuisance, a regulatory hurdle, or a simple privacy matter. But the recent “WannaCry” and “Petya” ransomware attacks have wreaked havoc by disabling organizations worldwide, including parts of England’s National Health Service (NHS) and the Heritage Valley Health System in Pennsylvania. These events are just two examples of a wave of cyberattacks forcing a new conversation about health care information security. With the delivery of health care increasingly dependent on information systems, disruptions to these systems result in disruptions in clinical care that can harm patients. Health care information security has emerged as a public health challenge. (William J. Gordon, Adam Fairhall and Adam Landman, 7/12)

The Des Moines Register: Feds Fail To Protect Nursing Home Residents
The nation's worst nursing homes have never received enough oversight, and the problem is getting worse. In 1998, federal regulators attempted to crack down on homes that had an established pattern of injuring and, in some cases, killing elderly residents, then briefly cleaning up their act, sometimes by adding temporary workers, to appease state inspectors and maintain their licenses. (7/13)

The New York Times: An Ancient Cure For Alzheimer’s?
In 2011, Ben Trumble emerged from the Bolivian jungle with a backpack containing hundreds of vials of saliva. He had spent six weeks following indigenous men as they tramped through the wilderness, shooting arrows at wild pigs. The men belonged to the Tsimane people, who live as our ancestors did thousands of years ago — hunting, foraging and farming small plots of land. Dr. Trumble had asked the men to spit into vials a few times a day so that he could map their testosterone levels. In return, he carried their kills and helped them field-dress their meat — a sort of roadie to the hunters. (Pagan Kennedy, 7/14)

RealClear Health: Digital Health Hope: Telemedicine And Increasing Access To Care
Telemedicine—which can be strictly defined as a remote virtual doctor-patient interaction—is rapidly gaining popularity. When initially developed, telemedicine was designed to allow health care professionals to evaluate, diagnose and treat patients in remote and rural locations using telecommunications technology. Now, many are beginning to utilize telemedicine as a replacement for the traditional doctor visit even when they are located in a city or town with many brick and mortar offices. The push for an increased use of telemedicine by insurers, third party payers, and many global businesses has led its development as a worldwide multi-billion dollar industry. (Kevin Campbell, 7/14)