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Kaiser Health News Original Stories

Health Insurers Try Paying More Upfront To Pay Less Later

Some health plans are beginning to offer free maintenance care for people with chronic health problems, hoping that spending a little more early on will save a lot of money in the long run. (Mark Zdechlik, Minnesota Public Radio, 7/17)

Political Cartoon: 'Tired Out?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Tired Out?'" by Lisa Benson.

Here's today's health policy haiku:


Working together
Pols CAN improve on health care.
(But not here on Earth)

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

Summaries Of The News:

Health Law

With No Room For Error, McConnell Delays Health Vote While McCain Recovers From Surgery

Without Sen. John McCain (R-Ariz.) -- who had a craniotomy Friday -- Senate Majority Leader Mitch McConnell (R-Ky.) wouldn't have the 50 votes needed to get his legislation passed. To add to the timeline, the Congressional Budget Office announced Sunday that it would not release an updated score of the bill Monday, as originally expected.

The New York Times: A Top Republican Vows A Vote On Health Care, But Uncertainty Reigns
A top Senate Republican vowed on Sunday to bring the party’s health care bill to a vote as soon as possible, even as detractors said they would use a delay caused by the absence of Senator John McCain to mobilize further opposition to the measure. “I believe as soon as we have a full contingent of senators, that we’ll have that vote,” the No. 2 Senate Republican, John Cornyn of Texas, said on NBC’s “Meet the Press.” (Pear, 7/16)

The New York Times: McCain’s Surgery May Be More Serious Than Thought, Experts Say
The condition for which Senator John McCain had surgery on Friday may be more serious than initial descriptions have implied, and it may delay his return to Washington by at least a week or two, medical experts said on Sunday. The Senate majority leader, Mitch McConnell, has already announced that votes on a bill to dismantle the Affordable Care Act will not begin until Mr. McCain’s return. (Grady and Pear, 7/16)

Bloomberg: No CBO Health Score Monday As McConnell Delays Vote For McCain 
McCain has said he’s concerned about the impact of proposed Medicaid cuts on his home state, and said on July 13 he couldn’t say whether he would support McConnell’s new bill. He said he was working with Arizona Governor Doug Ducey, a Republican, on a series of Medicaid-related amendments to the bill. (Litvan, 7/15)

The Wall Street Journal: GOP Push To Pass Health-Care Law Faces New Setback
The delay prolongs the uncertainty over the bill’s prospects. GOP leaders have pursued a fast-paced timeline, as health-policy changes are often controversial. Sen. John Cornyn, a member of Senate GOP leadership, told reporters last month that passing the bill is “not going to get any easier” with time. Another GOP senator, Lindsey Graham of South Carolina, said the bill “is not like fine wine; it doesn’t get better with age.” (Tau, Radnofsky and Peterson, 7/16)

The Hill: McCain Recovers From Medical Procedure In Arizona
McCain’s fellow Arizona Sen. Jeff Flake (R-Ariz.) reached out to McCain in a statement calling him “tenacious and resilient.” “I have never known a man more tenacious and resilient than John McCain. I look forward to seeing him back at work soon. In the meantime, Cheryl and I extend our best wishes to John, Cindy and the entire McCain family and pray for his speedy recovery," Flake said in a statement. (Manchester, 7/15)

The Hill: White House Pre-Buts CBO Healthcare Score: 'Little More Than Fake News' 
Two White House aides are preemptively casting doubt on the accuracy of the Congressional Budget Office's assessment of Senate Republicans' healthcare plan, claiming the estimate will be "little more than fake news." In an op-ed published in The Washington Post, White House legislative affairs director Marc Short and Brian Blase, a special assistant to the president for healthcare policy at the National Economic Council, urged Americans to give "little weight" to the CBO analysis, known as a score. (Greenwood, 7/15)

Delay Provides Breathing Room To Net More Votes, But Also Gives Time For Doubts To Fester

Both moderate and conservative Republicans on the fence about the proposed legislation, with Sen. Susan Collins of Maine saying at least eight of her colleagues have expressed concerns.

USA Today: Republican Health Care Bill Faces Perilous Path After Vote Delay
Republicans already lost two of their members on the revised bill – the moderate Collins and Kentucky conservative Sen. Rand Paul, who said they would vote against a procedural motion to bring the bill to the floor – and can’t afford to lose a third. Without McCain’s vote in favor, the bill does not have enough support to pass. (Collins and Sullivan, 7/16)

The Washington Post: GOP Opponents To Senate Health-Care Bill See Vote Delay As An Advantage
A vocal conservative opponent of the measure, Sen. Rand Paul, predicted the delay would strengthen critics’ position by giving them more time to mobilize against the bill. “The longer the bill is out there, the more conservative Republicans are going to discover it is not repeal,” Paul (R-Ky.) said Sunday in an interview with CBS’s “Face the Nation.” (Viebeck, 7/16)

Politico: Who’s In And Who’s Out: McConnell’s Twisting Path To 50
Moderate senators like Ohio’s Rob Portman, Alaska’s Lisa Murkowski and Nevada’s Dean Heller are still on the fence about the bill, worried about its deep cuts to Medicaid. At the other end of the spectrum, conservative Sen. Mike Lee is undecided even after GOP leaders tried to include his idea for rolling back more of Obamacare’s regulations. (Cancryn, 7/15)

The Hill: After Delay, Senate Republicans Struggle Not To Let Healthcare Stall 
Pessimism peppered appearances by senators on this week’s Sunday show circuit, including the two senators who last week came out against the motion to proceed on the bill. “At the end of the day, I don’t know whether it will pass,” Sen. Susan Collins (R-Maine), one of the “no” votes, told CNN’s “State of the Union.” (Shelbourne, 7/16)

Politico: Meet Obamacare Repeal’s Top Salesman
Senate Republicans are in a grumpy mood these days. Then there’s John Cornyn, who’s almost unfailingly optimistic about the GOP’s chances of passing its Obamacare repeal bill despite the increasingly long odds. “I mean, if you’re going to be in a leadership role, you don’t have the luxury of public hand-wringing,” Cornyn, the Senate majority whip, said in a recent interview in his Capitol office. (Kim and Everett, 7/16)

Politico: How The White House And Republicans Underestimated Obamacare Repeal
The longer Republican efforts to repeal Obamacare flounder, the clearer it becomes that President Donald Trump’s team and many in Congress dramatically underestimated the challenge of rolling back former President Barack Obama’s signature achievement. The Trump transition team and other Republican leaders presumed that Congress would scrap Obamacare by President’s Day weekend in late February, according to three former Republican congressional aides and two current ones familiar with the administration’s efforts. (Cook and Everett, 7/17)

Politico Pro: Republicans Use State Payoffs To Win Votes For Repeal Bill
Republicans hammered Democrats seven and a-half years ago for larding Obamacare with state-specific payoffs and sweeteners to secure the last few votes for passage... But the revised Senate Obamacare repeal bill shows Republicans engaged in the same pattern of horse trading as they try to win 50 ayes to advance an unpopular bill. (Demko, 7/14)

Meanwhile, a look at the individual senators who will make or break the legislation —

The Hill: Five Key Senators Who Will Make Or Break Healthcare Reform 
The fate of Republican legislation to repeal and replace major parts of ObamaCare rests on a handful of senators who have strong reservations about the bill and a variety of political reasons to either support or oppose it. Two Republicans have already said they will vote against a motion to proceed to the bill next week, giving Senate Majority Leader Mitch McConnell (R-Ky.) no margin for error. (Bolton, 7/15)

The Associated Press: Nevada Sen. Dean Heller Is The Man To Watch On Health Bill
Health care legislation is hanging by a thread in the Senate, and no one is under more pressure than Republican Sen. Dean Heller of Nevada. Heller was already seen as the most endangered GOP incumbent senator in next year's midterm elections. He is the only one running for re-election in a state President Donald Trump lost to former Democratic presidential candidate Hillary Clinton. (Werner and Noon, 7/14)

Los Angeles Times: In His Small Hometown, Arizona's Jeff Flake Faces Perils And Pressure Of Senate Healthcare Debate
Ron McArthur is a man with big plans. As head of the chief medical provider in this rural slice of eastern Arizona, McArthur firmly believes what’s good for Summit Healthcare is good for communities tucked in the foothills of the White Mountains. “We’re the economic engine,” he said. “We sponsor everything, we’re the biggest employer, we offer the highest-paying jobs.” (Barabak, 7/17)

McClatchy: Senate GOP’s Healthcare Problem Is Not Trump
One big reason Senate Republicans are having trouble uniting around a plan to overhaul the nation’s health coverage is that a lot of them just don’t get along. These intra-party clashes of personality and policy stymie the bill’s progress as much as any other political force. (Wise, 7/17)

McClatchy: Progressives Lobby GOP Senators On Republican Health Bill
Moderate Republican senators who opposed the original Obamacare replacement bill will face increased pressure from health care advocates to hold the line next week in a possible vote on the revised legislation... Senate Majority Leader Mitch McConnell is pushing for a vote, possibly as early as Tuesday, on a motion to allow a floor vote on the amended Better Care Reconciliation Act, which was unveiled on Thursday to heavy criticism from a variety of health care groups. (Pugh, 7/14)

Politico: White House Announces New Theme Weeks Amid Health Care Bill Uncertainty
With Republicans’ health care bill in jeopardy, the White House is once again turning to a series of unrelated themed weeks to organize President Donald Trump’s schedule. ... Administration officials bristled at the notion that the themed weeks could distract from the debate over repealing and replacing Obamacare, one of the president’s biggest policy priorities. (Restuccia, 7/16)

Pence, Price Try To Woo Governors, But Many Remain Skeptical

Despite their best efforts Vice President Mike Pence and Health and Human Services Secretary Tom Price did little to sway Republican governors, who are worried about the rollback of the Medicaid expansion, at their national conference.

The New York Times: Governors Give Chilly Reception To Health Bill Push
A handful of Republican governors rebuffed on Saturday an attempt by their Democratic counterparts to issue a joint statement from the nation’s governors expressing opposition or even concern about the Senate health care bill. But a smaller, bipartisan group of influential governors still may release a statement of their own in the coming days, a move that would greatly imperil passage of a measure that is already listing. While Republican governors stopped well short of declaring common cause with Democrats on health care, state executives from both parties gave a brusque reception to Trump administration officials who trekked to Rhode Island to lobby governors for their support. (Martin and Burns, 7/15)

The Hill: Pence Pitches Governors On ObamaCare Repeal Bill 
“Yes, President Trump will lead this Congress to rescue the American people from the collapsing promises of ObamaCare,” Pence told the National Governors Association summer meeting in Rhode Island. "Whatever your politics or your party, you know we’re talking about real people, a real crisis,” he added. (Manchester, 7/14)

The Washington Post: White House Launches Aggressive Push To Flip GOP Governors Opposed To Senate Health Bill
Despite the administration’s sales pitch, however, four influential governors reiterated their concerns about the bill’s impact on their states’ most vulnerable individuals — underscoring the challenge facing the White House and Senate Republicans as they seek to fulfill a seven-year GOP promise to undo the Affordable Care Act (ACA). “I’ve still got to come back to my concerns with regard to the Medicaid population,” said Gov. Brian Sandoval (R-Nev.) on his way to a private session with Vice President Pence here at the summer meeting of the National Governors Association. Pence had earlier delivered a detailed speech to the entire group defending the bill. (Sullivan, Eilperin and Balz, 7/14)

The Washington Post: Nevada Gov. Brian Sandoval Still Doesn’t Support The Senate Health-Care Bill. That’s Big Trouble For Republicans.
Among the 32 state executives who attended the National Governors Association summer meeting here this weekend, no one drew more attention and interest than Sandoval, a square-jawed 53-year-old with neatly parted dark hair, a made-for-TV smile and a political disposition that is the antithesis of President Trump. All weekend, he has been besieged — by reporters taking his temperature and by administration officials, including Vice President Pence, trying to persuade him that the Senate bill would not hurt his Nevada constituents despite its deep federal spending cuts to Medicaid. (Sullivan and Balz, 7/15)

The Associated Press: White House Pitches Health Bill To Skeptical US Governors
U.S. Health and Human Services Secretary Tom Price and Centers for Medicare and Medicaid Services Administrator Seema Verma made their pitch Saturday morning during a closed-door meeting of the bipartisan National Governors Association. Vice President Mike Pence also met several of the governors privately after his public address at the Rhode Island conference on Friday. (7/15)

The Hill: Governors Voice Resistance To Senate Health Bill 
Governors on both sides of the aisle came out on Friday against Senate Republicans' revised plan to overhaul the country's healthcare system, as the White House launched a forceful bid to win over GOP governors. At an annual summer meeting of the nation's governors in Providence, R.I., both Republicans and Democrats voiced misgivings about the measure, which largely echoed the concerns of fellow partisans in the Senate. (Greenwood, 7/15)

Bloomberg: White House Takes Pitch For Health-Care Bill To U.S. Governors
Wisconsin Governor Scott Walker, a Republican and former presidential candidate, said he met with Pence and Price on Friday but still hasn’t taken a final position. “We’re hopeful they’re going to get to a point where they’re going to have a repeal and replace that works,’’ Walker said. (Niquette, 7/15)

The CT Mirror: Pence, Malloy Compete To Define What GOP Is Doing To Health Care
As the governor of Connecticut, a state where one in every five residents gets his or her health care through Medicaid, Malloy sees the latest Republican efforts to revamp the Affordable Care Act as bad public policy — a massive shift of expenses from the federal government to states that already are financially strapped. (Pazniokas, 7/14)

Possible Return Of 'Junk Insurance' Worries Those Who Remember Bare Bones Coverage All Too Well

Many Republicans, including President Donald Trump, say giving insurers the leeway to offer less-comprehensive plans will give people greater choice and cheaper options, but experts say it will skew the marketplace in favor of young, healthy people at the expense of sick people.

The New York Times: In Clash Over Health Bill, A Growing Fear Of ‘Junk Insurance’
Julie Arkison remembers what it was like to buy health insurance before the Affordable Care Act created standards for coverage. The policy she had was from the same insurer that covers her now, but it did not pay for doctor visits, except for a yearly checkup and gynecological exam. “I couldn’t even go to my regular doctor when was I sick,” said Ms. Arkison, 53, a self-employed horseback-riding teacher in Saline, Mich. (Abelson, 7/15)

The Associated Press: Health Plan Hinges On The Young, But They're A Tough Sell
Julian Senn-Raemont isn't convinced he needs to buy health insurance when he loses coverage under his dad's plan in a couple of years — no matter what happens in the policy debate in Washington, or how cheap the plans are. The 24-year-old musician hasn't known a world without a health care safety net. But he hates being forced by law to get coverage, and doesn't think he needs it. (Johnson, 7/17)

The Hill: Insurers Warn Cruz Provision Will 'Skyrocket' Premiums For Sick People 
The two leading health insurer trade groups sent a strongly-worded letter Friday expressing opposition to a controversial conservative provision included in the latest GOP ObamaCare replacement bill. America’s Health Insurance Plans and the Blue Cross Blue Shield Association warned that the provision from Sen. Ted Cruz (R-Texas) would mean “premiums will skyrocket for people with preexisting conditions” and “millions of more individuals will become uninsured.” (Sullivan, 7/14)

The Wall Street Journal: Senate Health Bill Frays Republicans
Insurers have worried that under the Cruz proposal, the health market would be split in two. Healthy and younger people would flock to cheaper, less comprehensive plans, while people with pre-existing conditions who need more comprehensive coverage could have to pay far more. That has alarmed centrist GOP senators who want to maintain protections for people with pre-existing conditions. And although conservatives sought the Cruz measure, its current version has left them divided because of a change in the way the market where people buy insurance when they don’t get coverage on the job would be structured. (Armour and Peterson, 7/14)

Los Angeles Times: Obamacare Repeal Bills Could Put Coverage Out Of Reach For Millions Of Sick Americans
“The fundamental guarantee at the heart of the Affordable Care Act was that people who are sick can get insurance at the same price as everyone else,” said Larry Levitt, an insurance market expert at the nonprofit Kaiser Family Foundation. “The House and Senate replacement bills move the system back to a place where healthy and sick people are treated very differently.” (Levey, 7/16)

Kaiser Health News: Analysis: Senate’s Latest Health Blueprint Cuts Costs At The Expense Of Chronically Ill
The latest Senate health proposal reins in costs by effectively splitting the individual insurance market, with healthy people diverted into stripped-down plans and chronically ill individuals left with pricey and potentially out-of-reach options, insurance analysts said. This draft — a fresh attempt by the Republican Party to undo the Affordable Care Act — injects more uncertainty into plans for people with preexisting conditions such as cancer, asthma, diabetes or other long-term ailments. Those people, insured through ACA marketplaces now, could be more isolated than in an earlier version of the Senate bill. (Hancock, 7/17)

Preventive Care Efforts Were Boosted Under ACA, But GOP's Plan Would Make Them Vulnerable Again

Regular screenings and preventive care are responsible for catching serious problems before they become expensive disasters. But with the cuts under the GOP's proposed legislation, some worry the progress made through the Affordable Care Act will be lost. Meanwhile, the Republicans' plan depends on young people buying insurance even though that lesson was already learned, and a look at the winners and losers under the plan.

The Associated Press: Trump's No 'Dying In The Streets' Pledge Faces Reality Check
President Donald Trump has often said he doesn't want people "dying in the streets" for lack of health care. But in the United States, where chronic conditions are the major diseases, people decline slowly. Preventive care and routine screening can make a big difference for those at risk for things such as heart problems and cancer, especially over time. (Alonso-Zaldivar, 7/15)

The Associated Press: New GOP Health Care Bill Will Determine Winners, Losers
Republicans' latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.It would give consumers more responsibility for their insurance choices, a goal long held by conservatives who argue that's key to a true health care market. Younger adults and healthy people in the solid middle class may find more agreeable options. But low-income people may not be able to afford coverage, along with older and sicker adults. (7/15)

In other news on the Republicans' proposed legislation —

The Wall Street Journal: Health-Law Taxes Divide The GOP, Signaling A Shift
Republican efforts to pass a health-care bill have revealed a party fissure on tax policy with potentially far-reaching repercussions. In his latest attempt to rewrite President Barack Obama’s signature health-care law, Senate Majority Leader Mitch McConnell (R., Ky.) retained a 3.8% investment-income tax and a 0.9% payroll tax that apply to individuals earning more than $200,000 and married couples earning more than $250,000. (Rubin, 7/17)

Kaiser Health News: Podcast: What The Health? Senate Health Bill 2.0. Still On Life Support
Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of and Margot Sanger-Katz of The New York Times discuss the changes to the proposed Senate health bill, and whether they can win the 50 votes needed to pass it. Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too. (7/14)

Des Moines Register: 58% Of Iowans Oppose Congress' Actions On Health Care, New Iowa Poll Shows
Few Iowans like how Congress is attempting to revamp the nation’s health care system, a new Des Moines Register/Mediacom Iowa Poll shows. Just 29 percent of Iowa adults say they mostly support the direction congressional Republicans are taking on health care, according to the poll. Twice as many — 58 percent — say they mostly oppose that direction. Thirteen percent are unsure. (Leys, 7/15)

Bloomberg: Obamacare's Pocketbook Problems Made Worse In GOP Health Bill 
Concern about patients spending too much of their own money on health care has driven the debate over repealing and replacing Obamacare. But the latest Senate Republican health bill does little to address those fears and may exacerbate them. The bill, rolled out anew on Thursday after a raft of Republican defections threatened to sink the original legislation, faces a narrow road to passage despite alterations aimed at winning over lawmakers who balked at the earlier draft. Two Republican Senators signaled their opposition; a third dissent could doom the measure, and a long-held GOP vow to overturn the Affordable Care Act. (Tracer and Edney, 7/14)

If GOP Plan Passes, Some States Will Likely End Medicaid Expansion Early

The program would likely become too costly for them to maintain. Meanwhile, a new report shows that the proposed legislation would cut Medicaid funding by as much as 39 percent. And media outlets report on other news on the program out of Pennsylvania, Montana, Michigan, California, Texas, Virginia and Ohio.

The Hill: New Medicaid Worry Emerges For Centrists
Some states would likely end their Medicaid expansions earlier than 2024 if the Senate GOP’s healthcare bill becomes law, according to several sources. That dynamic could deepen concerns among several senators who are undecided about the healthcare bill because of its changes to Medicaid, the federal-state healthcare program for the poor and disabled. (Roubein, 7/16)

The Hill: States May See Up To 39 Percent Decline In Medicaid Funding Under Repeal 
Federal Medicaid funding could drop by as much as 39 percent over the next two decades under Senate Republicans' healthcare plan, according to a report presented at the National Governors Association meeting. The report, authored by the consulting firm Avalere Health and first reported by Politico, estimates that the GOP's plan to overhaul large parts of the country's healthcare system would offer deep cuts to Medicaid, ranging from 27 to 39 percent. (Greenwood, 7/15)

Modern Healthcare: Analysts Predict Drop In Provider Net Revenue Under BCRA 
Provider revenue would take a sizable hit under the latest version of the Senate's bill to repeal and replace the Affordable Care Act, a new report found.​ The revised Better Care Reconciliation Act, released yesterday, retains the caps on Medicaid spending and rollback of the Medicaid expansion afforded to states' most vulnerable populations. A Congressional Budget Office review of the original bill estimated that 22 million people would lose coverage by 2026. (Kacik, 7/14)

Nashville Tennessean: With Medicaid Cuts Still In Trumpcare Bill, Many Veterans Remain Opposed
Though the revised American Health Care Act includes changes that could woo Republican moderates and opponents enough to support the legislation, many veterans and mental health advocates say it still would jeopardize benefits for millions of veterans. Specifically, they oppose the steep cuts to Medicaid, which they argue about 1.75 million veterans and some 600,000 family members depend on to supplement benefits not provided by the VA. The revised version, released Thursday, still aims to cut some $800 billion in Medicaid benefits and faces opposition from enough Senate Republicans to put the passage of the bill at risk. (Lowary, 7/16)

The Philadelphia Inquirer/ At Rural Pa. Hospitals, A Tense Wait As Congress Weighs Funding Changes
Bucktail Medical Center, a one-story building on the outskirts of town, doubles as the local nursing home. It has two emergency-room bays, 21 acute-care beds, one physician on hand at any given time, and an ever-precarious bottom line. At a larger hospital, the nursing director’s list of duties would employ five people. Officials here are still saving up to buy their first CT scanner. And as the GOP’s health-care bill winds its way through Congress, the staff is watching with bated breath. Like many other rural hospitals known as “critical-access hospitals,” it relies heavily on federal funding from Medicaid and Medicare reimbursements — for Bucktail, which has a $6 million operating budget, it’s nearly 80 percent of its revenue. (Whelan, 7/16)

Detroit Free Press: Michigan's Medicaid Expansion Helps Rural Counties, Men
The expansion of Medicaid eligibility under the Affordable Care Act (ACA) has increased Michigan's Medicaid rolls by 29% from 1.9 million residents in April 2014 to 2.5 million residents in May 2017.  Statewide, 1 out of 4 Michigan residents is enrolled in Medicaid. Medicaid has expanded as part of the ACA in 32 states and the District of Columbia. The expansion simplified eligibility requirements and expanded income eligibility to 133% of the poverty level, $16,000 for a single person or about $33,000 for a family of four. (Tanner, 7/14)

Los Angeles Times: One Child, A $21-Million Medical Bill: How A Tiny Number Of Patients Poses A Huge Challenge For Medi-Cal
Somewhere in California, one child’s medical expenses in 2014 totaled $21 million — a bill covered entirely by Medi-Cal, the state’s version of Medicaid. The child’s condition is not known. But the cost of care was mentioned in recent Twitter and Facebook posts by Jennifer Kent, head of the state Department of Health Care Services, which runs Medi-Cal. (Karlamangla, 7/16)

Cleveland Plain Dealer: Ohio Nursing Homes Fear Losing $800 Million In Medicaid Funding In Healthcare Bill: A Critical Choice
On Thursday, Republicans in the U.S. Senate released a revised draft of a healthcare bill that, again, proposes deep reductions in Medicaid funding. As the plan stands, published reports show, the hundreds of billions of dollars in cuts to Medicaid in the revised plan are similar to those in an earlier draft of the plan GOP senators released in late June. (Caniglia and Corrigan, 7/17)


States Scramble To Cajole, Entice and Pressure Insurers Back Into Marketplace

“There is a general feeling that we’re on the front lines,” says Julie Mix McPeak, Tennessee’s insurance commissioner.

The Wall Street Journal: States To Health Insurers: Please Come Back
Nevada officials were stunned last month to learn that Anthem Inc., the only insurer selling plans statewide through the insurance exchange, was planning to pull back next year, leaving consumers in most counties with no way to get plans under the Affordable Care Act. “It felt like a gut punch,” says Heather Korbulic, executive director of Nevada’s insurance exchange, where consumers buy ACA coverage online. When she learned of the situation from insurer filings, she says, she blurted out loud: “Holy shit, what are we going to do?” Nevada officials quickly began pushing to solve the problem. (Wilde Mathews, 7/14)

Seattle Times: Health Insurers Seek Double-Digit Rate Increases In Washington State — Despite Billion-Dollar Reserves | The Seattle Times
At the same time Regence is abandoning customers in Washington’s market for individual insurance, it is seeking rate increases in the state averaging 30 percent next year...Regence is not alone, according to filings with the state Office of the Insurance Commissioner. Premera Blue Cross has proposed 28 percent increases, on average, and reported a surplus of $1.5 billion at the end of 2016. Kaiser Permanente is asking for rate increases averaging 13 percent and had a $917 million surplus. Insurers say they need deep reserves in the event of unforeseen disaster. (Young, 7/16)

Denver Post: Colorado Health Insurers Seek 27 Percent Premium Hike
Colorado health insurers are asking to charge customers in the individual market nearly 27 percent more on average in premiums next year, the state Division of Insurance announced Friday. The division must still review and approve the requests — after receiving public comment. But insurers can back out of the market if the state doesn’t OK their premium hikes. (Ingold, 7/14)

Meanwhile, places that were finally finding their feet in terms of health care are worried they're going to be pushed back to the ground —

The Washington Post: In An Arid, Lonely Stretch Out West, The Health Coverage That Bloomed Is Now At Risk
In this speck of high desert, along a stretch of highway that Life magazine once called the loneliest road in America, the only doctor in town comes just one day a week. In the past few years, though, health insurance has arrived in force. The county that includes Silver Springs now has more than 3,500 additional residents on Medicaid, because Nevada’s governor was the first Republican in the country to expand the program through the Affordable Care Act. Nearly 1,400 others have private plans through the law and the Silver State Health Insurance Exchange. (Goldstein, 7/16)

Hospitals Lobbied Hard To Keep Tax Breaks Under ACA, But They're Not Sharing Their Windfall

Through millions of newly insured patients, hospitals have raked in money since the Affordable Care Act was passed. But their spending on direct charity care has actually fallen.

Politico: How Hospitals Got Richer Off Obamacare
A decade after the nation’s top hospitals used all their advertising and lobbying clout to keep their tax-exempt status, pointing to their vast givebacks to their communities, they have seen their revenue soar while cutting back on the very givebacks they were touting, according to a POLITICO analysis. (Diamond, 7/17)

Politico: How The Cleveland Clinic Grows Healthier While Its Neighbors Stay Sick
On the Cleveland Clinic’s sprawling campus one day last year, the hospital’s brain trust sat in all-white rooms and under soaring ceilings, looking down on a park outside and planning the next expansion of the $8 billion health system. A level down, in the Clinic’s expansive alumni library, staff browsed century-old texts while exhausted doctors took naps in cubbies. And in the basement, a cutting-edge biorobotics lab was simulating how humans walk using a cyborg-like meld of metallic and cadaver parts. (Diamond, 7/17)

Anthem Sues Insys Therapeutics Over Reimbursement 'Scheme' For Painkiller

Anthem, one of the nation's largest health insurers, is alleging that the drugmaker used a “creative, illegal, and fraudulent” scheme in pursuing reimbursement for the painkiller Subsys.

Stat: Anthem Sues Insys Over A 'Creative' Scheme To Win Reimbursement For Its Painkiller
Anthem, which is one of the nation’s largest health insurers, has filed a lawsuit accusing Insys Therapeutics of engaging in a “creative, illegal, and fraudulent” scheme to obtain reimbursement for its Subsys painkiller, adding a new layer of legal challenges for the beleaguered drug maker. In its lawsuit, which was filed on Wednesday in federal court in Arizona, Anthem accused the company of bribing doctors with “sham” speaker fees to write prescriptions for unapproved uses for its drug, which contains fentanyl and carries a high risk of dependency. We asked Insys for comment and will update you accordingly. (Silverman, 7/14)

Arizona Republic: Chandler's Insys Therapeutics Sued By Insurers Over Opioid Marketing
Insys Therapeutics of Chandler, already facing numerous legal challenges over the alleged improper marketing of a powerful opioid drug, was hit this week with a lawsuit from health insurer Anthem Inc. The lawsuit came the same week that two of the company's former sales representatives — one of them the wife of the company's former CEO — pleaded guilty to arranging kickbacks for medical professionals. (Wiles, 7/14)

Public Health And Education

More Americans Getting Sick From Making Mistakes With Their Medication

Accidentally taking the wrong dose or drug is leading to more “serious medical outcomes,” a study finds. Today's other public health news headlines cover Alzheimer's, artificial sweeteners' role in weight loss, diet and exercise counseling, anorexia, the benefits of dirt, diabetes, belly fat and a bizarre medical case.

NPR: High Alzheimer's Rates Among African-Americans May Be Tied To Poverty
Harsh life experiences appear to leave African-Americans vulnerable to Alzheimer's and other forms of dementia, researchers reported Sunday at the Alzheimer's Association International Conference in London. Several teams presented evidence that poverty, disadvantage and stressful life events are strongly associated with cognitive problems in middle age and dementia later in life among African-Americans. (Hamilton, 7/16)

NPR: Artificial Sweeteners Don't Help With Weight Loss
The theory behind artificial sweeteners is simple: If you use them instead of sugar, you get the joy of sweet-tasting beverages and foods without the downer of extra calories, potential weight gain and related health issues. In practice, it's not so simple, as a review of the scientific evidence on non-nutritive sweeteners published Monday shows. (Hobson, 7/17)

The New York Times: ‘To The Bone’ Opens Frank Dialogue On Eating Disorders: ‘They Steal Your Voice’
When Marti Noxon set out to make “To the Bone,” a film about a 20-year-old battling an eating disorder, she initially faced the question: Was the topic too niche? The answer came in the form of a rousing premiere in January at the Sundance Film Festival, Netflix’s reported $8 million purchase of the film, a trailer that went viral with 54 million views in the first week and arguments over whether it glamorized excessive thinness. The film debuted on Netflix on Friday. (Minsberg, 7/14)

NPR: 'Dirt Is Good': New Book Explores Why Kids Should Be Exposed To Germs
As a new parent, Jack Gilbert got a lot of different advice on how to properly look after his child: when to give him antibiotics or how often he should sterilize his pacifier, for example. After the birth of his second child, Gilbert, a scientist who studies microbial ecosystems at the University of Chicago, decided to find out what's actually known about the risks involved when modern-day children come in contact with germs. (Garcia-Navarro, 7/16)

Stat: Trying A New Tack: Delivering Insulin To The Liver To Control Type 1 Diabetes
Type 1 diabetics, armed with glucose meters and insulin pens, are caught in a delicate high-wire act. Too much glucose wreaks havoc on nerves and blood vessels, while too little causes dizziness and nausea. A Cleveland biotech company is trying to change that by delivering insulin to the liver, where it naturally goes. Diasome has three phase 2 clinical trials in progress testing nanoparticles known as hepatocyte-directed vesicles. These particles, smaller than the period at the end of this sentence, stick to insulin like Velcro and bring it to the liver. Diasome believes its approach will better manage patients’ blood sugar than administering insulin alone. (Wosen, 7/17)

Stat: Redeeming Qualities For Belly Fat? When It's Actually The Omentum, Sure
Look down. See any belly fat? The answer should be yes, for everyone — because that fat pad isn’t just sitting there quietly. Some of it is actually part of an organ called the omentum. And the omentum — specifically, its immune cells — may be where researchers need to focus if they want to find new treatments for some stubborn cancers that have spread. Researchers like Troy Randall hope that might be possible if we understand a bit better how the omentum works. Randall and his team at the University of Alabama at Birmingham have looked at how omentum’s immune cells respond in ovarian cancer; they published a review paper about the organ’s immune system in Trends in Immunology in June. (Sheridan, 7/14)

State Watch

State Highlights: Ariz.'s Doctor Shortage Reflects National Crisis; Nurses Strike Continues At Tufts Hospital

Media outlets report on coverage from Arizona, Massachusetts, D.C., New York, California, Pennsylvania, Washington, Kansas and Louisiana.

NPR: Rural Arizona's Doctor Shortage A Symptom Of 'Forgotten America'
For Heather Gijanto, going to the doctor means taking a day off work and driving at least 60 miles round trip from her home in McNeal, Ariz., to the town of Bisbee. And that is assuming there is a primary care doctor available in Bisbee to get her in. "You select one doctor and then you find out a few months later that that doctor is no longer going to be available," Gijanto says. "So then you have to start the whole process over again. And then you find that doctor and, for whatever reason, that doctor leaves as well." (Siegler, 7/14)

Boston Globe: Tufts Hospital Officials Say Buses Carrying Replacement Nurses Were Attacked
As Tufts Medical Center nurses and their supporters began a fifth day of picketing outside the hospital Sunday, some protesters allegedly confronted replacement nurses at hotels miles from the facility... The protesters appeared at a hotel near Logan International Airport and another in the Boston suburbs, where the substitute nurses were being put up, Hynes said, and tried to block buses preparing to take the nurses to the hospital. (Fox and Salinas, 7/16)

USA Today: Steve Scalise Hospital Rates Low Among Level 1 Trauma Centers
The trauma center where Louisiana Rep. Steve Scalise has been treated since his gunshot wounds last month is ranked low even when compared to other level 1 trauma centers, including some in other diverse urban areas like Washington, D.C. Patients who are taken to a level 1 trauma center have about a 25% better chance of survival over other hospitals, according to a 2006 study in the New England Journal of Medicine (NEJM). These hospitals, including Scalise’s Medstar Washington Hospital Center, treat the most seriously injured patients. (O'Donnell, 7/16)

San Jose Mercury News: Some Bay Area Doctors Learning To Navigate California's Physician-Aid-In-Dying Law
Based on Oregon’s experience with its two-decade-old law, Compassion & Choices, a group that advocates nationally for aid-in-dying laws, had predicted that about 1,500 lethal prescriptions would be written in California during the law’s first year — and that about two-thirds of the medications would actually be ingested. Bay Area physicians of all stripes — both those participating in the new law and those who vehemently object to it — point to a confluence of factors that might explain the relatively low number of Californians using the law. (Seipel, 7/16)

Los Angeles Times: An Overdose, A Young Companion, Drug-Fueled Parties: The Secret Life Of Then-USC Med School Dean
In USC’s lecture halls, labs and executive offices, Dr. Carmen A. Puliafito was a towering figure. The dean of the Keck School of Medicine was a renowned eye surgeon whose skill in the operating room was matched by a gift for attracting money and talent to the university.There was another side to the Harvard-educated physician. (Pringle, Ryan, Elmahrek, Hamilton and Parvini, 7/17)

The Philadelphia Inquirer/ GE Healthcare Puts 'Disruption' Teams In Jefferson Hospitals
GE Healthcare has begun moving 100 staffers into 13 area hospitals of the Jefferson Health network and its Abington and Aria facilities, under a deal the partners say should generate more than $500 million in savings and new revenue over the next eight years through increased use of GE data systems and health-care machinery...About 70 Jefferson radiology workers and biomedical staff will transfer over to work as GE employees. Jefferson hospitals, colleges, and affiliates employ about 29,000, second only to the University of Pennsylvania and its health system among the area’s private employers. (DiStefano, 7/17)

Seattle Times: Seattle Startup BloomAPI Helps Health Clinics Phase Out Faxes 
Fax machines have been largely phased out of many offices, but health clinics still rely on them. One Seattle startup wants to change that and help clinics modernize how they electronically share medical records. BloomAPI, founded by Seattle entrepreneur Michael Wasser, develops technology that lets doctors send medical records directly from one computer system to another — no faxing required. (Lerman, 7/16)

San Francisco Chronicle: Thousands Pack Golden Gate Park For AIDS Walk SF
More than 10,000 people turned out at Sharon Meadow in Golden Gate Park on Sunday for the annual AIDS Walk San Francisco, where organizers implored the crowd to fight for health care for all Americans, not just those living with HIV and AIDS. Before the event began, many participants were handed fill-in-the-blank signs distributed by organizers that read, “My Pre-Existing Condition Is ______.” (Ioannou, 7/16)

Kaiser Health News: Calif. Hits Nerve By Singling Out Cardiac Surgeons With Higher Patient Death Rates
Michael Koumjian, a heart surgeon for nearly three decades, said he considered treating the sickest patients a badge of honor. The San Diego doctor was frequently called upon to operate on those who had multiple illnesses or who’d undergone CPR before arriving at the hospital. Recently, however, Koumjian received some unwelcome recognition: He was identified in a public database of California heart surgeons as one of seven with a higher-than-average death rate for patients who underwent a common bypass procedure. (Gorman, 7/17)

KCUR: Mindfulness, Yoga And A 40-Foot Jump: KC Veterans Group Teaches Holistic PTSD Healing 
“Kansas City has PTS,” says Justin Hoover, director of marketing at Warriors’ Ascent. “Our warriors do, our first responders do.” “And if they do, so do we.” PTS, or post-traumatic stress, occurs in some people who have experienced a traumatic event, such as a terrorist attack, combat situation or even a traffic accident. Symptoms include hypervigilance, painful flashbacks and depression, among others. For veterans and first responders, extreme circumstances like these come with the job. (Campbell, 7/14)

New Orleans Times-Picayune: 2 Slidell Residents Sentenced In $25 Million Medicare Fraud Scheme
Two Slidell residents who owned psychological services companies received long prison terms for their involvement in $25 million scheme to defraud Medicare by charging for nursing home services that were unnecessary or never performed. Rodney Hesson was sentenced Thursday (July 13) to 15 years in prison and Gertrude Parker to seven years behind bars for health care fraud by U.S. District Court Judge Carl J. Barbier, according to the U.S. Attorney's Office. (Chatelain, 7/14)

Editorials And Opinions

Perspectives: Governors Step Up As Senators Step Back; More Tough Takes On The GOP Health Plan

Opinion writers examine the policy and political dynamics in play as the Senate GOP continues its efforts to replace the Affordable Care Act.

The Washington Post: Governors Push Back While GOP Lawmakers Roll Over
If House and Senate Republicans have largely been supine in the face of President Trump’s assaults on the truth, fiscal probity, conflicts of interest, climate change and health care, governors have not and therefore point the way toward restoration of a once admirable party. (Jennifer Rubin, 7/16)

Los Angeles Times: Here Are The Hidden Horrors In The Senate GOP's New Obamacare Repeal Bill
enate Republicans unveiled a new, “improved” version of their Affordable Care Act repeal bill Thursday, so the treasure hunt is on: the search for provisions so horrifically inhumane that they’ve had to be concealed deep in the measure’s legislative language and procedural maze. We’ve found quite a few, with the help of professional spelunkers Andy Slavitt, David Anderson, Larry Levitt and others. Here are some of the provisions in the so-called Better Care Reconciliation Act, or BCRA, that the Senate GOP really doesn’t want you to know about. (Michael Hiltzik, 7/14)

Bloomberg: Put Trumpcare Out Of Its Misery
Congressional Republicans have just produced their latest version of Trumpcare. On the plus side, this one gives up on earlier proposals to repeal three taxes that the Affordable Care Act imposes on the wealthy, making it a bit less fiscally reckless. On the minus side, it's still a terrible plan. (7/14)

The Washington Post: On Health Care, History Is Watching. And It’s Watching Four Senators In Particular.
Over the past century, there has been a characteristic American cycle of response to far-reaching social reforms. When the breakthroughs are first proposed, conservatives fight them with a devout passion, warning that the measures on offer would move the nation toward socialism and perdition. Then, over time, the disastrous consequences never materialize, the reforms prove their worth, and Americans come to see the once-new benefits as rights. (E.J. Dionne, 7/16)

USA Today: The ‘Pro-Life’ Movement Is A Joke And Trumpcare Proves It
They might have gotten away with it if not for those meddling disability activists. Until several members of ADAPT were yanked from their wheelchairs and arrested for conducting a sit-in outside Senate Minority Leader Mitch McConnell’s office on the day the Senate GOP’s first draft of Trumpcare went public, Republicans had done a beautiful job of hiding the truth about their effort to “repeal and replace” Obamacare. (Jason Sattler, 7/17)

The Washington Post: The Fundamental Error In The CBO’s Health-Care Projections
In the coming days, the Congressional Budget Office will release an updated analysis of the Senate bill to repeal and replace Obamacare. The CBO will likely predict lower health insurance coverage rates if the bill becomes law. The American people and Congress should give this prediction little weight in assessing the bill’s merit. (Marc Short and Brian Blase, 7/14)

State And Local Views: Senate GOP Health Bill 'Fundamentally Wrong;' Devastating To Rural Families

Editorial pages across the country take a hard look at the Senate GOP health care plan and examine their own senators' roles in the debate and the current proposal's local impact.

St. Louis Post-Dispatch: New GOP Healthcare Bill Is As Fundamentally Wrong As All The Others
The fifth iteration of congressional Republicans’ health care bill — two from the House, three from the Senate — is likely to be the last one for a while. If the Senate passes it this week, the House will surely go along. If it fails, Republican leaders appear ready to throw up their hands and work with Democrats to fix the Affordable Care Act rather than replace it. That would be the best outcome. Version 5.0 suffers from the same basic problem as its four predecessors: At its heart, it’s really an attempt by the well-off to cut spending for the less fortunate. Fundamentally, it is an attack on Medicaid, the federal-state program for the poor, the disabled, children and nursing home patients. (7/15)

Cleveland Plain Dealer: Senate Health Reform Bill Would Devastate Family Health Care In Ohio
As a practicing physician, I have seen firsthand how my patients have benefited from the Affordable Care Act (ACA) and Medicaid expansion, especially many patients in traditionally underserved communities such as those who are low-income or live in rural areas. The ACA and Medicaid have been critical sources of health coverage for these patients, increasing their access to many basic health care services, including maternity care, preventive health services, mental health care, and treatment for substance use disorder. (Wayne Trout, 7/16)

Lexington Herald Leader: Will Health-Care Repeal Drive Ky. Families Off Their Farms?
My husband, John, and I farm on land outside Versailles that has been in his family for generations. Over the years, it has produced tobacco, cattle and hay, and now pastured livestock for meat, organic vegetables and flowers. Farming is a calling we actively chose. We worked hard to gain the knowledge and skills we’d need. We expected the hard work, but we weren’t adequately prepared for the challenges presented by health care. (Sue Churchill, 7/14)

The Des Moines Register: Iowa Poll Shows GOP In A Corner On Health Care
No wonder Republicans in Congress are tying themselves in knots as they try to pass health care reform. In Iowa, at least, they have created a no-win situation, results of the new Iowa Poll indicate. Sen. Chuck Grassley, an Iowa Republican, warned on Twitter last weekend that Senate Republicans would face dire consequences if they didn’t pass health care reform. (Kathie Obradovich, 7/16)

Arizona Republic: Obamacare Has One Last (And Best) Defense
The Affordable Care Act has flaws that require fixing, but it continues to serve the people of this nation in ways that many are just now starting to appreciate. President Trump and congressional leaders should devote themselves to correcting the problems in Obamacare, not craving its collapse. (Reginald Ballantyne, 7/14)

Boston Globe: Fixing Health Care The Right Way
But there is a great deal of uncertainty and instability in health care due to changes being considered at the federal level that would result in higher costs for seniors and children with disabilities, a loss of federal revenue for the state, and a reduction in payments for health care providers... Without regard to what’s happening in Washington, Massachusetts needs to continue to innovate and create a sustainable health care system for both our residents and our economy. Health care costs currently strain not only the state’s budget, but also those of our businesses and families. (Stan Rosenberg and Jim Welch, 7/17)

The Columbus Dispatch: Portman, Brown Could Make History
Sen. Rob Portman was right to reject a Republican health-care bill that would have slashed the Medicaid spending upon which millions of Ohioans depend for basic health care. As the GOP effort to replace the Affordable Care Act grinds on, Portman finds himself in a position of great influence to stand up for an approach that balances fiscal pragmatism with compassion and decency. (7/17)